Running head: THE AGING NURSE WORKFORCE 1

The Aging Nurse Workforce: Is the Cause the Solution?

Anita L. Riddle

Ferris State University

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AbstractAmerica is aging as a nation. Who is going to provide healthcare services to this aging population, when those providing healthcare services are aging themselves? The nursing shortage is a reality, and is expected to increase over the next decade. “Between 2001 and 2008, the number of nurses employed full time in the United States increased by 476,000, of these 368,000, (77%) were ages 50 or older” (McIntosh, Palumbo, & Rambur, 2010, p. 56). This scenario represents the impending reality of the aging caring for the aging. “Before the current recession, forecasters predicted that, given the imminent retirement of the largest cohort of practicing nurses (the Baby Boomers), only 64% of projected demand would be met by 2020” (McIntosh, Palumbo, & Rambur, 2010, p. 58). This paper will address concerns being raised by the nursing profession related to the nursing shortage and the aging nurse workforce. The aging nurse workforce will be examined as a contributing factor and a possible solution. Written by an aging registered nurse (RN), who falls into the category of a Baby Boomer, the effects and recommendations for the retention of the aging nurse will be discussed as a logical short term solution.

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The Aging Nurse Workforce: Is the Cause the Solution?The first Baby Boomers are turning 65 this year. “By the year 2050, the portion of

individuals 60 years and older is expected to double, and this group will account for 21% of the total global population” (Keller, & Burns, 2010, p. 437). What does this mean to the healthcare profession and the healthcare consumer? The United States is entering a time period that will face multiple challenges in providing adequate experienced nurses, to provide quality health care, to an aging population. This scenario is not limited to just the United States. “Australia, Canada, the United Kingdom and the United States report the median age of nurses as mid-to-late 40’s; with only 10% or less under the age of 30 and 30-40% aged over 50” (Fitzgerald, 2007, p. 237). “In many countries, this was the first generation of nurses who established discrete advanced nursing roles, the first doctoral programs in nursing, who led the development of programs of nursing research, and pioneered the notion of evidence base for nursing” (Jackson, 2008, p. 2950). In order to resolve the impending shortage of nurses, the healthcare industry needs to take action now.

In 2008, there were 2.54 million nursing jobs in the U.S., making nursing the largest U.S. profession in healthcare (Keller, & Burns, 2010). Not only is the nursing workforce aging, “there is a declining pool of younger persons available to draw from in an economy that has a growing need for employees (due to the declining national birth rate)” (Keller, & Burns, 2010, p. 437). Nursing candidates applying to nursing programs are in their late twenties and early thirties, many pursuing a change of career (Fitzgerald, 2007, p. 238). “It is imperative that older nurses be retained, if not only for their experience and expertise, but to prevent worsening an already critical nursing shortage” (Keller, & Burns, 2010, p. 439). In order to address the impending nursing shortage, and aging nurse workforce needs, the current workforce, and their employers, will need to examine existing professional practices, job satisfaction, and solutions for nurse retention. The nursing workforce of the future will be multi-generational, with middle aged and elderly workers far outnumbering the younger workforce (Keller, & Burns, 2010). Although the aging nurse population is considered a prime contributor to the nursing shortage, the older nurse may be a short term solution for the future of health care.

What is Aging?Aging is a normal process that each living species progresses through. There is no

proven way to stop this process, only interventions to manage or enhance it. Aging has many different definitions and is individual in nature. There are both negative and positive aspects to the aging process. “All individuals age chronologically at the same speed, but the ways in which individuals age depend on genetics, lifestyle choices, health habits, illnesses, and home and work environments” (Keller, & Burns, 2010, p. 438). To some degree, each person can chart their aging course.

Aging affects the body physically, mentally and spiritually. The physical effects are the most obvious, such as wrinkles and weight gain. “Other physiological changes frequently seen with aging include, decreased stamina, impaired immunological factors, muscle wasting and decreased visual and hearing acuity” (Keller, & Burns, 2010, p. 438). Studies related to the mental changes of aging, have concluded the older worker maintains psychological and intellectual skills, and may even improve (Keller, & Burns, 2010). In the nursing profession critical thinking skills are not optional; they are required for every patient encounter. These

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aging characteristics, along with life and work experiences, support the older worker as a valuable member of the workforce.

Demands of the Aging NurseThe nursing profession is both physically, mentally and emotionally demanding for

nurses of all ages. “Nurses are often encouraged to work long shifts, (typically 12 hours), associated with more stress, higher work dissatisfaction, and decreased work quality” (Keller, & Burns, 2010, p. 439). “[T]here is an almost perfect correlation between sick time and overtime” (O’brien-Pallas, Duffield, & Alknis, 2004, p. 298). The physical demands alone put the nurse at risk for injury and chronic illness. Older nurses are prime candidates for musculoskeletal injuries. “Aging decreases the speed of the circadian adaption to night shift work, increasing the risk of sleep disorders and negative health effects, and can even threaten safety in work environments designed for younger employees” ( Keller, & Burns, 2010, p. 438).

Older nurses currently practicing, provide not only a wealth of knowledge, but a short term solution to the impending nurse shortage. Aging along with the general population, this group of nurses represent “the almost one million U.S. nurses over the age of 50 years who are approaching retirement age or have already turned 65” (Wieck, Dols, & Landrum, 2010, p. 8). If this trend continues, the average retirement age of nurses will become the new average age of the nursing workforce (McIntosh, Palumbo, & Rambur, 2010).

BarriersCurrently, the nursing workforce is predominantly a white (aging) female profession.

African Americans and Asians are represented in the nursing profession equally to their proportion in the overall workforce (Buerhaus, Auerbach, & Staiger, 2009). “The stigma of nursing as a traditionally female-dominated profession is believed to be one of the major factors discouraging men from becoming nurses” (Buerhaus, Auerbach, & Staiger, 2009, p. 666). The lack of role models for men and Hispanics may also be a barrier, while financial and education factors may further deter Hispanics. They represent an untapped source, as the nursing profession is only 9% men and 5% Hispanic. “However if these barrier could be removed, then it is not unreasonable to expect that men and Hispanics could add enough new RN’s into the workforce to avoid the projected deficit through 2025” (Buerhaus, Auerbach, & Staiger, 2009, p. 666).

Job Satisfaction Over the past few years nurse satisfaction has become a key issue to the nursing and

healthcare profession (Wieck, Dols, & Landrum, 2010). There is currently a decrease in job satisfaction, related to “long hours and physical demands” that nurses of all ages are expected to adhere to (Wieck, Dols, & Landrum, 2010, p. 7). Physically, the older nurse is very susceptible to “musculoskeletal injuries, which may be cumulative overtime exacerbating other physical dimensions of nurses’ aging bodies”, thus decreasing job satisfaction (Fitzgerald, 2007, p. 239). Many hospitals have made ergonomic changes to accommodate these physical needs and decrease the risk of injury. McIntosh (2010), suggests the use of the Older Worker Lure Scale (see Appendix A), to assess an organization’s capability to attract and retain the older nurse.

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Mental and emotional stressors are also contributing factors that lead to dissatisfaction in the nursing profession. The nursing profession is fast paced (especially the acute care setting), leading to “feelings of guilt, frustration and fear of making an error” in the older nurse. (Fitzgerald, 2007, p. 239). “These factors often encourage nurses, especially the older ones, to seek positions in other delivery settings where demands are less intense, or exit the profession” (Fitzgerald, 2007, p. 239). Another emotional challenge is dealing with death and dying. As a nurse ages, they are also expected to manage these issues for immediate family and friends, outside of their professional career responsibilities. Ethical issues also present added stressors.

“A unique challenge in today’s work environment is the fact that work ethics and values of the emerging workforce vary greatly from those of their Baby Boomer parents” (Wiek, Dols, & Landrum, 2010, p. 8). Baby Boomers are a very devoted group of workers. They are loyal to their employers and value their work, as generation Xers view their employment as a job, and strive to achieve balance between work, and leisure (Apostolidis, & Polifroni, 2006). It is important to recognize the needs of each generation in order to provide job satisfaction and retain nurses. By achieving job satisfaction, productivity and quality of care will increase, thus increasing patient satisfaction. Job satisfaction will lead to nurse retention.

Retention of the Older NurseNurse retention is one source of providing the aging population with quality healthcare.

It will take time and research to determine the best plan to meet the needs of the older nurse. Many retention strategies have focused on the needs of the more junior members of the workforce. Offering scholarships for additional education or child care facilities may not be as much of an incentive for nurses age 50+ years as would an additional week of leave for every 5 years of additional service, or membership to a gym or a half day golfing expedition regularly, or leave to care for elderly parents. (O’Brien-Pallas, Duffield, & Alksnis, 2004, pp. 301-302)

It is estimated that the cost of replacing one medical-surgical nurse is 92,422 dollars (Fitzgerald, 2007, p. 240). With this in mind, the healthcare industry needs to assess the needs of the aging nurse in order to retain them in the workforce. “Changes that organizations are likely to make include building more age-diverse cultures, offering more training in intergenerational relationships, rethinking the way work is structured, paying increasing attention to ergonomics and to job reengineering, and further developing employee assistance programs” (McIntosh, Palumbo, & Rambur, 2010, p. 56). In addition, the pay scale needs to reflect the vast knowledge the experienced nurse possesses. Flexible scheduling and creative use of Paid Time Off is currently being researched as contributing factors to retention.

RetirementNurses choose retirement for various reasons. “A large percentage of nurses, who are

aging, plan to retire themselves within the next 10-15 years” (Fitzgerald, 2007, p. 237). With 30-40% of a 2.54 million nurse workforce, currently over the age of 50, this mass exodus will be devastating. This will place an already struggling healthcare system in crisis. “[T]he magnitude of the 2025 deficit (Appendix B), would still be more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960’s” (Buerhaus, Auerbach, & Staiger, 2009, p. 664).

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The National Healthcare Plan is in the first stage of implementation, it is uncertain the full impact it will have on the nursing profession. “An adequate supply of nurses will be necessary for reform that emphasizes the expansion of health insurance coverage while improving the quality, safety, and efficiency of care” (Buerhaus, Auerbach, & Staiger, p 667). The National Healthcare Plan is attempting to shift healthcare from the acute care setting to a community setting. This shift may allow the older nurses to leave the acute care setting (bedside care), and enter the community setting which is less stressful and physically demanding, delaying the need for retirement.

There may be implications to the quality of healthcare if the aging nurse does not choose to retire. As in any career or workforce, not all employees are suited to work past the age of retirement. Some are not even suited to work to the age of retirement, due to health, family, or personal issues. However, there is a need to encourage every capable nurse to remain active in the nursing profession in some capacity. “Aging, experienced nurses represent the present and future of nursing and their valuable experiential knowledge is necessary for providing optimal healthcare services” (Fitzgerald, 2007, p. 241).

ConclusionThe U.S. and the world are currently facing the reality of an aging population. “The

nursing workforce mirrors the trend in population; that is, it is aging” (Fitzgerald, 2007, p. 237). The demand for nurses is increasing while the supply is diminishing. “Factors that contribute to older nurses continuing to work after retirement age 65, changes in employer provided pension plans, lack of retirement benefits, an unstable economy, and financial insecurity” (Keller, & Burns, 2010, p. 434). However, a careful screening of abilities and needs, is crucial to assure the nurses staying in the profession are providing the quality of care today’s healthcare consumer expects.

Retention of the aging nurse is a vital step in providing quality healthcare, to both the young and the elderly generations. “As a very experienced generation withdraws from the workforce and enters retirement, there is a potential for a lack of depth of experience, and knowledge at the bedside, in the classroom and in managerial positions” (Jackson, 2008, p. 2949). Now is the time for the health care system and policy makers to stand up and take notice. A long term solution needs to be implemented now, as it will take a decade to rectify.

As an aging registered nurse, my contribution to this dilemma will be finishing my Master’s degree and entering the teaching profession. “The nursing profession has an obligation to older nurses who have spent their careers caring for others; it is now time to care for the older nurses” (Keller, & Burns, 2010, p. 434). “Finally, if these projected shortages develop (which, of course, depends on how much future demand increases), then they will fall upon a much older RN workforce than did shortages that occurred in prior decades” (Buerhaus, Auerbach, & Staiger, 2009, p. 664).

References

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Apostolidis, B. & Polifroni, E. (2006). Nurse work satisfaction and generational differences.

Journal of Nursing Administration, 36(11), 506-509.

Buerhays, P., Auerbach, D., & Staiger, D. (2009). The recent surge in nurse employment: Causes

and implications. Nurse Employment, 28(4), 657-668).

Fitzgerald, D. (2007- April). Aging, experienced nurses: Their value and needs. Contemporary

Nurse, 24(2), 237-243.

Jackson, D. (2008). Editorial: The aging nursing workforce: How can we avoid a retirement

brain drain? Journal of Clinical Nursing, 17, 2949-2950.

doi: 10.111/j.1365-2702.2008.02414.x

Keller, S., & Burns, C. (2010). The aging nurse: Can employers accommodate age-related

changes? American Association of Occupational Health Nurses, Inc., 58(10), 437-444.

McIntosh, B., Palumbo, M., & Rambur, B. (2010-December). An aging nursing workforce

necessitates change. American Journal of Nursing, 110(2), 56-58.

Novak, M. (2009). Issues in aging (2nd ed.). Boston, MA: Pearson Education, Inc.

O’Brien-Pallas, L., Duffield, C., & Alksnis, C. (2004). Who will be there to nurse? Journal of

Nursing Administration, 36(6), 298-302.

Wieck, K., Dols, J., & Landrum P. (2010, January-March). Retention priorities for the

intergenerational nurse workforce. Nursing Forum, 45(1), 7-17.

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Appendix A

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Appendix B

(Buerhaus, Auerbach, & Staiger, 2009, p. 663).