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Multi-generational Conflict in the Cath Lab

Recently I was enjoying lunch with three other colleagues, and the discussion turned to a physician who had misbehaved earlier that day. Four separate opinions emerged as to how the situation should have been handled.

The first person was over 60 years old. She said that she would have “blown his hair right back”. I am in my 50s. I said, “I would have waited to the end of the case, then have a serious discussion with the physician about the “ill behavior”. The next person was in her mid 30s. She said, “this is why I am looking for another job”. The last person was in their early 20s. That young man said, “payday is still Friday, ain’t it?” It was then that I realized the significance of working in a multigenerational workplace. I also realized that the differences in these generations could well affect the functioning of our organization and Cath Labs in general. This article attempts to address the challenges faced by Cath Lab professionals as they work side-by-side coming from a variety of generational cohorts. This article also hopes to address how to recognize the rich diversity of these generational perspectives, and realize when valued, nurtured, and integrated, can lead to a more creative, functional, and adaptable work environment.

I work in a large metropolitan multiroom Cath Lab. There are 55 technical and nursing staff members here. The staff ranges in age from the early 20s to the mid 60s. The physicians range in age from the early 30s to the mid 70s. At St. Luke’s we have 11 Cath Labs with 10 labs up and functional on any given day. I am Room Leader of a very active coronary room.

Our staff is cross-trained and comes from varied allied health professions. Among the professions are RNs, LVNs, Radiology Technicians, Respiratory Therapists, Circulatory Support Technicians, and Cardiovascular Technicians (both CCVT and RCIS). As varied as the professions are, the generations are just as varied. There are four generational cohorts. There are those from the Veteran generation, Baby Boomers, Generation X, and the Millennial Generation (or Nexers).

The first generation is the Veterans. These individuals have birthdates between 1925 and 1945. There are very few Veterans in our Lab, but they are here and vocal. These people grew up during an era of political and economic uncertainty. It has led them to be hardworking, financially conservative, and cautious. This generation has seen what has and hasn’t worked over the years and look to the past for guidance. Organizational loyalty is important to this generation, and they feel seniority is important to advance in one’s career (Carlson, 2005: Halfer, 2004: Ulrich: 2001). They tend to be respectful of authority, supportive of hierarchy, and disciplined in their work habits (Sherman, 2006).

Working in a Cath lab is physically challenging at best. Wearing lead and standing long hours can lead to conflict between some veterans and other generations. Issues crop up with fair division of labor. The younger generations can clash with the Vets about the amount of time spent out on the floor in lead. Vets often feel that the younger generations should be more respectful of their wisdom and experience. The challenge rests with the management of the Lab to create an acceptable middle.

The second group is Baby Boomers. These individuals were born between 1946 and 1964. Baby Boomers grew up in a healthy post-war economy. For the most part, they grew up in two-parent households where the father earned the family income and the mother was the home caretaker. The attention and prosperity afforded the Boomers, along with changing world and societal values, created an emphasis on freedom to be yourself and the “me” generation. Lack of conformity to the old rules became an established pattern. Longstanding societal rules and expectations were examined and altered, creating the assumption in the minds of Boomers that they should question authority and that the status quo could be transformed by working together (Lancaster& Stillman, 2002). Boomers are known for their strong work ethic, and work has been a defining part of their self worth and their evaluation of others (Greene, 2005; Sherman, 2005). This strong work ethic can make the Boomer appear hypercritical of others, setting the stage for conflict. In nursing, this group is the largest cohort in the workforce (Buerhaus, Staiger, &Auerbach, 2000; Thrall, 2005). This is not true for the Cath Lab staff of mixed professionals. The majority of cath lab professionals fall into the Generation X group (Cath Lab Digest 2008). Significant numbers of Baby Booming Cath Lab professionals will be eligible to retire beginning 2010, increasing the numbers of Xers even more.

The third group is Generation X. These individuals were born between 1963 and 1980. This was the first generation where both parents were likely to work outside the home and many were raised as latchkey kids. Rising divorce rates resulted in 40% of Generation X children being raised in a single parent household (Strauss &Howe, 1991). As a result many Xers learned to manage at a young age, becoming adept, clever, and resourceful. Their friends became increasingly important, as well.

Their formative experiences, including exposure to massive corporate layoffs, have led them to value self-reliance and work- life balance. They are described as less loyal to the corporate culture (Karp et al.). Technology is a major part of their lives. Generation X tends not to understand why the older generations cannot readily embrace changing technology. This technogap can be a source of conflict in the Lab, with Labs becoming more reliant on sophisticated computer technology.

The last group is the Millennial generation or the Nexers. They were born between 1980 and 2000.

Strengths the Nex generation brings to the workplace comprise their techno competence, openness to expectation of virtual teams, ands collective action (Howe& Strauss, 2000; Kupperschmidt, 20001). They were raised in a time where violence, terrorism, and drugs were realities of life. This is a global generation and accepts multiculturalism as a way of life. Technology and instant communication by cellular phones have always been part of their lives. This generation has been compared to Vets in their work ethics.

Gerke (2001), and Duchsher and Cowan (2004), have stressed the importance of all staff learning about colleagues’ differences and dialoging about how generationally determined values and expectations are being played out in their organizations.
Traditional colleagues value hard work and respect authority whereas Boomers value teamwork. Generation Xers value self-reliance and Net Generation values achievement.
It is important to stress Cath Lab professionals do not have to adopt colleagues’ generational values; but they do have to recognize, allow and respect these different values.

Generational conflict is nothing new. Generational gaps have always been a part of our world, bringing with them the potential for flash points or areas of disagreement (Greene, 2005) In 1 Kings, Chapter 12, of the Holy Bible, Rehoboam, the young king of Israel, rejected the advice of his elders (men of his father’s generation) and took the advice of younger men (his generation). This generational conflict split the nation of Israel. More recently, the presidential campaign of 2008 is setting historical precedents on many levels, with generational differences not being the least of these.

One of the reasons working in a Cath Lab is challenging is because of the many varied professions that must work as a close team on a daily basis. Cross training of individuals in the Lab has helped make the workplace a more collegial and functional atmosphere. However, there has been no cross training for a multigenerational workplace. The best teams must be able to pull the strengths and contributions from individuals and their generational cohort’s skills and strengths.

Cath Lab management would do well to study and recognize generational strengths and shortcomings and use the information to properly place personnel and develop the best teams. Too ignore generational differences and place teams together solely on the basis of professional training can be a recipe for conflict the Lab as a whole may find difficult to digest. It is important that every employee is held to the same work expectations, organizational policies and procedures. However, leaders should also consider individual employee needs and generational differences.



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  • Carlson, S. (2005). The Net generation in the classroom . The Chronicle of Higher Education, pp.A34-A37.
  • Cath Lab Digest 2008
  • Gerke, M. (2001). Understanding and leading the quad matrix: Four generations in the workplace. Seminars for Nurse Managers, 9, 173-181.
  • Greene, J. (2005, March 14). What nurses want: Different generations, different expectations. Hospitals and Health Networks. Retrieved from www.hhnmag/hospitalconnect/search/article.jsp?
  • Halfer, D. (2004). Developing a multigenerational workforce. Paper presented at the annual meeting of the American Organization of Nurse Executives. Phoenix , Arizona.
  • Holy Bible, 1 Kings, Chapter 12
  • Karp, H. Fuller, C., & Sirias, D. (2002). Bridging the Boomer Xer Gap.Palo Alto: Davies-Black.
  • Lancaster, L. & Stillman, D. (2002). When generations collide. New York: HarperCollins.
  • Sherman, R. O. (2005). Growing our future nurse leaders. Nursing Administration Quarterly, 25(2), 125-132.
  • Strauss, W., & Howe, N. (1991). Generations. New York: Quill William Morrow.
  • Thrall, T. H. (2005). Retirement boom? Hospitals and Health Networks, 79(11), 30-38.
  • Ulrich, B. T. (2001). Sucessfully managing a multigenerational workforce. Seminars for Nurse Managers, 9(3), 147-153.



Yvonne B. Singletary
St. Luke’s Episcopal Hospital
Houston, TX

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