Intergenerational Dynamics among Women and Men in Nursing

Intergenerational Dynamics among Women and Men in Nursing1 MARCI D. COTTINGHAM Orcid.org/0000-0003-3519-4100 JANETTE S. DILL Forthcoming in Gender, Age and Inequality in the Professions (eds. M. Choroszewicz and T. Adams), Routledge Series on Gender and Organizations. https://www.routledge.com/GenderAge-and-Inequality-in-the-Professions-1st-Edition/ChoroszewiczAdams/p/book/9780815358572 Abstract Research on nursing has focused heavily on the gendered aspects of nursing care while often overlooking diversity within the workforce, including age-related dynamics and multigenerational conflict on the job. This chapter explores the salience of age-related issues alongside gender in a sample of Baby Boomer (age 51+) and Millennial (age 23–31) nurses from the US to understand how age shapes the experiences and interactions of men and women in the nursing workforce. Based on survey data, Millennial nurses report feeling negative emotions more intensely compared to their Baby Boomer colleagues. Baby Boomer nurses are also more likely to evaluate their own care more highly overall and across a range of specific features of the job. Using audio diary data, themes of uncertainty and fear of future emotional burnout emerge from Millennial nurses while some Baby Boomer nurses in our sample express open disdain for younger nurses in terms of work ethic and the interruptions they cause. Training of younger nurses can be experienced as burdensome and exhausting. We use the results to further 1 FUNDING: The research reported here uses data from a larger study, “Identity and Emotional Management Control in Health Care Settings,” funded by the National Science Foundation (SES1024271) and awarded to Rebecca J. Erickson (PI) and James M. Diefendorff (Co-PI). Cottingham and Dill 2 theorise an emotion practice approach that highlights nurses’ need to conserve emotional resources and channel them toward patient care rather than co-worker support. Introduction The gendered nature of the nursing profession has received considerable attention from sociologists (Dill, Price-Glynn, and Rakovski 2016; Williams 1992). The roles of race (Cottingham, Johnson, and Erickson 2018; Wingfield 2009) and sexuality (Cottingham, Johnson, and Taylor 2016) have also received some consideration, but age and generational dynamics have been less developed within sociological research on nursing. This is particularly surprising considering that predictions in workforce shortages are specifically linked to the retiring of Baby Boomer nurses (Buerhaus, Donelan, Ulrich, Norman, and Dittus 2006) coupled with increasing health demands of an aging population (Hecker 2001; US Department of Labor Statistics 2018a). Younger, well-trained nurses are increasingly needed to meet demand, yet recent research indicates that they have the highest turnover rate and levels of turnover intention (LavoieTremblay et al. 2010; Tourangeau and Cranley 2006). Given the diversity of nursing, the profession can shed light on how experiences in an emotionally demanding profession vary across age, generational cohort, and experience levels. Past research has shown that older nurses are significantly more satisfied in their jobs as compared to younger nurses (Widger et al. 2007; Wilson et al. 2008). Leiter et al. (2009, 2010) found that Generation X nurses report higher levels of distress as compared to Baby Boomer nurses, including higher exhaustion, cynicism, turnover intent, and negative physical symptoms. In order to address the high turnover rates of younger nurses, Erickson and Grove (2007) call for Cottingham and Dill 3 more experienced nurses to serve as ‘emotional mentors’ to younger nurses. Following this call, further research can shed light on the day-to-day negotiations of nurses with variation in experience levels as well as the conflicts that could limit the success of emotional mentorship. Past research on age and experiences at work among nurses has highlighted the conflict that can emerge between younger and older nurses. Younger nurses can experience bullying on the job (Vessey, DeMarco, Gaffney, and Budin 2009), including belittling and public shaming perpetuated by more senior nurses as well as physicians. In their qualitative study of intraprofessional conflict, Boateng and Adams (2016) find age and race to be particularly salient categories that structure co-worker interactions. Older nurses might refuse to help new nurses or resent interruptions to their work. The recurrent theme in nursing culture is that nurses ‘eat their young’. Kelly and Ahern (2008: 916) frame this phenomena as a hangover from ‘19th century hierarchical traditions’. Turning to the complexity of emotions that nurses confront on the job might additionally identify particular practices that shape conflict between younger and older nurses. Despite the advances of the sociology of emotion over the last four decades (Bericat 2016), research on the relationship between emotion, age, and generational cohorts has been notably limited. Research on age and emotion tends to focus on old age and emotional changes (Carstensen and Charles 1998), family, marriage, and love (Sumter, Valkenburg, and Peter 2013), or children’s emotional development (Andrew 2015; Froyum 2010), with less focus on how age and generational diversity shape emotion in the workplace. One notable exception is recent work on intergenerational communication and emotional labour among nurses (Anderson and Morgan 2017a; Anderson and Morgan 2017b). Anderson and Morgan (2017a) find that the saying that ‘nurses eat their young’ is used iteratively to construct older and younger nurses as Cottingham and Dill 4 fundamentally distinct and ‘positioned age groups against each other’ (385). With these distinctions naturalised, the bullying that younger nurses experience is also naturalised and partly justified. This chapter builds on this past work by using both quantitative and qualitative data to compare differences in nurses’ emotional experiences while at work. Combining survey and audio diary data allows us to address both general responses along with situationally specific emotional reflections. This methodological combination aligns with a theoretical framework of emotion practice (Cottingham 2016; Erickson and Cottingham 2014; Erickson and Stacey 2013; Scheer 2012). In this approach, emotions are viewed as relational, not limited to nurses as isolated emotion managers (Burkitt 2017). Individual nurses are always embedded in connections with co-workers, patients, organisational policies, and units. In turn, organisations are shaped by broader cultural beliefs about gender (Ridgeway 2011), race (Evans and Moore 2015), and generational differences (Mannheim 1952). Distinct emotions emerge from one’s ongoing engagement with divergent others and environments. The extent to which an individual can anticipate and meet situational demands with pre-developed skills and resources, the greater likelihood that feelings of comfort, ease and generally positive emotions will emerge. Friction between internalised dispositions (‘habitus’ in Bourdieu’s 1990 framework, see also Gould 2009; Reay 2015) and situational demands leads to feelings of unease, discomfort, and further negative emotions. Emotion-based skills, resources, and capacities are theorised in this approach as part of a nurse’s ‘emotional capital’ (Cahill 1999; Cottingham 2016; Stacey 2011), which is in turn drawn upon to meet the interactional demands of providing care and comfort to patients, patient family members, and co-workers. Nurses both bring and develop their emotional capital throughout the course of their nursing career as they Cottingham and Dill 5 confront novel demands and develop expertise. Using an emotion practice framework draws our analytical gaze to the ongoing situated practices that make up nursing. This approach can shed light on the emotional complexities of nursing and the generational differences that emerge out of this complexity. Methods For investigating the role of intergenerational dynamics in nurses’ emotion practice, we draw on survey and audio diary data collected from nurses in two Midwestern hospital systems in the US. For the survey, a complete listing of full-time, direct care registered nurses (RNs) was obtained from the health system’s human resources department and written questionnaires in sealed envelopes were distributed to eligible RNs employed within each hospital (N = 1702). Completed surveys were returned by mail from 762 participants, or 45% of the original eligible sample. This response rate is consistent with other studies among registered nurses (eg, Lucero, Lake, and Aiken 2010). Cases with missing observations were dropped from the analysis; this resulted in a final sample of 730 respondents. The data collection protocols were reviewed and approved by the University of Akron Institutional Review Board. We use the survey data to look at a variety of outcomes for Millennial and Baby Boomer nurses, including negative and positive emotions experienced at work and self-perceived performance at work. In measuring age, we divide nurses into three age groups: Millennial nurses (age 23–31), mid-career nurses (age 32–50), and Baby Boomer nurses (age 51+). In most of our analyses we focus exclusively on Millennial nurses and Baby Boomer nurses. In our regression analyses, we include a few personal demographic characteristics (gender, race), and some work characteristics that might influence a nurse’s experience at work (patient acuity, job tenure). Table 1 includes a description of all the measures that we use from the survey data. Cottingham and Dill 6 [Insert Table 1 about here] A diverse sample in terms of gender, race, and generational cohort was sought for the audio diary data. We targeted all men, all nurses of colour, and all Millennial-aged nurses (born on or after 1980) from the first hospital system. We continued to target these subgroups in a second hospital system. The final audio diary participants included 48 nurses total, including 37 women and 11 men; 38 identified as white, 8 African American, and 2 Asian American. Fifteen participants were born in or after the year 1980. The average age was 44 years old. Participants were given a digital recorder and instructed to make recordings during or after six consecutive shifts. Generally, each nurse was told that the research project focused on the emotional experiences of nurses. They were prompted to provide as much detail as possible in terms of key players, settings, events, and implications of their experiences on the job. Audio diary recordings were transcribed and uploaded to a qualitative data analysis program (Dedoose). All names used are pseudonyms and participant IDs are provided in parentheses. Findings – Survey Data Table 2 contains summary statistics for the nurses in our survey sample, by age category. Thirtytwo per cent of the sample is between the ages of 23 and 31, 39% is between the ages of 36 and 50, and 29% of the sample is over the age of 50. Nursing is a female-dominated occupation, and our sample, which is around 90% female, largely reflects national gender demographics (US Department of Labor 2018b). Five per cent of the sample is African American, 5% are another minority, and 90% of respondents are white, percentages that are fairly consistent across age categories. About 57% of nurses work in settings with high patient acuity. Millennial nurses have an average job tenure of 41 months, while Baby Boomer nurses have an average tenure of 332 months. Cottingham and Dill 7 [Insert Table 2 about here] Table 3 contains mean values for emotions that a respondent experienced during the last week while at work and mean values for self-perceived performance at work. In Table 3, we only include Millennial nurses (age 23–31) and Baby Boomer nurses (age 51+) to better contrast the experiences of younger and older nurses. Millennial nurses report more negative emotions and less positive emotions at work as compared to Baby Boomer nurses. We find that younger nurses are more likely to report that they experienced being afraid, angry, anxious, frustrated, guilty, helpless, and irritated as compared to older nurses (p<.05), as determined by t-tests. Younger nurses report significantly lower mean values for feeling calm and relaxed while at work during the last week as compared to older nurses (p<.05). Millennial nurses also have significantly lower self-perceived performance at work as compared to Baby Boomer nurses across all measures, indicating that Millennial nurses are much more insecure about their ability to meet the demands of their jobs as compared to their more experienced counterparts (p<.05). Millennial nurses rate their ability to show concern for patients, anticipate patient needs, explain procedures to patients, demonstrate skill in the provision of care, help calm patient fears, communicate effectively, and respond to patient requests at levels lower than Baby Boomer nurses. [Insert Table 3 about here] In Table 4, we present a regression analysis of scales of the measures described above: negative emotions experienced at work, positive emotions experienced at work, and perceived performance at work. We use a continuous measure of age and control for a variety of demographic (gender, race) and work characteristics (patient acuity, and tenure). We find that age is negatively related to negative emotions experienced at work (p<.01), indicating that older Cottingham and Dill 8 nurses experience fewer negative emotions at work. Positive emotions are not significantly related to age in our regression model, but perceived performance is positively related to age (p<.05). Older nurses rate their performance higher as compared to younger nurses. [Insert Table 4 about here] Findings – Qualitative Diary Data Findings from the survey data suggest that Millennial nurses report feeling fear, anger, anxiety, shame, frustration, and helplessness more intensely than their Baby Boomer counterparts. Using an emotion practice framework, we can interpret these differences in emotional experience as a result of the ongoing, habitual expectations to which older nurses have, over time, endured and adapted. As the fit between expectation and experience becomes more predictable to experienced nurses, the intensity of felt emotions on the job decreases. With some variation, we find similar examples in audio diary data that suggest that younger and older nurses experience the profession differently. Millennial Nurses – Feeling Young and Inexperienced Millennial nurses (age 23–31) in our sample discuss stress as the norm. Good days are often the exceptions. As Megan relays: ‘So today overall was a good day, I’ve had some pretty stressful days, no sleeping cause I can’t get things off my mind, but today was a good day and overall very positive’ (5002). Ending a shift where a patient died, Melanie has ‘mixed feelings’ and tries to run it through my mind. Did I make the right choice by coming down to a different department? I don’t know … Just trying to get used to everything; maybe I’ll get used to it at some point. Probably not but I’ll keep working at it (5011). Cottingham and Dill 9 Getting ‘used to everything’ in an emotion practice framework means developing the habituated dispositions that match the objective demands of her work. Melanie contrasts her prior work as an LPN (Licensed Practitioner Nurse) with her current role as an RN (Registered Nurse) in the emergency unit: Started working in the emergency room about a month ago. And I like it, but I guess I’ve seen more people die than I did when [pause] I was a nurse—an LPN for about three years before I became an RN. RN for a year and even during clinicals, I never saw anyone die. Yesterday I had someone come in full arrest. Did CPR. Tried everything and they didn’t make it (5011). Melanie uses the phrases ‘I don’t know’ and ‘I guess’ some 27 times in her diaries and details numerous scenarios where she is unsure how to act. Ending her final diary entry, she returns to the issue of death: I guess, I don’t know, I’m still getting used to so many patients dying. When I worked on the floor I only had one patient of mine actually pass away and I’ve—I saw another one which wasn’t my patient. I just went in to assist with a few things until the other staff got there to help. So I guess this is just something new for me. And I’m just trying to—kind of getting used to that emotion of, ‘okay, wow this patient actually died.’” (5011). In this quote we see both the intensity of emotion from the job as she relays her shock from a patient’s death as well her continued uncertainty on the job (‘I guess, I don’t know’). Yet Melanie interprets her shock with death as a sign of her emotional investment as a nurse: I don’t know, but then I try to look at it as … well I guess since I actually care about patients that I will work very hard to try and bring them back if they don’t seem like they’re going to live. So I guess, in a way, it’s a good thing (5011). Becoming ‘used’ to patient death is not merely a matter of becoming emotionally numb, but of maintaining her active concern for her patients while also becoming less jarred by the unexpected loss of a patient. Other Millennial nurses talk of not ‘really know[ing] how to feel’ (5022 and 5002) or being ‘uncomfortable’. For example, Molly (1301) is uncomfortable with emergency situations, Cottingham and Dill 10 while Ella (1986) is uncomfortable with exerting authority over support staff. Both are in their twenties. Lianna, the youngest nurse in our sample, mentions not knowing what to do in a situation where patients look to her for answers while the power ultimately rests in the hands of the physician. In terms of co-workers, Lianna says that there are ‘certain people I am uncomfortable with’ (1497). Talk of discomfort can signify a habitus in flux as it encounters novel demands and experiences friction between those demands and the familiar patterns of practice that individuals take for granted. Younger, Millennial nurses, with fewer work experiences, have had less time and exposure to the demands of the job. Despite this lack of experience and the incongruities between demands and embodied capital (skills, knowledge, and capacities), this does not always mean that Millennial nurses share the same needs in terms of training. For example, Rachel discusses a notably stressful shift in which the distribution of patients was particularly uneven across the nurses on the unit. So it wasn't bad, but still, why when everybody has four should one guy have one patient? And I'm sure after the budget meeting we just had that is not gonna make my manager happy. This one RN—the—Luke the guy who only had one patient, he's really nice. He was really helpful. He always offered help to everybody. Anything he could do for you he absolutely would. He didn't hesitate at all but it made me feel guilty to have him help me. I felt guilty when he answered my call lights. I have—I personally have trouble accepting help. I want to do things on my own. I wanna know that I can do them. I want my co-workers to know that I am a strong asset to the team that I’m not the weak link (5006). In this excerpt, Rachel explicitly mentions her interactions with a male co-worker. While the gender of her co-worker does not appear to influence her reaction to the situation, it is clear that her inexperience manifests itself in a desire to be seen as ‘strong’ and able to tackle the demands of the job independently. Guilt with having to ask for help emerges from her sense of helplessness as a sign of weakness. Adjusting to a teamwork dynamic is a skill that Rachel has yet to develop as a part of her emotion practice on the job. Cottingham and Dill 11 Differences in experience level do not simply lead to better training or skills. In the case of some Millennial nurses, more experienced, Baby Boomer nurses appear to become too detached from patients and their families. Megan uses the language of ‘we’ to refer to herself and other newer nurses in contrast to ‘nurses that have worked there for a long time’. Reflecting on these differences, she says: I just hope and pray that my attitude never changes. I mean, I think I’m pretty much known as being a caring nurse on that floor with my patients—I interact with them, I feel like they’re, I don’t know, like they’re family almost. I get connected to them, to their families. I have conversations. I don’t know, I just—I couldn’t imagine not caring and I just—I notice a lot of that and it’s just pretty sad and I hope the day that I stop caring that’s the day that I just quit cause you can’t not care in this field (5002). Within this excerpt from Megan we see her making a distinction between herself as a newer nurse and those who seem to have become jaded with the job. Rather than become jaded, she hopes that she can retain her active connection with patients or leave the profession altogether. The notion of nurses becoming more emotionally distanced from patients over time seems to echo some of the reflections of male nurses. Overall men talk of learning to reframe the nursing role in a way that creates more emotional distance between themselves and patients and families (see the case of Russell in Cottingham 2015). Young men talk of ‘fixing’ patients, while older male nurses shift their understanding of their role away from fixing and into technical expertise and providing comfort. Baby Boomer Nurses – Embodying the Nurse Habitus While Baby Boomer nurses (age 51+) still struggle with some of the stress and pressures of the job that Millennial nurses describe, they appear to have developed distinct coping strategies that come with the repeated pressures to mould one’s habituated disposition to the external demands of the job. For example, Muriel reflects on the tendency of nurses to ruminate on negative Cottingham and Dill 12 experiences on the job. While she initially seems to mimic the sentiments of Millennial nurses, she then speaks at length about the emotion-specific skills (as part of her emotional capital) that she has developed over the course of her 30 years in nursing: And I've worked on this for 30 years and you have to learn to just let it go. There are some things that stick with you and that's when I'll find a trusted co-worker or find the head nurses and kind of joke about it a little bit and try to release some of the pressure. At lunchtime sometimes, if it's nice, I'll just take a little walk around outside and just get some fresh air, but at the end of the day, a day like today, even now I'm sitting here thinking of things maybe I'm sure I missed something and what was - and do I need to deal with it and call him and have someone else deal with it or is it something I can let go. And you're left with that almost every day. Days like this when my drive is 40 minutes, I try to blast the radio and try to forget it, but some days like today, I spend the whole time thinking about everything. The whole day running through your mind. The whole day and what did you not do that you should have done, but [I] haven't come up with anything yet. I think the important things are taken care of. I'm home now after nine plus hours (1851). Like Megan and Melanie above, Muriel discusses the practice of rumination as an inevitable feature of the job. Yet, she has developed distinct strategies for pulling herself out of a nonproductive spiral of rumination. These include finding trusted co-workers to vent to in order to release the pressure, taking a walk, or blasting the radio during her commute home. While Millennial nurses cite the need to adjust to novel work experiences as a primary source of stress, Baby Boomer nurses described interruptions to the flow of work as one of their main sources of frustration (3025; 2241; 1929; and 1451; 1497 is a Millennial who reports feeling like she annoys her manager when she interrupts). While Millennial nurses seem to experience stress and intense negative feelings as a result of not knowing what to expect, Baby Boomer nurses are more likely to view organisational policy changes, missing equipment, and disruptions to their workflow as sources of stress. Judy, a nurse in her early sixties, discusses changes in meal policies. While in the past, food trays would come at specific times for breakfast, lunch, and dinner, patients are now free to order their meals when they wish: Cottingham and Dill 13 Now trays arrive on the floors at all different times. We have to, you know—there's some medicines that we have to give to the patients on an empty stomach and you walk in the room and they—they have a breakfast or a meal sitting in front of them. So then you have to re-time the medicine in your head that you—you get it to them before their lunch comes up next time. And some medicines you know are—are just timed. They have to be eight hours apart and this is, you know—these menus are interruptive to OUR routine (1451). Similarly, Marge highlights residents as a source of interruption during the intake process that can have potentially grave consequences: [T]he residents are coming in at 6:30 too to pre-op a patient, and you could be talking to a patient, or a family member, and basically swallow and they interject and just talk like you're not even there, they just interrupt, which is so rude to begin with. And it's just so disruptive, you may—because you're interrupted, a piece of information, a very valuable piece of information may get missed (1929). Marge highlights the potential implications of missing critical information when residents interrupt their conversations with patients. In addition to residents and hospital policy changes, Millennial nurses were also seen as sources of interruption. Discussing a particular conflict with a younger nurse, Violet relays her views of Millennial nurses: This particular nurse is in her probably late twenties and of the generation that my children are [laughter]. And that—I think they [are] pretty much wrapped up in getting things done on their time schedule and not truly understanding that the world does not revolve around them. I know that this is very presumptuous for me to say but that's how I was feeling at the time. This particular nurse doesn't follow the protocol that the rest of us do, which is when an order needs to be done by the doctor—which sometimes there can be up to 50 in a week—there is a specific place where we put these charts when the order comes due of when a new order needs to be written so that the doctor can do this at his convenience, not interrupting patient care throughout the day. But usually at the end of the day when we no longer have patients and he and I can sit and review the orders if there's anything specific (3025). Older nurses can see younger nurses as unable to manage time and more likely to manipulate the scheduling to get more time off (1929). Older nurses can refer to the younger nurses that they are mentoring in patronising terms: Nora refers to her mentee (a new RN) as her ‘little helper’ and Cottingham and Dill 14 Violet admits that she must continually remind herself that the younger nurses are not her ‘children’. When it comes to disruptions, the training of newer nurses (or ‘preceptorship’ as it is called in nursing) can be an additional source of annoyance and frustration. While the preceptor/preceptee relationship should be one of mentorship and guidance, teaching new nurses can be viewed as an additional burden that older, more experienced nurses have to shoulder (1851, 1940). As Muriel notes, ‘it's taxing to have someone constantly say “why did you do that?”’ (1851). The taxing nature of teaching, though, stems from the now automatic and nonconscious nature of how she works. Muriel elaborates: [A]nd I had to think about it because I don't think about it. I had to actually do it and say, ‘I guess I do’ because it's not something you do consciously. I've just been doing it for so many years it just automatically happens. So all of those tiny little things that they question especially when they're fresh out of the gate, and everything is new to them. The new girls generally see every little thing you do and question you about it. And that's a good thing and I think I came up with the good explanations for what I do and why I do it. And she actually, for someone whose just been there for four days scrubbing, she is doing as well as you can expect. And she has a nice attitude—wants to get in there and learn and that's a refreshing thing and it helps with the whole process. It kind of lessens your stress a little bit when you're teaching someone. You don't want to feel like you’re having to pull them through it and they’re at least attempting to engage and try to learn (1851). Additionally, Muriel highlights one aspect of the work environment that appears to be unique to young women in nursing: the issue of sexual harassment. As she explains: [S]ome of these the surgeons can be very intimidating, especially some of the older ones. They feel this is their domain. Plus you're with them all the time and you know and when you're working, they’re there […] And I think the young nurses, especially the younger ones I think, I see the ones that come in later in life who come in from a different career or another area of nursing are better able to deal with them. But for me I think it's just that I've dealt with them for so long and I come from an era where sexual harassment or harassment of any kind was hardly even spoken of. And the young kids coming in today, it is very much part of our society, and some can be taken aback by the attitudes of some of surgeons towards them and the people they work with. And it's hard to tell them or explain to them how to deal with it. I think they just have to- they, first of all, I think you Cottingham and Dill 15 either have to be able to do it or you can't. I mean, I think you find out early on if you're meant for the OR [operating room] (1851). Both of these reflections from Muriel richly highlight the extent to which she has adopted the taken-for-granted practices of being a nurse and the processes of practical adaptation within an emotion practice approach. The nurse habitus has been fully attuned to the procedural expectations to such an extent that performing her tasks becomes second nature. Her frustration with mentoring a new nurse stems from the need to interrupt her well-worn, nonconscious practices and instead enact them consciously, thinking through how and why she performs her duties in a particular way. This takes effort and emotional energy that might otherwise be channelled into patient care. In her second quotation here, Muriel highlights the entrenched gendered dynamics of OR nursing that she has come to take for granted (‘it’s hard to tell them or explain to them how to deal with it’), but that she sees younger nurses struggle to accept. While she might morally decry sexual harassment in the workplace, she also believes that tolerating the attitudes and behaviours of older male surgeons is simply part of the job. And yet, with the rise of the #metoo movement to challenge sexual harassment (Chira 2018), her claims raise questions about when female nurses should adapt to the job and when they should challenge the very expectations to which Baby Boomer nurses have adapted and, indirectly, accepted. ‘Emotional mentorship’, as Erickson and Grove (2007) highlight in their research, should go beyond younger nurses simply adopting the tried and tested practices of their experienced colleagues, but to also provide a safe relationship in which dialogue between Millennial and Baby Boomer nurse might foster solidarity and the potential to challenge some of the expectations placed on nurses in today’s healthcare environment. Muriel’s final quote also highlights the distinction between biological age, generational cohort, and levels of experience that are somewhat confounded in our Cottingham and Dill 16 qualitative data. According to Muriel, middle-aged and older women (non-Millennials) who enter nursing later in life seem to be well adapted to the gender norms of tolerating male surgeons’ harassment, despite having limited experience as nurses. This suggests that there are expectations of the job that go beyond nursing to include norms of female acquiescence to male demands. Such norms might vary across generational cohort or age. Discussion and Conclusion Survey data from a generationally diverse sample of men and women in nursing revealed striking differences between Millennial and Baby Boomer nurses. Millennial nurses reported feeling a range of emotions more intensely than their Baby Boomer counterparts. Additionally, Baby Boomer nurses reported significantly fewer negative emotions on the job than their Millennial counterparts, controlling for tenure. Higher levels of satisfaction have been linked to working longer in a specific unit or hospital (Bjørk et al. 2007; Li and Lambert 2008), but our findings suggest that the effect of age has an impact that is beyond that of tenure in a job. Older nurses also rate their quality of care higher than younger nurses, suggesting that they are more confident in their skills, while younger nurses are insecure. Using data from audio diaries, we find additional evidence of differences in emotional experiences and confidence levels between Millennial and Baby Boomer nurses. While Baby Boomer nurses have distinct coping strategies as part of their emotional capital, Millennial nurses discuss rumination, stress, and a lack of confidence in themselves as nurses. Lacking the specific emotional capital needed to meet the demands of the job, Millennial nurses have yet to embody the nurse role in a way that allows for a smooth fit with the environment. Baby Boomer nurses, as more experienced and adapted to the demands of the profession, highlight interruptions as their main frustration on the job. The reflections from Violet, Muriel, and others Cottingham and Dill 17 highlight the potentially negative views that Baby Boomer nurses can have of Millennial nurses as well as the processes by which mentoring younger nurses exacts emotional energy from older nurses who otherwise perform nursing tasks routinely without conscious effort. Using an emotion practice approach (Erickson and Stacey 2013; Scheer 2012), notions of habitus, emotional capital, and practice can shed light on the discrepancies between Millennial and Baby Boomer nurses. Through continuous exposure to the technical and emotional demands of nursing practice, older nurses develop the emotional capital needed to cope with stressinduced rumination, grief, and sexual harassment that they encounter. While the nurse habitus is continuously in flux, older nurses develop a ‘feel for the game’ that goes beyond articulation. Indeed, the act of mentoring younger nurses forces them to consciously articulate practices that generally operate at the level of nonconscious habit. Younger nurses, in their effort to learn, interrupt the practical flows of their mentors in ways that can unintentionally bubble into conflict. Yet, it is only through these interruptions and the ongoing trial and error of younger nurses’ practices that will hone the habitus and lead to the development of embodied capital needed for expertise. Our findings highlight the need to contextualise discussions of age, generational differences, and experience levels in nursing with a comprehensive understanding of the emotional complexities of the profession. The training of new Millennial nurses highlights challenges within the profession. New nurses require support and mentorship if they are to remain. Yet, new nurses can also push back against the expectation that they become emotionally numb to the death of patients or tolerant of sexual harassment from surgeons. While policies might be instituted to provide additional time to older nurses to train the next generation, additional time does not necessarily mean that conflict can or should be fully eradicated. Indeed, Cottingham and Dill 18 conflict can be a productive force for challenging accepted practices in the profession and the wider workplace climate. The case of sexual harassment is one example of a professional norm that Millennial nurses, no matter how long they remain in nursing, might be loath to accept. In this way, individuals can exert agency and resist rather than merely adapt to situational demands accepted by prior generations. Cottingham and Dill 19 Table 1. Survey measures. Outcome measures Response categories Negative emotions at work (e.g., afraid, angry, anxious, frustrated, guilty, helpless, irritated, sad) Scale from ‘Not at all’ (0) to ‘Very intensely’ (5) Positive emotions at work (e.g., calm, excited, happy, proud, relaxed, surprised) Scale from ‘Not at all’ (0) to ‘Very intensely’ (5) Self-perceived performance at work (e.g., showing concern for patients, anticipating patient needs) (1) Did not provide, (2) Poor, (3) Fair, (4) Good, (5) Excellent Age Millennial (age 23–31), mid-career (age 32–50), and Baby Boomer nurses (age 51+) Female Female (1) and male (0) Race White (0), Black (1), and other minority (1) Patient acuity in work setting High patient acuity (1) and low patient acuity (0) Job tenure Reported in months Source: Caring about Relationships and Me Always (CARMA) dataset, 2011. Cottingham and Dill 20 Table 2. Demographic characteristics of study sample, by age category. Millennial Mid-Career Baby Boomer (Age 23–31) (Age 32–50) (Age 51+) Mean or % Mean or % Mean or % Age 27.3 40.6 57.2 Male 5.2% 12.5% 7.3% Female 94.8% 87.5% 92.7% White 91.6% 85.7% 92.1% African American 2.8% 8.1% 4.8% Other minority 5.6% 6.2% 3.1% High patient acuity 69.4% 52.4% 47.1% Job tenure (in months) 40.7 136.4 332.2 N 251 308 229 Source: Caring about Relationships and Me Always (CARMA) dataset, 2010. Notes: Respondents included in the “other minority” category are any respondents that identified as a race-ethnicity other than white or African American. Cottingham and Dill 21 Table 3. Mean values of emotions and self-rated performance at work, by age category. Age 21–31 Age 51+ Positive emotions experienced at work in the last week Calm 2.996 3.171* Excited 2.044 1.926 Happy 2.916 3.078 Proud 3.004 3.096 Relaxed 2.360 2.641* Surprised 1.144 1.005 Negative emotions experienced at work in the last week Afraid 0.764 0.404* Angry 2.016 1.468* Anxious 1.816 1.336* Frustrated 3.132 2.894* Guilty 0.408 0.234* Helpless 1.229 0.959* Irritated 2.916 2.413* Sad 1.152 1.170 Self-rated performance at work Showing concern for patients 4.522 4.636* Anticipating patient needs 4.382 4.565* Explaining procedures to patients 4.212 4.507* Demonstrating skills in provision of care 4.410 4.629* Helping calm patient fears 4.200 4.552* Communicating effectively 4.348 4.484* Responding to patient requests 4.368 4.533* Overall nursing care 4.364 4.575* Source: Caring about Relationships and Me Always (CARMA) dataset, 2010. Notes: Only Millennial nurses (age 21–31) and Baby Boomer nurses (age 51+) are included in Table 3 to better highlight the differences between younger and older nurses. * indicates a significant difference in the mean values of Millennial and Baby Boomer nurses (p<.05). Cottingham and Dill 22 Table 4. Linear regression models predicting negative emotions, positive emotions, and perceived performance at work. Age Sex (reference male) Female Negative emotions last week Positive emotions last week Perceived performance Coeff. Coeff. Coeff. (SE) (SE) (SE) -0.015** 0.008 0.006* (3.38) (1.46) (2.40) 0.035 -0.208 0.009 (0.32) (1.56) (0.16) -0.082 0.009 (0.64) (0.06) (0.73) -0.161 -0.055 0.11 (1.20) (0.33) (1.55) 0.174** -0.111 0.025 (2.86) (1.46) (0.78) 0.000 0.000 0.000 (1.24) (0.82) (0.42) Race (reference White) Black Other minority High patient acuity Job tenure (months) Constant R 2 N 1.84** (9.74) 0.05 703 2.717** (11.54) 0.01 703 0.05 4.19** (41.97) 0.04 696 Source: CARMA dataset, year. *p < .05; **p < .01; ***p < .001 Notes: Respondents included in the “other minority” category are any respondents that identified as a race-ethnicity other than white or African American. Cottingham and Dill 23 References Anderson, LB and Morgan, M (2017a) ‘An Examination of Nurses’ Intergenerational Communicative Experiences in the Workplace: Do Nurses Eat Their Young?’ 65 Communication Quarterly 377, 385. doi: 10.1080/01463373.2016.1259175 ——(2017b) ‘Embracing the Opportunities of an Older Workforce: Identifying the Age-Based Strategies for Coping With Emotional Labor’ 3 Work, Aging and Retirement 403. doi: 10.1093/workar/waw039 Andrew, Y (2015) ‘“I’m Strong Within Myself”: Gender, Class and Emotional Capital in Childcare’ 36 British Journal of Sociology of Education 651. doi: 10.1080/01425692.2013.835711 Bericat, E (2016) ‘The Sociology of Emotions: Four Decades of Progress’ 64 Current Sociology 491. doi: 10.1177/0011392115588355 Bjørk, IT, Samdal, GB, Hansen, BS, Tørstad, S, and Hamilton, GA (2007) 'Job satisfaction in a Norwegian population of nurses: A questionnaire survey' 44 International Journal of Nursing Studies 747. https://doi.org/10.1016/j.ijnurstu.2006.01.002 Boateng, GO and Adams, TL (2016) ‘“Drop dead … I need your job”: An Exploratory Study of Intra-Professional Conflict Amongst Nurses in Two Ontario Cities’ 155 Social Science & Medicine 35. doi: 10.1016/j.socscimed.2016.02.045 Bourdieu, P (1990) The Logic of Practice (Stanford, CA, Stanford University Press). 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