They grew up in a world where the internet was always at their fingertips. They could swipe before they could talk, and they reflexively turn to Google and YouTube for information.
They are set to become the most diverse, well-educated, and politically active generation in human history.
And now, they are entering the nursing workforce.
Generation Z (Gen Z), also known as iGen, Digital Natives, or Zoomers, includes anyone born from 1997 - 2012, according to the Pew Research Center. In the same way that the widespread emergence of the internet, the 9/11 terrorist attacks, and the Great Recession influenced Millennials born in the United States, the youngest generation of nurses has been shaped by the ubiquity of smartphones and social media, the looming climate crisis, and witnessing the financial hardships of their parents – not to mention how a global pandemic is reshaping the country’s social, political, and economic landscape.
“The generation as a whole is very diverse and open minded. They are super tech savvy. They are well educated, and they are information seekers who care very deeply about the world,” explains Susan Bindon, DNP ’11, MS ’96, RN, NPD-BC, CNE, CNE-cl, associate professor and associate dean for faculty development. As part of her role, Bindon guides faculty on evidence-based practices for transforming classroom, clinical, and online learning experiences to best suit Gen Z needs.
According to the World Economic Forum, 38% of Gen Zers are aiming for a career in health care. Bindon believes that UMSON will see a “great influx of students” because several core generational characteristics align with the nursing profession. This includes Gen Z’s overall sense of pragmatism after having seen the effects of the 2008 global financial crisis on their parents, as well as its prioritization of social responsibility and a desire to make an impact on the world, she says. And so far, the COVID-19 pandemic seems only to have amplified that passion: There was a 5% increase in enrollment at the School between fall 2019 and fall 2020.
“For these incoming classes, we can notice trends and commonalities and prepare ourselves to be welcoming,” says Bindon, who points out that characteristics of generations are not absolutes. “Our job is to help them become nurses. We need to understand how to engage them, how to stimulate their thinking, how to develop rapport and trust, and how to help them step into the professional world.”
GENERATIONAL DIFFERENCES
When Karina Rozenberg, BSN ’19, RN, was in nursing school, she often spotted a very familiar face on campus: her father, Ilya, PhD ’20, MS ’01, BSN ’99, CRNP. The elder Rozenberg was admitted into UMSON’s Bachelor of Science in Nursing (BSN) program shortly before Karina was born in 1997, and he was back on campus working toward his PhD while Karina was just starting her nursing education.
“The field of nursing and the respect for the profession evolved tremendously over those 20 years,” Ilya says. Very little of his BSN education had an online component. “You read the book, took notes, and there was a lecture,” he recalls, adding that clinical skills were mostly learned in the field rather than practiced in a simulated environment before seeing patients.
When the National League for Nursing described UMSON’s Debra L. Spunt Clinical Simulation Labs, which opened when Ilya was a student in 1998, as “the preeminent nursing student learning labs in the world,” it would have been impossible then to imagine how the labs would grow and how technology would advance. Today, there are 20 state-of-the-art labs in Baltimore and eight at the Universities at Shady Grove in Rockville, Maryland, where students can develop new skills and expand their abilities using high-fidelity manikins and other equipment without compromising patient safety.
“We are a technology-based generation,” says Karina, who believes simulation had a “big impact” on her confidence as a nurse, a field she chose because she saw it as the “best way to be at the forefront and to be really hands on with patients.” Though she was originally an aspiring ballerina until an injury forced her to reevaluate her path, she had watched her dad go from bedside nursing to earning an advanced degree to starting his own psychiatric nursing practice. “Watching him grow through that was motivating,” says Karina, who now works in the cardiac surgery intensive care unit at the University of Maryland Medical Center.
Both Ilya and Karina agree that despite any future technological advancements, nursing will never lose its human touch. “No matter where you work as a nurse, the ability to connect and empathize is crucial. It is what clearly separates nursing from other fields,” Ilya says.
THE GEN Z PERSPECTIVE
Though Gen Z is often characterized as being too tuned in to their digital devices – and according to research by Global Web Index, the majority are online for about nine hours a day – research shows that Gen Z values face-to-face interaction over screen time.
That human connection was one of nursing’s main draws for Fatai Muritala, RN, an RN-to-BSN student and a nurse at Sheppard Pratt Health System. “As a nurse, you are in contact with the patient more often than in any other health care field,” he explains.
Before he decided to go into nursing, Muritala was considering a gap year between high school and college. “Financial freedom is a big issue for me,” Muritala says, noting that he wanted to have a solid plan for his education to avoid accruing debt. Before beginning his studies at UMSON, he applied and was accepted as a Conway Scholar, covering the cost of his in-state tuition, fees, and books.
According to the World Economic Forum, 89% of Gen Zers say they try to avoid debt to cover the costs of higher education, and 88% consider job preparation to be the objective of college. And while Millennials tend to prioritize finding jobs that are fulfilling over ones that simply pay the bills, Gen Zers generally place compensation and benefits first and are often motivated by job stability, reports XYZ University, a company that educates organizations on generational differences.
This sense of pragmatism is a widely cited characteristic of Gen Z, which tends to be cautious when it comes to their emotional, physical, and financial security due to having grown up in uncertain times. But this will not dissuade Muritala’s generation from wanting to make a difference, he explains. “We are motivated to change the world,” he says, adding that he sees technology as a tool that his generation can use to effect change, including sharing information on social media.
Social justice issues are top of mind for most Gen Zers, and social media is overwhelmingly where conversations happen. As the most diverse generation in American history, Gen Z perceives positively the country’s growing ethnic and racial diversity and tends to be politically progressive, reports Pew Research Center. Members of this generation have lauded the legalization of same-sex marriage and bolstered the Black Lives Matter movement, and they have been vocal on issues important to them such as climate change, gun violence, immigration, police brutality, transgender rights, and religious freedom, as their passion for positive change often turns to online activism.
Online information sharing is second nature for this generation, and it can also be helpful when it comes to finding answers to their nursing-related questions. Anika Zamurd, a BSN student and Conway Scholar, says that she uses YouTube videos to supplement classroom learning. “Videos can help break things down and summarize everything you need to know or help test your knowledge,” she says. A Business Insider survey found that 62% of people between the ages of 13 and 21 are daily YouTube users. “Gen Z grew up around technology, and because of our access to it, we’re learning every day,” Zamurd continues.
Of course, YouTube and other social media platforms have faced criticism for spreading false information – including dangerous medical advice. Zamurd says that her UMSON professors have taught information literacy skills so students can identify what is and is not credible. “We have access to so much information. It’s exciting, but sometimes it can be overwhelming,” she says.
Zamurd is far from the only one in her generation who feels overwhelmed. Anxiety and stress levels are higher for Gen Z than for other generations, with 27% reporting that their mental health is fair or poor and 91% reporting that they have experienced at least one physical or emotional symptom of stress in the past month, according to data from the American Psychological Association (APA). The stressors are wide ranging and include anxiety about the future of the country and the world, as well as intense feelings of isolation and loneliness, factors that have been exacerbated by the COVID-19 pandemic. The good news is that the APA also reports Gen Z is more likely to receive treatment or therapy than any other generation.
For Zamurd and other nursing students, another source of anxiety is transitioning into practice during the pandemic after spending the bulk of their time learning online. “It does make me nervous about when I graduate,” Zamurd admits, saying that she hasn’t had as much time in the simulation labs as she would have liked. “But everyone is graduating in the same boat.”
After encouragement from UMSON faculty, Zamurd recently completed an externship at the Johns Hopkins Hospital. “It’s been really helpful to me in terms of my bedside manners and talking to patients. I lost a lot of that because we were online,” she says.
THE FUTURE OF NURSING SCHOOL
Bindon says that while the School demonstrated during the pandemic that some educational components can be effective online, nursing education as a whole simply can’t be replicated virtually. In addition to the techniques that need to be practiced via simulation labs and clinical practicums, it is especially important for Gen Z nursing students to develop their social and relational skills, she explains. “They have talked much of their life electronically, so face-to-face interactions and personal interactions are very high stakes for them,” she explains.
To help bridge that gap, UMSON employs another kind of experiential learning. Through the Standardized Patient Program, students refine their clinical and communication skills by practicing scenarios with actors who portray patients. These interactions allow students to understand how to provide compassionate care and to work through difficult emotional situations in a simulated clinical environment.
New nurse graduates are also supported by the Maryland Nurse Residency Collaborative, a program spearheaded by the Maryland Organization of Nurse Leaders. As of 2019, all 40 of the state’s acute care hospitals fund and require 12-month residency programs for newly licensed nurses, providing them with a structured transition into clinical practice. Maryland is the first state in the nation to meet this recommendation outlined in the National Academy of Medicine’s 2010 Future of Nursing: Leading Change, Advancing Health report.
UMSON’s curriculum is also undergoing a revamp after the American Association of Colleges of Nursing (AACN), which sets the national curriculum standards for nursing education, endorsed new Essentials for nursing education in April. The new framework was approved by deans from AACN-affiliated nursing schools and focuses on competency-based education, a move that will significantly alter how nurses are prepared for entry-level and advanced roles. According to the organization, this approach involves students demonstrating that they have learned the knowledge, attitudes, motivations, self-perceptions, and skills expected of them as they progress through their program of study. For example, instead of being evaluated based on an objective test, a student may be asked to create a viable dietary plan for a heart failure patient or draft a policy brief about nurse practitioners ordering cardiac rehab as if presenting to a legislator.
At the same time, the ways that students are evaluated is shifting to a competency-based model as well. Students beginning entry-level programs this fall will be the first to experience the new Next Generation National Council Licensure Examination (NCLEX). The National Council of State Boards of Nursing, which administers the NCLEX, is introducing new types of questions that assess clinical judgment and decision-making in nursing practice. For example, in lieu of a multiple choice item, a test taker may be given a list of six actions and have to put them in the correct order, or they may be asked to click their mouse on the spot where someone would listen for specific heart sounds.
“The goal is to teach students to think like a nurse,” Bindon explains. “Clinical judgment is this beautiful, intuitive knowledge and wisdom that nurses have. It takes a lot of practice to look at the cues, analyze the cues, and prioritize the actions.”
To prepare nurse educators in Maryland for these changes, Rebecca Wiseman, PhD ’93, RN, associate professor and chair, UMSON at the Universities at Shady Grove, has been leading statewide faculty development workshops through the Maryland Nursing Workforce Center, housed at UMSON and created through a Nurse Support Program II grant, which is funded through the Maryland Health Services Cost Review Commission and administered by the Maryland Higher Education Commission. The sessions aim to inform nursing faculty about the changes and to foster collaboration and idea sharing on how to adjust educational offerings, clinical and simulation instruction, and evaluation methods.
“The students are changing, course delivery is changing, and the NCLEX is changing,” Bindon explains. “By 2040, the workplace will mostly be composed of Gen Z and Millennials, so the implications for us to understand them and get this right are enormous.”
FAST FACTS ABOUT GEN Z
DIVERSITY IS THE NORM
49% identify as non-white
22% have an immigrant parent
PLUGGED IN
9 hours of screen time daily
71% watch 3+ hours of online videos daily
FINANCIALLY MOTIVATED
44% measure success by their salary
89% attempt to avoid higher education debt
MENTAL HEALTH MATTERS
31% expect employers to offer paid mental health days
37% have received help from a mental health professional
SOCIAL JUSTICE WARRIORS
60% have taken action in the past year
68% feel stressed about our nation’s future
Sources: American Psychological Association, Forbes, Global Web Index, Pew Research Center, Workforce Institute, and World Economic Forum
TIPS FOR WORKING WITH GEN Z NURSES
Bindon shares ideas for aligning your teaching strategies or workplace culture to Gen Z needs.
PROVIDE LOTS OF FEEDBACK
Specific, frequent feedback is important, and it’s best to deliver it privately in a supportive manner to build confidence.
ENCOURAGE PARTICIPATION
This risk-averse generation may be less likely to engage with others, so actively involve them in decision-making and invite them to participate in committees and on projects.
INCORPORATE INTERACTIVITY AND VISUALS
Using videos, infographics, gamification, and electronic polling are simple but effective ways to engage this technology-driven generation.
GIVE THEM OPTIONS
Gen Z prefers individualistic experiences and seeks flexibility, so give them more than one way to apply information and to evaluate them.
BREAK LEARNING INTO BITE SIZES
Make your objectives clear, and give them milestones to complete. For example, if a class or session is an hour long, break it up into four or more chunks.
THIS ARTICLE FIRST APPEARED IN THE FALL 2021 ISSUE OF MAGAZINE.