記住我
A generation is an identifiable group that is born and raised during a defined period and shares historical and social life experiences (Kupperschmidt, 2000). Nursing organizations include nurses of different generations who work closely in roles ranging from first-line nurses to nurse managers. The current nursing workforce spans three generations, including “baby boomers” (1945–1964), “Generation X” (1965–1980), and “Generation Y” (aka millennials, 1981–2000; Stevanin et al., 2018). Generational differences in assessing the value and meaning of work can be a source of conflict within an organization (Appelbaum et al., 2022). Therefore, efforts to promote intergenerational understanding and integration are important in multigenerational organizations.
Since around 2000, research into the generational differences among nurses has been conducted in several countries because in part of the need to resolve chronic nurse shortages. In addition, the trend toward later-age retirement in the United States is making healthcare workplaces more multigenerational. Efforts have been made to identify the management implications of this change (Christensen et al., 2018; Waltz et al., 2020), as generational differences in terms of an individual's characteristics, occupational views, and attitudes may increase the risk of conflict among colleagues and affect productivity and patient safety (Stevanin et al., 2018).
In Korea, most Generation Y nurses, accounting for over 80% of the nursing workforce, were educated and are currently managed by Generation X nurses. Therefore, nursing managers must acknowledge different generational experiences and employ appropriate strategies to foster desirable peer relationships within the organization.
This qualitative meta-synthesis study was developed to differentiate and classify the experiences of nurses from different generations based on the findings of previous studies designed to explore the experiences of new nurses (i.e., nurses working in their first year after graduating) in South Korean hospitals.
Methods DesignThis meta-synthesis of qualitative studies was conducted in accordance with the reporting guideline document Enhancing Transparency in Reporting the Synthesis of Qualitative Research (Tong et al., 2012).
Search Strategy and Selection CriteriaA literature search was conducted from June 25 to 30, 2020. Four Korean electronic databases (Korean Medical Database, Korean Studies Information Service System, National Science Digital Library, and Research Information Sharing Service) and four international electronic databases (PubMed, EMBASE, Cochrane, and CINAHL) were explored.
The search was conceptualized based on the study's thesis question: “What are the experiences of new nurses in Korea identified in qualitative research?” The search terms were selected with the help of a professional librarian by referencing the keywords of related articles. The search strategy used three groups of keywords in combination: (a) new graduate nurses, (b) experience, and (c) Korea. No restrictions were used in the initial search with regard to research method, language of publication, or year of publication. Inclusion and exclusion criteria are shown in Table 1.
Table 1. - Inclusion and Exclusion Criteria Inclusion Exclusion • Qualitative studiesThe study screening and selection process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for systematic review reporting (Page et al., 2021). Two thousand four hundred eighty-two articles were retrieved from nine databases. After reviewing 1,932 titles and abstracts, 550 duplicate articles were removed, and after considering the study selection criteria, another 1,903 articles were excluded. After reviewing the full text of the remaining 29 articles, a further 10 were excluded as not meeting the eligibility criteria, leaving 19 studies available for inclusion and analysis in the meta-synthesis (Figure 1).
Figure 1.: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart for Study Screening and Selection ProcessNote. RISS = Research Information Sharing Service; KMBASE = Korean Medical Database; NSDL = National Science Digital Library; KISS = Korean Studies Information Service System.
Quality AppraisalThe quality of the included studies was appraised using the Critical Appraisal Skills Programme Checklist for Qualitative Research (Critical Appraisal Skills Programme, 2018). This checklist, consisting of 10 yes/no response items, is designed to evaluate the validity of research results, the statement of results, and the value of the research. The appraisal was conducted independently by, respectively, one author and one research assistant. In cases of disagreement, consensus was reached through mutual discussion. For all of the 19 articles, the answers to all 10 items were “yes,” confirming all of the selected articles as suitable for this study.
Data SynthesisThe study data were extracted and sorted by author, publication year, aim, participant characteristics, methodology, data collection method, analysis method, and main themes using Excel software (Table 2). The thematic synthesis method proposed by Thomas and Harden (2008) was used. First, two of the authors of this study independently performed code generation to discern the meaning and content of each sentence while reading the results of each article. The articles were read multiple times. Codes were compared and categorized based on common content. In the process, differing opinions between the two authors were synthesized through repeated review. Subsequently, descriptive themes representing the classified content were determined. Finally, analytical themes presenting integrated interpretations were extracted by synthesizing the themes presented in individual research results and focusing on their relevance.
Table 2. - Summary of Included Studies Author (Year) Participants Method of Analysis/Data Collection (Year) Results Quality Assessment n Age (Years) (1) Working PlaceCore category: entering orbit
The process of new nurses' adaptation: confusing, confronting, becoming a member, settling in hospital setting
Strategies: reducing stress, maintaining good interpersonal relationship, grasping, compensating, persisting, and introspecting
Intervening factors: negative image of nursing, conflict of interpersonal relationship, educational program
Yes Good S. H. Yun (2002) 8 Average = 24.5Clinical adaptation and endeavor
Professional conflict of nursing
Disability of nursing performance
Work stress and management
Maladaptation of human relationships
Diverse emotions of interpersonal relationships
Change of personal identity
Yes Good Hwang et al. (2002) 10 Not mentioned (1) Not mentionedExperience difficulties in making interpersonal relationship
Negative feelings
Fatigue and unskilled work performance
Self-reflection
A sense of accomplishment
Identify formation as a nurse
Yes Good J. Y. Kim & Kim (2004) 9 Average = 23.7Experience related to job: being unskilled for the job, needing self-study to gain knowledge for nursing practice, being corrected after having made a mistake
Preceptor served as a role model
No idea about working conditions related to the hospital organization or administration
Experience reality shock
Yes Good J. H. Park & Chun (2008) 6 Not mentioned (1) Not mentionedProblems with interpersonal relationship
Chronic fatigue
Unprofessional nursing
Confused nursing experience
Effort to be a competent nurse
Adapted oneself to be a nurse
Yes Good Noh et al. (2009) 7 Not mentioned (1) Not mentionedCore category: the process of being “routine”
The process of new nurses' experience on care of dying patients: draw back, experience, get off
Yes Good H. S. Park et al. (2011) FemaleEndless new beginning
Pressure of work due to lack of senior nurses
Wanting to quit
Attachment for the complete hospital and ICU
Preciousness of colleagues
Pride in self-growth
Yes Good G. L. Kim et al. (2013) 15 ≤ 25 (n = 14), 30 (n = 1) (1) ICU and emergency room (ER;Limitation of job competence
Work-related burden
Dissatisfaction with work environment
Loss of self-esteem
Stress-related psychosomatic reaction
Disappointment of the unsupportive reaction from nurse managers
Yes Good K. O. Park & Kim (2013) 10 24–26 (1) ICU (n = 1),Beginning of hardship journey
Feeling of inability in workplace
Struggling hard to develop
Endure hardships by soothing oneself and peer support
Beginning of an exciting journey
Yes Good Suh & Lee (2013) FemaleUnskilled nursing practice
Psychological pressure related to duties
Physical exhaustion and appearance of health problems
Suffering and distress from interrelationships
Dissatisfaction with work environment
Inability to enjoy personal life
Being uncertain of nursing value
Enduring and making effort to adapt
Finding herself changing
Yes Good S. A. Kim & Jeon (2014) 5 Average = 24.6 (1) Not mentionedBurden by role
Nevertheless, difficulties in endure
Painful relationship
Uncertain future
Factors that affect the turnover
Unsolved situation of physiological needs
Lowered self-esteem
Not regret the turnover
Want to work as a nurse again
Hide minds
The fear of changing for their own
Hopeful for the future
Yes Good H. R. Kim & Kwon (2014) 9 Not mentioned (1) Not mentionedDifficulty in performing cancer ward work
Problem with interpersonal relationships
Strive to be a good nurse
Satisfaction and rewarding nursing
Adapted oneself to be a nurse
Yes Good Im et al. (2015) FemaleExcessively heavy working environment
Relationship problem
Physical/emotional withdrawal
Realizing the absence of goal in job
Yes Good Y. M. Kim & Kim (2016) FemaleCentral phenomenon: shaky daily life due to the sleep change
Core category: finding my place in a shaky everyday life
Causal condition: heavy shift work, not released after getting off work, body and mind are exhausted
Context: an environment does not tolerate mistakes, clogged breathing due to worries
Intervening factors: support of colleagues, recovery volition in restoration of altered relationships due to sleep
Action/interaction strategies: to strive for a good sleep, require a reasonable
Duty schedule, find a breakthrough
Consequence: become the master of a shaky daily life, accepting the life of a nurse
Yes Good Lee et al. (2017) FemaleFeeling like a different world
It's hard to endure with endless things
Feeling heavy heart
Gaining the power to bear
Thinking about my parents
Feeling better
Yes Good M. Y. Kim et al. (2018) FemaleCommunication is ignored
Poor communication on the system
Communication difficulties
Conflict over nurse role
Leaving the nursing profession
Yes GoodNote. Q1 = Was there a clear statement of the aims of the research?; Q2 = Is a qualitative methodology appropriate?; Q3 = Was the research design appropriate to address the aims of the research?; Q4 = Was the recruitment strategy appropriate to the aims of the research?; Q5 = Were the data collected in a way that addressed the research issue?; Q6 = Has the relationship between researcher and participants been adequately considered?; Q7 = Have ethical issues been taken into consideration?; Q8 = Was the data analysis sufficiently rigorous?; Q9 = Is there a clear statement of findings?; Q10 = How valuable is the research?
To ensure trustworthiness, the authors shared data analysis with each other during regularly held meetings. The authors were all nurses with clinical experience, graduate-level training in qualitative methodology, and prior experience conducting systematic reviews. In addition, one of the authors had previous experience conducting qualitative studies.
Ethical ConsiderationThis study was approved by the institutional review board of the Catholic University of Korea (No. MC19ZESI0097).
Results Study DescriptionThe 19 included articles were published between 2001 and 2020 and included 182 individuals, all of whom had participated in interviews. In 17 of the studies, the participants had fewer than 12 months of work experience, with the remaining two including participants with over 12 months of work experience (Lee et al., 2017; K. O. Park & Kim, 2013).
As the articles included in this study did not contain sufficient data, for example, participant age or year of birth, to infer their generational affiliation, the participants were categorized into Generation X or Generation Y for this study based on their general characteristics (average age) and year of data collection. As data for the 19 articles were completed between 1998 and 2019, baby boomer participants were excluded. The participants in the four studies conducted between 1998 and 2003 were classified as Generation X, and those in the 15 studies conducted between 2007 and 2019 were classified as Generation Y.
Qualitative SynthesisThe experiences of new nurses were divided into three analytical themes, from which eight descriptive themes were extracted.
Work experience 1. Dissatisfied with own work performanceAfter graduating from university, new nurses, regardless of generational affiliation, expressed feeling “overwhelmed,” “frustrated,” and “terrified” about the nursing tasks they performed for the first time as healthcare workers rather than as students. However, there were general differences among their responses. Generation X nurses found an external locus for their difficulties. For example, they believed that their training, which limited them to following and observing senior nurses around the wards, was inadequate and would not ensure their adaptation to independent nursing practice.
I had only been observing, and then I had to do it myself all of a sudden, which drove me crazy…. If I had proper training on that, I would not have felt so lost. I could not stop thinking about it. (S. H. Yun, 2002)
Generation Y nurses felt a greater burden of responsibility and were more likely to self-blame for being unable to solve problems independently and for making mistakes. When senior nurses intervened, they felt ashamed and worthless. Furthermore, millennials perceived their abilities and knowledge as insufficient and anxiously questioned their own judgment, decisions, and work.
I thought that I had to take responsibility and do my best to prevent problems from happening to my patients.… I really hate this situation where senior nurses have to take care of my patients because I am not good enough. It hurts my pride…. (J. H. Park & Chun, 2008)
I was [often] burdened by the roles and responsibilities given to me…. I increasingly lost confidence when making many trivial mistakes…. (Im et al., 2015)
Am I doing right by the patient? Am I doing something wrong? I kept thinking about it…. (Suh & Lee, 2013)
2. Negative feedback on work outcomesNew nurses frequently reported difficulties related to receiving negative feedback from senior nurses. Furthermore, there were differences in their interpretations of and responses to this feedback. Generation X nurses complained about being scolded and hoped to avoid it.
I used to pray on my way to work: “I really hope that I can make it through the day without being scolded.” (Son et al., 2001)
What am I doing here being scolded like this? I was angry. (S. H. Yun, 2002)
However, Generation Y nurses felt more strongly that it was unreasonable for them to be ignored or criticized for being new nurses and saw this as inhumane, especially when they were scolded in front of patients, caregivers, or nursing students. They felt disrespected and tormented by such treatment.
[No matter how good new nurses are,] I think they suffer some sort of stigma for a while.… I am the new whipping boy. (Y. M. Kim & Kim, 2016)
There are people who make me feel personally attacked rather than being scolded for my own mistakes. I felt embarrassed and frustrated, and wanted to quit working. (H. J. Yun et al., 2018)
3. Irregular daily lifeNew nurses frequently experienced “difficult adaptation,” “lack of personal life, such as meeting with friends and hobbies,” “sleep disturbance,” and “fatigue” because of irregular shift work. Millennials in particular compared their situations with those of their peers engaged in other occupations and lamented that their lives, centered around the hospital, were neither happy nor normal.
My life does not feel normal. How do others live? Am I the only one living such a difficult and dull life?... I keep going back and forth between the hospital and home, so I have little joy in life. Even though I earn money, what can I do with the money living like this?... I do nothing…. I am working to enjoy life, but I do not feel happy at all. My entire life is in the hospital.... (Suh & Lee, 2013)
Interpersonal relationshipsThe interpersonal work relationships of the participants were distinguished into work-related relationships with colleagues (senior and junior nurses, doctors, and healthcare workers in other departments), peers (cohort-mates in the organization), and patients and caregivers (recipients of nursing services).
1. Colleagues who help adapt to work life or make work life harderNew nurses were forced to form new relationships with their colleagues in an unfamiliar environment. They reported feelings of “unfamiliarity,” “distance,” and “being disregarded” in their new surroundings.
Notably, unlike how they felt regarding their other colleagues, new nurses felt that nurse preceptors protected them like a mother and perceived them as reliable.
2. Feelings of sympathy toward peersNew Generation X and Generation Y nurses perceived peers as people with similar experiences. They formed relationships while “talking to each other a lot” about the mistakes they made during working, their experiences of being scolded by senior nurses, and hardships at work, relieving stress and providing mutual consolation and reliance.
The Generation X nurses compared their situations with those of their peers and felt relieved that they shared the same hardships.
Hey, it was even worse for me last time, you know. I was scolded even harder. (Son et al., 2001)
My friends talk about how they have been scolded as well. It really makes things seem better. (G. L. Kim et al., 2013)
The Generation Y nurses expressed feeling grateful to their peers because their peers understood them best, provided great support, and helped them endure hardships at work.
I may not have made it through up to this point if not for my peers. (H. S. Park et al., 2011)
When things got hard for me, I turned to my peers the most. They understand me the best. (Lee et al., 2017)
3. Disrespectful patients or caregiversNew nurses frequently perceived distrust, disregard, and uncooperative attitudes from patients and caregivers while providing nursing care. These nurses were embarrassed and frustrated by situations they could not understand.
Adaptation 1. Effective reactionsA few months after joining their organizations, new nurses reported feeling they had improved their work performance and relationships with colleagues.
Generation X nurses gained skills, knowledge, and confidence through repeated experiences and learned to deal with problems with a more positive attitude.
I have done CPR three times. On my third attempt, I thought, “Oh, I get it.” … I have gained know-how. (Son et al., 2001)
At first, I could say nothing when I was being scolded by the senior nurses for something that I did not intend to do. I was afraid I would appear disrespectful [to my senior]. Now, I have some ideas about the work. When it is not my fault, I tell them. (Hwang et al., 2002)
Generation Y nurses became increasingly familiar with their work and could fulfill their assigned duties. These nurses felt proud and gained confidence in their job performance when their colleagues and patient caregivers trusted them, when they were recognized as full-fledged nurses, and when they received positive feedback about their work.
I am very proud that I can help with this. I'm really happy when I've done my part.… As I make more friends in the ward, I receive more compliments. It feels great. (J. H. Park & Chun, 2008)
I understand things more clearly now than before, and I make fewer mistakes.… There have been moments when I felt good and proud, when my senior nurses compliment me for being much better than before. (H. R. Kim & Kwon, 2014)
The new nurses reported experiencing “comfort,” “friendliness,” and a “sense of belonging” in their relationships with colleagues. The Generation X nurses felt recognized as “ward members” as they helped and received help from senior nurses, whereas the Generation Y nurses reported feeling they became “family members” through daily communication and believed that private meetings with colleagues helped form close bonds.
Now that I get help from my colleagues and give them help, I feel comfortable…. I feel like I am being treated as a member of the ward. (S. H. Yun, 2002)
We have some private conversations and invite each other to our homes…. I feel happy. (J. H. Park & Chun, 2008)
We go get a drink after work and talk about things. I feel like a family member. (H. R. Kim & Kwon, 2014)
2. Ineffective reactionsNew nurses who considered leaving their jobs were often concerned regarding the “uncertainty about their future” at the hospital.
At first, my future seemed very unclear to me. It is still not clear to me. (S. H. Yun, 2002)
The biggest motivator (90%) that made me think about leaving the job was that I couldn't picture my future here. (Y. M. Kim & Kim, 2016)
Watching experienced nurses, Generation X nurses found it difficult to envision an improvement in their current situation and pondered leaving their hospital, whereas Generation Y nurses expressed a desire to leave their position after failing to discover a sense of meaning in their work.
… I think it's better to leave the hospital if I have to keep doing trivial things, even if I'm in a high position. (S. H. Yun, 2002)
I did not want to do it (my job) without knowing why I had to or needed to do it. (Im et al., 2015)
DiscussionIn this study, the shared and divergent experiences of new nurses from different generations in South Korea were explored. New nurses from Generations X and Y were found to share common experiences related to work, interpersonal relationships, and adaptation. The characteristics of the Generation Y nurses in this meta-synthesis were similar to those in previous studies in terms of their valuing appropriate feedback, work–life balance, and flexibility more than the Generation X nurses (Keith et al., 2021; Waltz et al., 2020). The significant findings of this study are discussed in the following paragraphs.
The new Generation Y nurses were more likely to express a strong sense of responsibility for their work, anxiety, and self-reproach for poor performance. Previous studies have found that, although Generation Y individuals respond well to praise, have high self-expectations, and tend to utilize teamwork, they lack the confidence to work alone and become disheartened when they do not receive immediate feedback (Christensen et al., 2018; Feeg et al., 2022; Monaco & Martin, 2007). This study found that new Generation Y nurses experienced serious difficulties when they did not receive appropriate feedback from senior nurses. They felt inexperienced and incompetent in the face of the high expectations they set for themselves. Similarly, a Canadian study found new nurses experienced stress when they were unprepared for work and suggested that these nurses should receive appropriate feedback from senior nurses along with long-term coaching and should always have someone able to answer their questions (Lavoie-Tremblay et al., 2010).
Meanwhile, in response to negative feedback regarding work outcomes, new Generation Y nurses expressed that being scolded in front of patients and caregivers was unethical. Millennials emphasize collaboration rather than hierarchical relationships (Keith et al., 2021) and expect sincerity and ethical behavior from their superiors (Twenge & Campbell, 2008). Thus, other research confirms and reinforces the reported sensitivity of the new Generation Y nurses in this meta-synthesis to not being respected. To motivate new millennial nurses and increase their morale within an organization, horizontal relationships based on respect are needed, along with a safe and respectful working environment supported by ethical leadership. Furthermore, nursing organizations should create a mutual support system among colleagues to help new Generation Y nurses develop the confidence and competence necessary to grow as professionals.
The new nurses in this meta-synthesis who worked three shifts reported difficulties adjusting to their lifestyle and struggled to handle the related physical and mental health problems and the absence of a personal life. Although both new Generation X and Y nurses reported strongly valuing a balance between work and life, there were differences in what they considered “balanced.” Individuals from Generation X tend to value recognition at home and work (
留言 (0)