About one-third of U.S. workers are 50 years of age or older, according to the U.S. Census Bureau. Within a couple of years, about half of all registered nurses will reach the traditional retirement age.1 ASCs need these older employees, but ASCs also need younger workers in the staffing pipeline. Balancing both needs can be challenging because of societal differences in a multigenerational workforce, says Cindy Young, BSN, RN, CASC, administrative director at Surgery Center of Farmington in Farmington, MO.

“In our surgery center, we don’t have much turnover,” Young says. “A lot of people have been here for many, many years, and we’re aging.”

When an employee retires or moves, the ASC usually will replace the person with a millennial.

“The millennials are very eager to get in there; they want to take charge, and they want to make a difference,” Young says. “Sometimes, the older generation has difficulty with, ‘I’ve been here. I’ve got the experience. You’re new.’”

Directors have to reassure older, much more experienced workers that their expertise and work history matter when it comes to scheduling, responsibility, and pay. But, simultaneously, everyone has to acknowledge the younger workers’ need for relevance — making a difference and taking on responsibilities that matter.

“I feel like a lot of millennials, and I have a daughter in that generation, are kind of a take-charge generation that feels like they should come in and have a good position,” Young says. “They want to be at the top of the ladder.”

But in Young’s own generation, the belief is that they started at the bottom and worked their way up, so the younger employees should do the same. Millennials disagree.

“Millennials want to be at the top quickly,” Young says. “They’re the instant generation — instant fast food, instant internet, and they struggle when you hold them back.”

From a managerial perspective, there must be a balance between encouraging them, giving praise, and finding work roles that are important to them and useful to the surgery center.

Baby boomers and Generation X are accustomed to the workplace management style of “If I don’t acknowledge you, then that means you’re doing good.” For millennials, there must be more attention and recognition. A little praise can go a long way, Young says. “If you don’t say anything to them, they think they did something wrong.”

Another issue involves training millennials. Managers should be clear with older, more experienced staff that training younger workers is not a sign managers are phasing out older workers.

“It’s a touchy subject,” Young notes. “The older generation came from a belief that ‘If somebody learns my job, they’re going to replace me.’”

Make it clear to existing staff that they’re doing a good job with the training and that the purpose of bringing on new, younger workers is to give other employees more flexibility in their time off and to prepare for the time when older workers decide to cut back on hours or retire, Young suggests.

“Focus on the positives that as long as we train new workers to do the same jobs, then long-time staff will be able to take time to do more things they love,” Young says.

Despite the prevailing belief that millennials will switch jobs more readily than baby boomers and Generation Xers, this isn’t necessarily true.

“We have one millennial who has been here eight years,” Young says. “You have to support them, and as long as you make them feel important and give them responsibilities, they’re more apt to stay.”

Another way to attract and retain millennials is to offer them work-life balance.

“I think it’s generational, and I talk with other millennials — and even my daughter is the same way,” she notes. “They only want to work a certain amount of time. They want more time to spend with their children and less time to work.”

Surgery Center of Farmington employees can earn benefits, starting at 32 hours per week. So, a four-day work week is popular with some younger staff. Building staff camaraderie is an important strategy for maintaining morale, particularly when the workforce is multigenerational. For instance, the Surgery Center of Farmington arranges staff activities outside the surgery center, which included gathering staff to attend a baseball game. Another was a holiday party. There also are potlucks and a Thanksgiving dinner at the center.

“Sometimes, staff will arrange outings among themselves, like they might go shopping one Saturday,” Young says. “They want this center to be more of a family than a job, and whenever you can mingle a family in there, then coming to a mundane job every day is not as stressful.”

Other morale-building ideas are to engage staff in team-building activities and to give each employee a one-on-one lunch with the manager on their birthdays. “We have an hour for lunch and talk about their life and home,” Young says.

Areas that can cause morale trouble involve starting salary, raises, and annual reviews. For example, potential new hires often say that their previous salary was greater than what the new job will offer, and so they expect to receive that higher amount.

“I say, ‘I’m sorry, but this is our wage scale, and if I hire you at that rate, then it will be unfair to others, and I can’t do that,’” Young says. “I’ve had people turn down the job because of the wage, but I’m fair to the employees I have, and I won’t hire someone from outside the company for more than what someone inside the company is making.”

In some instances, the potential employee will agree to the lower wage because they want a different work environment, she says.

Working in an ASC can be a challenge for new employees of any generation because of its fast pace, Young says.

“We’ve had a couple of employees over 17 years who couldn’t keep up with the pace and ended up leaving,” she explains. “The surgery center environment is not for everyone.”


1. Harrington L, Heidkamp M. The aging workforce: Challenges for the health care industry workforce. Issue Brief of the National Technical Assistance and Research Center, March 2013. Available at: http://bit.ly/2hs1n9M. Accessed Nov. 20, 2017.