Guiding Gen Z Nurses Through COVID-19

HCA Healthcare's Chief Nurse Executive Jane Englebright shares how the hospital system has helped her nurses cope with the pandemic.

While COVID-19 is taking an emotional toll on nursing staffs, indications are that Gen Z nurses—those between the age of 18 and 22—generally are having a much tougher time.

Generally, the simple fact of their age, with its lack of life experiences and adversity, and therefore resilience, is a major factor, according to the study, Keeping an Eye on Generation Z Nurses.

"Most Generation Z nurses have less experience with adversity," the study states. "It is difficult for them to put the COVID-19 experience into any context."

Data from a recent survey, Nurse Wellbeing At Risk, indicated that Gen Z nurses were the most likely (57.3%) to report that COVID-19 had negatively impacted their overall well-being; they were the least likely (23.5%) to report managing work-related stress and anxiety; and only 15.4% felt comfortable discussing their well-being with their manager—a sharp difference from their baby boomer counterparts (59.6%).

Going into the pandemic, HCA Healthcare, based in Nashville, had a handle on Gen Z nurses from a recruiting study it had commissioned and released in February 2020. The study, conducted by The Center for Generational Kinetics was designed to better understand what motivates and drives the younger generations of nurses.

Jane D. Englebright, PhD, RN CENP, FAAN, is senior vice president and chief nursing executive for HCA Healthcare, which employs about 98,000 nurses, most of whom, she says, are millennials and Gen Z.

HealthLeaders recently spoke with Englebright about how HCA has helped the hospital system's nurses—particularly its youngest nurses—navigate the pandemic.

The following is a transcript of the conversation, lightly edited for clarity and brevity.

HealthLeaders: HCA commissioned a study last year on millennial and Gen Z nurses' perceptions. What, overall, did the study reveal about Gen Z?

Jane Englebright: What it helped us do was to prioritize the things that were important to this growing segment of our nursing population. What came out of it was their need for flexibility, how important relationships were to them, having a positive work environment, and the importance of teamwork and how they want to feel part of a team. We got a lot of insight into training that we ended up using a lot this year in terms of how they prefer to receive training information. And then there's the whole idea that they needed a way to have a voice. All of those things we sort of knew going in, but it gave us a little more insight, and we turned around and tried to apply that to almost everything that we were dealing with [with COVID-19].

HL:  How did the study help HCA prepare to manage through a pandemic?

Englebright: It was important and continues to be important as we manage a continuous flow of up-to-date, accurate information. Do you remember in the beginning of the pandemic, that we were still having conflicting guidelines coming out? As everything evolved and continued to change, and as we learned more, we had to get education to the front line fast. We had already been working on our centers for clinical advancement and a new education model and moving a lot of our education from the PowerPoint with voiceover to little mini videos, so we ramped that up in a significant way.

The other thing we came up with was how to put reference materials at their fingertips that would never be out of date. We made these posters that can be hung up in the wall of the nurses' station, or even in a patient room, that had a QR code on it that links you to the master document and they could always just scan that code and read the latest. We could maintain everything in a central database that had all the latest information in it and not worry about a lot of outdated information still being out there in the unit.

HL: Even more seasoned nurses are struggling with the effects of the pandemic. How have your younger nurses grappled with it?

Englebright: Every age group has had the full spectrum of responses. There are different life stressors, but they're all struggling with the disruption in their personal lives, as well as the disruption in their work life. This last month, I've spent quite a bit of time working in the TriStar vaccination clinic and you see the nurses coming through it and you can see the variation of how they're coping and their response. Some are coming in playing their walking music and dancing it out, happy that we're to the vaccine stage. Others come in in tears because we're in the vaccine stage. And I think that's what we've seen all along. At every stage of this, we've had the full range of responses.

HL: How did HCA help the nurses cope as the pandemic worsened?

Englebright: We put in place a Nurse Care Program [a free, confidential program partnered with a company offering licensed psychologists, counselors, and therapists]. We had been piloting it in 2019 and when we got into the situation in March, we ramped it up and rolled it out to the rest of the company in a six-week period and it's been widely accepted. About 90% of the calls that come through are the Gen Z and millennial nurses. Of almost 26,000 calls, about 20,000 of them are related to COVID, so the younger nurses are calling in larger numbers than the more seasoned nurses.

HL: How have you measured the outcomes of some of these actions that you've taken for your nurses?

Englebright: A couple of ways. We've done some poll surveys asking, "What's important to you, and what else do you need?" What we got back from them was that they had two things that were their key needs. One was frequent communication. That was the No. 1 way they felt that they were being supported. And then the other thing they need is to feel a sense of being safe at work and an understanding of all the work-related stress. So I think we've done that.

Our universal protection protocol that we put in place about being safe in the work environment seems to have worked and people seem to have confidence in it. And then with work-related stress, how we came at that was, first, the Nurse Care Program. The second was we leaned heavily on our behavioral health experts throughout the organization and had them assemble resources on stress management [on our intranet]. While I was making rounds at one of our hospitals, I saw some of the nurses gathered around a computer together and I asked, "What are you guys doing?" and they said, "We're watching the mindfulness video. We do it every day at this time."

HL: The Nurse Well-being At Risk survey says that only 15.4% of Gen Z nurses felt comfortable discussing their well-being with their manager. Given that, how does a CNO or other nurse managers successfully "take the temperature" of how their youngest nurses are doing?

Englebright: Besides the couple of things I mentioned and the pulse surveys that we do periodically, we also have a practice of employee rounding, where managers spend time with each employee on a regular basis, where they just talk about them: "How are you doing? What are your career aspirations? Where do you want to go next? How can I help you develop?"

Then we've launched an app that our nurses designed, that we call HCA Inspire. This app has social networking features and where [nurses] can recognize each other. [It] also has an ability to find a mentor; [nurses] can go in and match up with a mentor to talk.