Anesthesia eJournal Volume 2 Issue 1 2014 AEJ Educated Hand Publishing LLC “The Science Behind the Art” Anesthesia eJournal - Online ISSN 2333-2611 Popular press coverage has noted that generational diversity exists in the workplace, suggesting strategies for generational harmony and improving job satisfaction. However, little empirical evidence has linked job satisfaction to generational profiles. The current nurse anesthesia workforce includes three predominant generations: Baby Boomers, Generation X, and Generation Y. A quantitative descriptive design was used to compare job satisfaction between generational cohorts of CRNAs in Michigan. Four hundred and seven respondents completed an online survey (The Nursing Work Index – Revised) as a measure of job satisfaction. Results indicated that overall, nurse anesthetists have a relatively high job satisfaction across generations. CRNA job satisfaction scores were impacted by their sense of autonomy, their ability to work with clinically competent peers, working for employers who provide opportunity for advancement and education, and having leadership representation at high administrative levels. ANOVA revealed no significant differences in job satisfaction scores between the three generations. Information from this study has implications for surgical teams, patients, hospital administrators, nurse anesthesia leaders and individual CRNAs. Understanding factors that influence CRNA job satisfaction can enhance the work environment and prove to be beneficial to all generations of CRNAs. Keywords: Generation, job satisfaction, values, CRNA Abstract Job Satisfaction Among Certified Registered Nurse Anesthetists: A Multigenerational Analysis Lisa Mileto CRNA, DNP Barbara Penprase RN, PhD, CNOR Author Correspondence: Lisa Mileto CRNA, DNP Lmileto3@gmail.com Barbara Penprase RN, PhD CNOR penprase@oakland.edu A generational transformation is occurring in healthcare across America. For the first time in history, the workforce consists of three generations working together.1 Exploring Certified Registered Nurse Anesthetist (CRNA) job satisfaction from a generational perspective could encourage leaders to capitalize on unique, generation- specific opportunities to recruit and retain highly qualified CRNAs, maximize departmental effectiveness and communication, and create favorable employment arrangements. Understanding generational differences may diffuse intergenerational conflicts that can emerge when values are not aligned. A national dialogue is developing amongst generation experts, researchers, and leaders suggesting that generational needs be taken into account to improve job satisfaction, particularly in nursing.2-5 The purpose of this study was to determine if there is a difference in job satisfaction among CRNAs from three different generations. The factors influencing CRNA job satisfaction that were examined in this study are central concepts in the Nursing Work Index - Revised (NWI-R) survey, including autonomy, control over practice setting, nurse-physician relationships, and organizational support.6 Table 1 defines these factors. mailto:Lmileto3@gmail.com mailto:penprase@oakland.edu Anesthesia eJournal www.anesthesiaejournal.com Volume 2 Issue 1 2014 BACKGROUND Each generation has innate core values influenced by the era in which they were born and experiences in their life span.3,7 Strauss and Howe’s7 Generational Theory was used to guide this research. This sociological theory examines the things that drive people’s behavior. A generation is a cohort group who share birth years and are deeply influenced by and bound together by their experiences.3 The events people experience throughout their formative years partly determine who they are, how they see the world, and what they value. Events that capture the attention and emotions of millions of people throughout their youth contribute to the development of a generational personality.7 Table 2 is a demographic overview of three generations. The Baby Boomers (born between 1946-1964) grew up in a time of economic expansion and prosperity, significant social movements, and national optimism.7 Defining events that occurred during the Baby Boomers’ formative years included the Cold War, Elvis Presley and the Beatles, the Vietnam War, and the Civil Rights Movement. They were empowered by protests, an emerging drug culture, and sexual and spiritual evaluation. 3,7,8 Rosa Parks, assassinations of Martin Luther King and John F. Kennedy, and Woodstock all left an indelible mark.3,7,8,9 Today, Baby Boomers are concerned about their workplace environment and they value participation, fairness, and equality. Boomers are team players that believe in inclusion and collaboration.8,9 Additionally, they are fiercely competitive and go to great lengths to get what they want.3 Table 3 lists the core values of Baby Boomers.9 During their formative years, Generation X (born between 1965-1977) witnessed corporate layoffs and corruption, inflation, the energy crisis, and nuclear proliferation.8 Rapidly rising divorce rates and women entering the workforce changed family dynamics. These defining events contributed to Generation X developing a prevailing skepticism.8 Institutions that were previously stable began to fail, leading to distrust, disappointment, and a survivor mentality.3 Watergate, the fall of the Berlin wall, the Challenger disaster, and Operation Desert Storm were all sentinel events that influenced Generation X.8 Today, Generation X value balance in their lives, particularly between their work and personal lives; they do not define themselves by their work.9 They are frugal and are not influenced by trendy brand names or hype.9 Having little regard for corporate life, they often challenge or work around authority and the status quo.9 They are independent problem solvers who excel at multitasking and using technology.3 Table 3 lists the core values of Generation X.9 Defining events in the formative years for Generation Y (born between 1978-2000) included threats and acts of terrorism, including September 11th, 2001, the turning of a new century, the bombings in Oklahoma City, and school shootings.10 This cohort was raised in a child-focused environment.10 Parents were involved in their children’s lives in a style of parenting coined “helicopter parenting”, creating an environment of protection and guidance. Generation Y has received extensive accolades for their achievements and have been the recipients of a cultural shift toward the promotion of positive self-esteem.11 Generation Y is often referred to as the narcissistic generation. A study of 16,475 college students between 1982 and 2006 revealed that narcissism has steadily increased since 1982.12 The Narcissistic Personality Inventory results indicated that by 2006, two-thirds of the students had above-average scores on this inventory, ranking 30% higher than students in 1982.12 Current social media such as Facebook, Twitter, Vine, Instagram, and YouTube encourage self-promotion. Generation Y’s sense of entitlement is fed by their Baby Boomer parents, who spend billions of dollars each year on their children.12 In contrast to Baby Boomers, Generation Y values changing employment frequently to seek the work environment that meets their personal needs and desired lifestyle.8,11 In addition to having a sense of civic responsibility and social engagement, they are tech-savvy as well as tech-dependent.11 Table 3 lists Generation Y’s core values.9 Generational theory creates a powerful framework for examining the practice environment and job satisfaction of nurse anesthetists through exploration of core values, expectations, attitudes, and behaviors. Limited current research exists specifically related to job satisfaction of CRNAs, particularly in the United States. Work environment characteristics and personality dimensions among Dutch nurse anesthetists were examined in relation to burnout, job satisfaction, and turnover intention. Results revealed that 42% intend to leave their job within 2 years.13 Exploration of job satisfaction, emotional wellbeing, and working conditions of Austrian and Swiss anesthetists indicated that high levels of job satisfaction exist in anesthetists who found their work interesting and had opportunities to contribute skills and ideas to the workplace.14 Jones and Fitzpatrick15 conducted a descriptive study examining attitudes toward collaboration, surveying CRNAs and anesthesiologists in Texas. CRNAs consistently had higher mean scores than anesthesiologists in the four subscales examined: shared education and teamwork, caring opposed to curing, CRNA autonomy, and physician authority.15 Research involving factors that influence job satisfaction as it relates to generational differences is relatively recent. Wieck et al6 completed a generational assessment of job satisfaction, work environment, and favorable manager characteristics. Nurses’ satisfaction was measured using the Nurse Work Index-Revised.16 Surveying 1,773 staff Registered Nurses (RNs) from 22 hospitals, they found that Generation Y nurses were least satisfied with organizational support and their control over practice. Generation X nurses were least satisfied with control over practice and autonomy. Baby Boomers had the lowest satisfaction scores in the areas of control of practice and satisfaction with the work environment, but the highest overall satisfaction scores. Additional recent studies demonstrate significant diversity in job satisfaction and work values among generations, particularly in the areas of burnout, empowerment, value congruence, workplace cohesion, supervisor support, and organizational commitment.17,18,19 A survey of nurses and their experiences of distress and collegiality at work was conducted by Leiter et al.20 The aim of the study was to determine if generational differences exist between these experiences. Generation X nurses reported more negative experiences than Baby Boomers on all measures including incivility, cynicism, physical symptoms, exhaustion, and turnover intent. Wilson et al21 conducted a study to explore how overall job satisfaction and satisfaction with specific aspects of work are Anesthesia eJournal www.anesthesiaejournal.com Volume 2 Issue 1 2014 similar and different across generations of nurses (N = 6,541). Results indicated that Generation X and Y had a significantly lower level of job satisfaction as compared with Baby Boomers. Baby Boomers were significantly more satisfied with rewards such as pay and benefits. Baby Boomers also reported higher levels of satisfaction with professional opportunities, praise, and recognition as compared to Generation X. Generation X placed a higher value on self-directed recognition and professional opportunities and relied less on organizations. There were no differences in generational cohorts in satisfaction with nursing co-workers or other health care provider interactions. METHODOLOGY For this study, a quantitative descriptive design was used to compare job satisfaction between generational cohorts of CRNAs. The target population for this study consisted of 2,163 practicing CRNAs throughout Michigan who were, at the time of survey mailing, active members of the Michigan Association of Nurse Anesthetists (MANA). CRNAs born between 1946 and 1989 were included in data analysis and categorized according to generational cohort. Birth year was used to categorize the participants into generational cohorts: Baby Boomers, born between 1946-1964; Generation X, born between 1965 and 1977; and Generation Y, born between 1978 and 2000. For the purpose of data analysis, 1989 served as the cut-off for placement in the Generation Y cohort because it is unlikely that anyone born after 1989 would have achieved the educational preparation to be a CRNA. Permission to use human subjects was obtained from the Oakland University Investigational Review Board prior to data collection. MANA distributed the e-mail to all CRNA members, which included the informed consent with a link to the demographic questionnaire and the Nursing Work Index – Revised (NWI-R). Completion of the survey indicated implied consent. The NWI-R instrument was used to measure CRNA job satisfaction from three different generational cohorts. The NWI-R has been used successfully to assess nursing job satisfaction in a number of published studies over several decades, has proven sound psychometric properties, and has good to excellent reliability.16,22,23,24 Content validity of the instrument has been documented in multiple studies that have demonstrated the identification of work environment characteristics supportive of professional nursing practice.16,22,23,24 The NWI-R was slightly modified by minor language changes to fit CRNA practice. For example, the word “nurse” was changed to “CRNA” and the items “the use of written nursing care plans”, “working on highly specialized units”, “floating to different units”, and “caring for the same patient from one day to the next” were eliminated. This was done to allow for optimal answers about the individual’s work environment. RESULTS The electronic survey was opened by 450 CRNAs. In total, 43 cases were eliminated due to either the participant completing only the demographic questions and not the survey or the participant was born before 1946. This left 407 respondents (90.4%). The mean age was 47 (SD = 10) with a minimum age of 26 and a maximum of 66. Baby Boomers comprised 53.6% of the sample (n=218), Generation X comprised 31.2% (n=127), and Generation Y comprised 15.2% (n=62). Additional demographic data is presented in Table 4. The survey used 38 items and a 4-point Likert scale, asking participants to respond by indicating the extent to which they agree that each item is present in their current job, with 1 (strongly disagree), 2 (somewhat disagree), 3 (somewhat agree), and 4 (strongly agree); the higher the score, the higher the job satisfaction. The mean job satisfaction score was 2.89 (range = 1.50 to 3.92, SE = .04). The distribution had mild deviations from normality (skewness = -.13; kurtosis = .34) indicating that the largest portion of the data was above the mean (median = 2.87) with slight leptokurtosis. Therefore, it was determined that parametric statistical analysis using ANOVA was appropriate. The lowest mean score for Baby Boomers (2.24, SD = 0.86) was on the item “there is opportunity for advancement”. The lowest mean for Generation X (2.25, SD = 0.93) was on the item “department educators provide patient care consultation”, and the lowest mean for Generation Y (2.27, SD = 0.99) was on the item “a chief nurse executive or anesthesia leader is equal in power and authority to other top-level executives”. The highest mean for the Baby Boomers (3.64, SD = 0.55), Generation X (3.65, SD = 0.48) and Generation Y (3.72, SD = 0.49) was on the item “working with CRNAs who are clinically competent”, thus being the highest overall mean for all respondents (3.66, SD = 0.52). Table 5 lists the overall highest and lowest means of all respondents for specific items. The mean job satisfaction scores for each generation were: Baby Boomers, 2.90 (SD = 0.62); Generation X, 2.82 (SD = 0.47); and Generation Y, 3.01 (SD = 0.48). The four subscale means for all respondents were: Autonomy 2.80 (SE = 0.04), Organizational Support 2.93 (SE = 0.03), Control Over Practice 3.03 (SE = 0.04), and CRNA/Physician Relationships 3.03 (SE = 0.03). Analysis of variance (ANOVA) was used to compare the means of overall job satisfaction scores between generations and subcategories of job satisfaction between generations. Results indicated no difference in job satisfaction scores between generations F(2, 200) =1.524, p = .22. In addition to testing the mean job satisfaction score, the data were analyzed according to the NWI-R four subscales: Autonomy, Control Over Practice, Organizational Support, and CRNA/Physician Relationships. Mean scores were created for subscales in the same manner as the overall job satisfaction score. ANOVAs were run separately for each subscale to see if any generational differences might exist for any of the subscales. No significant differences were found on any of the subscale: Autonomy F(2, 339)=.865, P=.42; Control over Practice F(2, 351)=2.044, P=.13; Organizational Support F(2, 337)=.968, P=.38; and CRNA/Physician Relationships F(2, 386)=0.591, P=.55. DISCUSSION The findings revealed no significant difference in job satisfaction scores between three generations of CRNAs. There were, however, several interesting findings that warrant comment and further investigation. The American Association of Nurse Anesthetists (AANA) demographic data align closely with the descriptive data in this study (Table 8). According to a recent AANA Member Survey Data Report,25 the average age of Anesthesia eJournal www.anesthesiaejournal.com Volume 2 Issue 1 2014 CRNAs in the United States is 50; the average age of CRNAs in this study was 47. A surprisingly large percentage of CRNAs have been in practice for over 20 years. Many are eligible for retirement in the next 5 years, yet are not planning to retire.25 Are CRNAs choosing to postpone retirement due to recent economics changes, overall job satisfaction, or other factors? Are there generational implications of these findings? This study reports a total job satisfaction mean of 2.89 (on a 4 point scale), indicating CRNA respondents were somewhat satisfied with their job. Based on generational and subscale mean job satisfaction scores, CRNAs are somewhat satisfied with their job. This result aligns with the AANA Member Survey Data Report.25 The AANA used a 5-point Likert scale ranging from 1 (not favorable) to 5 (very favorable). The survey asked “How favorable is your primary work environment to CRNAs?” The mean was 3.9, with 72% responding 4 or 5 (n = 5,704). The AANA survey also asked “How satisfied are you with a career as a nurse anesthetist?” The mean response was 4.4, with 89% responding 4 or 5 on a scale of 1, (not satisfied) to 5 (very satisfied). The highest item mean impacting job satisfaction for all three generations in this study related to working with highly competent CRNAs. The lower mean item scores for job satisfaction found in this study included opportunities for advancement, educational needs of CRNAs, and CRNAs perceptions of the importance of administrative representation. This is valuable information for examining CRNA job satisfaction. These factors indicate the potential need for improved educational offerings for CRNAs at the workplace, having CRNA leadership that has influence with administration, and providing CRNAs with opportunities for advancement. The subgroup of autonomy had the lowest overall mean for all respondents. Items in this subgroup included: “not being placed in a position to do things that are against my judgment”, “freedom to make important patient care and work decisions”, “a supervisory staff that is supportive of CRNAs”, and “an anesthesia manager backs up CRNAs in decision making, even if the conflict is with a physician”. The results of lower job satisfaction related to lack of autonomy parallel results reported in earlier studies.4, 6,15 Similarly, the AANA survey indicated that 21% of CRNAs reported a lack of job autonomy as an issue affecting their practice.25 The demographics of nurse anesthesia are rapidly changing.25 Nurse anesthesia educational programs have increased in number and enrollment over the past 10 years. According to the AANA Practice Profile and Demographic Surveys and Database,26 in 1999 there were 2,472 students enrolled in nurse anesthesia programs, and in 2009 there were 5,490 students enrolled. This is a 122% increase in anesthesia student enrollment. Will the demographics abruptly shift in the next 10 years and impact CRNA job satisfaction? Will greater generational diversity in nurse anesthesia impact job satisfaction in the future? Exploring these questions empirically will be beneficial for the profession. This study was limited to CRNAs who were MANA members practicing in Michigan, thus the findings cannot be generalized beyond this population. A type II error may have occurred in this study due to a small sample size or small differences in measured effect between groups due to lack of precision in the instrument. Power analysis was not performed. Generational theory has been criticized for creating generalizations about groups of people based on anecdotal evidence, age, and demographic data. There may be an imbalance of extrapolated information that has grouped people into generations versus empirical evidence of generational differences.27 Alternatively, generational difference is a relatively new field of study with empirical and theoretical growth on the rise, making it an excellent area for study. Regarding the NWI-R, the statement that was most frequently answered as ‘not applicable’ or left blank was “department educators provide patient care consultation” (n = 75 blank), followed by “a preceptor program exists for new employees” (n = 59 blank or “not applicable”), followed by “CRNAs are supported in pursuing advanced degrees” (n = 56 blank). Possible reasons for incomplete responses include confusion about the statement, or the respondent felt something in the statement was not applicable to him or herself or their work environment, or other unknown reasons. Nurse anesthetists are advanced practice nurses that form a unique subset of nursing. This calls into question the validity of the NWI-R for use in nurse anesthesia. Even the minor modifications made to this tool could have a negative impact on reliability and validity. Ideally, a reliable and valid job satisfaction survey should be created that is specific to nurse anesthetists. Despite the limitations, this research provides important and unique insight into the job satisfaction of nurse anesthetists. Overall, nurse anesthetists have a relatively high job satisfaction across age ranges. CRNA job satisfaction is impacted by their sense of autonomy, opportunity for advancement, educational opportunities offered by their employer, and leadership representation at high administrative levels. Although not generationally specific, these concepts crossed all generations. Nurse anesthesia leaders can improve job satisfaction by modifying organizational practices to meet the workplace needs and values of CRNAs. Mainstream publications contain recommendations for generational management styles; general discussion about generational differences in the work place occurs regularly. People bring their life experience and values to work. Although this research did not find a significant difference between generations and job satisfaction among CRNAs, the negligible differences this study revealed may have practical interest and value for nurse anesthetists, and the data present interesting questions for further research. Nurse anesthetists should continue to explore factors that influence CRNA job satisfaction and develop strategies aimed at maintenance and improvement of the workplace environment. Anesthesia eJournal www.anesthesiaejournal.com Volume 2 Issue 1 2014 REFERENCES 1. Swenson C. Next generation workforce. Nurs Econ. 2008;26(1):64-65. 2. Lavoie-Tremblay M, O’Brien-Pallas L, Gélinas C, Desforges N, Marchionni C. Addressing the turnover issue among new nurses from a generational viewpoint. J Nurs Manag. 2008;16(6):724-733. 3. Martin CA, Tulgan B. Managing the Generation Mix: From Collision to Collaboration (Manager’s Pocket Guide Series). 2nd ed. Amherst, MA: HRD Press; 2006. 4. Zangaro GA, Soeken KL. A meta-analysis of studies of nurses’ job satisfaction. Res Nurs Health. 2007;30(4):445- 458. 5. Shacklock K, Brunetto Y. The intention to continue nursing: work variables affecting three nurse generations in Australia. J Adv Nurs. 2012;68(1):36-46. 6. Wieck KL, Dols J, Landrum P. Retention priorities for the intergenerational nurse workforce. Nurs Forum. 2010;45(1):7-17. 7. Strauss W, Howe N. Generations: The History of America’s Future, 1584 to 2069. New York, NY: William Morrow; 1991. 8. Lancaster LC, Stillman D. When Generations Collide. HarperCollins: New York; 2002. 9. Zemke R, Raines C, Filipczak R. Generations at Work: Managing the Clash of Veterans, Boomers, Xers, and Nexters in Your Workplace. New York, NY: AMACOM; 2000. 10. Huntley R. The World According to Y: Inside the New Adult Generation. Crows Nest, Australia: Allen & Unwin; 2006. 11. Twenge JM, Campbell K. The Narcissism Epidemic: Living in the Age of Entitlement. New York, NY: Free Press; 2009. 12. Twenge JM. Generation Me: Why Today’s Young Americans are More Confident, Assertive, Entitled – and More Miserable Than Ever Before. New York, NY: Free Press; 2006. 13. Meeusen VC, Van Dam K, Brown-Mahoney C, Van Zundert AA, Knape HT. Understanding nurse anesthetists’ intention to leave their job: how burnout and job satisfaction mediate the impact of personality and workplace characteristics. Health Care Manage Rev. 2011;36(2):155-163. 14. Kinzl JF, Knotzer H, Traweger C, et al. Influence of working conditions on job satisfaction in anesthetists. Br J Anaesth. 2005;94(2):211-215. 15. Jones TS, Fitzpatrick JJ. CRNA-physician collaboration in anesthesia. AANA J. 2009;77(6):431-436. 16. Aiken L, Patrician P. Measuring organizational traits of hospitals: the Revised Nursing Work Index. Nurs Res. 2000;49(3):146-153. 17. Sparks AM. Psychological empowerment and job satisfaction between Baby Boomers and Generation X nurses. J Nurs Manag. 2012;20:451-460. 18. Leiter M, Jackson N, Shaughnessy K. Contrasting burnout, turnover intention, control, value congruence and knowledge sharing between Baby Boomers and Generation X. J Nurs Manag. 2009;17(1):100-109. 19. Keepnews D, Brewer C, Kovner C, Shin J. Generational differences among newly licensed registered nurses. Nurs Outlook. 2010;58(3):155-163. 20. Leiter M, Price S, Spence Laschinger H. Generational differences in distress, attitudes and incivility among nurses. J Nurs Manag. 2010;18(8):970-980. 21. Wilson B, Squires M, Widger K, Cranley L, Tourangeau A. Job satisfaction among a multigenerational nursing workforce. J Nurs Manag. 2008;16(6):716-723. 22. Krebs J, Madigan E, Tullai-McGuinness S. The rural nurse work environment and structural empowerment. Policy Polit Nurs Pract. 2008;9(1):28-39. 23. Lake E. Development of the practice environment scale of the Nursing Work Index. Res Nurs Health. 2002;25(3):176-188. 24. Lake E. The nursing practice environment: measurement and evidence. Med Care Res Rev. 2007;64(2 Suppl):104S- 122S. 25. American Association of Nurse Anesthetists. Member Survey Data Report. Available at: http://www.aana.com/ myaana/AANAbusiness/aanasurveys/Documents/aana- member-survey-data-nov2011.pdf. Accessed Jan. 15, 2013. 26. American Association of Nurse Anesthetists. AANA practice profile and demographic surveys and database. Park Ridge, IL: AANA; 2010. 27. Hanson JC, Leuty ME. Work values across generations. J Career Assess. 2012;20(1):34-52. file:///Users/sheriharvey/Desktop/Customers/Anesthesia%20Journal/Generational%20Study-Mileto%20V.2-I.1/../AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/4AFRK31D/Available at: www.aana.com/myaana/AANAbusiness/aanasurveys/Documents/aana-member-survey-data-nov2011.pdf file:///Users/sheriharvey/Desktop/Customers/Anesthesia%20Journal/Generational%20Study-Mileto%20V.2-I.1/../AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/4AFRK31D/Available at: www.aana.com/myaana/AANAbusiness/aanasurveys/Documents/aana-member-survey-data-nov2011.pdf file:///Users/sheriharvey/Desktop/Customers/Anesthesia%20Journal/Generational%20Study-Mileto%20V.2-I.1/../AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/AppData/Local/Microsoft/Windows/Temporary Internet Files/Content.IE5/4AFRK31D/Available at: www.aana.com/myaana/AANAbusiness/aanasurveys/Documents/aana-member-survey-data-nov2011.pdf Table 1 Factors Influencing CRNA Job Satisfaction Autonomy: The freedom to make independent decisions in CRNA practice that are in the best interest of the patient. Control over the practice setting: Organizational autonomy or the freedom to take the initiative in shaping anesthesia departmental and institutional policies for patient care. Nurse-physician relationships: Involvement and connection between CRNA and physician regarding patient care. Organizational support: Administrative and managerial support for CRNAs, including opportunities for continuing education, advancement, and adequacy of resources. CRNA, Certified Registered Nurse Anesthetist. Source: Nurse Work Index-Revised survey.5 Table 2 Comparison of Three Generations3 Generation Birth Years Current Age Population Baby Boomer 1946-1964 50-68 80 million Generation X 1965-1977 37-49 46 million Generation Y 1978-2000 36 -14 76 million Table 3 Characteristics of Generations BABY BOOMER Main Values • Optimism • Teamwork • Personal gratification • Health/Wellness • Personal growth • Work Anesthesia eJournal www.anesthesiaejournal.com Volume 2 Issue 1 2014 Anesthesia eJournal www.anesthesiaejournal.com Volume 2 Issue 1 2014 Table 4 Comparison of Demographic Data MANA CRNA Surveya and AANA CRNA Surveyb Variable MANA Survey (N = 407) AANA Survey (N = 7,053 Mean Age 47 50 Age Cohort 48 - 66: 54% 36 - 47: 31% <35: 15% Over 49: 55% 35 - 49: 35% <34: 10% Years Experience Over 20 10 to 20 Less than 10 34% 28% 38% 35% 23% 42% Gender Female 61% 58% Male 39% 42% Practice Setting Hospital 89% 87% ASC 10% 11% Other 1% 2% Role Staff CRNA 90% 96% Administration 6% 2% Education 3% 2% aNWI-R electronic survey of Michigan CRNAs bAmerican Association of Nurse Anesthetists, Member Survey Data Report Table 5 High and Low Mean Job Satisfaction Scores – NWI-R Item Mean, SDa Mean, SDa High Scores Working with Competent Peers 3.66, 0.52 High Standard of Care Expected 3.60, 0.66 Satisfactory Salary 3.33, 0.77 Low Scores Opportunity for Advancement 2.28, 0.85 Anesthesia Leader Equal In Power to Executives 2.31, 1.02 Educators Provide Consultation 2.36, 0.93 aStandard Deviation