Bryant-Hampton, Linda MSN, RN, CPN; Walton, Ann Marie MPH, RN, OCN, CHES; Carroll, Tracy BSN, RN, PCCN; Strickler, Laura BSN, RN, BC
Authors' Affiliation: Clinical Nurse Education Specialist, Children's Services (Ms Bryant-Hampton), Clinical Nurse IV, Oncology Services (Ms Walton), Clinical Nurse IV, Center for Heart & Vascular Care (Ms Carroll), and Clinical Nurse III, Psychiatry (Ms Strickler), University of North Carolina Health Care, Chapel Hill.
Corresponding author: Ms Bryant-Hampton, University of North Carolina Health Care, 101 Manning Dr, Chapel Hill, NC 27514 (firstname.lastname@example.org).
Baby boomers currently make up 53% of the American workforce.1 Many have retired or are contemplating retirement, and this shift out of active employment is projected to continue for the next 15 years. This creates an area of concern for healthcare, as substantial numbers of the active nursing workforce are part of this generation. Although the current financial crisis may have forced some nurses to forego retirement plans, when this crisis ends, we could be faced with a mass exodus of nurses creating a nursing shortage to which previous shortages pale in comparison.
The average age of the working RN is 43.5 years.2 Data from the Nurses Sample Survey in March 2004 estimate that 41% of RNs are 50 years or older.3 Whereas the mature nurse is more likely to be employed in an outpatient setting, the average age of RNs working in a hospital setting is 43.4 years.3 At our organization, which includes both inpatient and outpatient services, approximately 45% of the nurses employed are 45 years or older, considered mature nurses.
Although there has been an increase in the number of second-career nurses entering the workforce at a later age, most mature nurses entered nursing in their 20s and are the most experienced and knowledgeable staff. The age an RN leaves the nursing workforce varies considerably, but the largest exodus occurs in those aged 62 to 65 years.4 However, at our organization, the average retirement age is 57 years, resulting in a potential loss of 5 to 8 additional years of valuable service.
Benefits of Retaining the Mature Nurse
Competition between healthcare organizations has never been more intense. Often, it is the quality of care provided that sets an organization apart from others. In the literature, mature, more experienced nurses have been associated with improved patient outcomes.5
Although there are financial costs associated with retaining mature nurses, the advantages of preserving the knowledge and experience of these nurses justify the expense. Their clinical expertise and organizational knowledge are invaluable to their patients, to their colleagues, and to the intellectual capital of the organization. These nursing professionals perpetuate excellence by mentoring less experienced staff. Given the extensive nursing shortage on the horizon, it is more important than ever to consider retention strategies for the mature nurse. Retention of the mature nurse could minimize the scope of this crisis. By postponing retirement, nurses contribute to the skill level, knowledge base, and size of the workforce.
The Senior and Generational Excellence Initiative
The Nursing Professional Development Council, one of five shared governance councils in our organization's Department of Nursing, identified the need to promote the recruitment and retention of experienced professional nurses. Given that our hospital employs more than 900 nurses aged 45 years and older (mature nurses), retaining this group is critical to the provision of quality care. To address retention of mature nurses, the Council created the Senior and Generational Excellence (S.A.G.E.) initiative in 2008. Shortly after this, we were given the opportunity to participate in the Mature Nurse Retention Survey (MNRS). This was a multisite survey developed to assess workforce issues among expert professional nurses older than 45 years. The survey was an initiative of our state's professional nursing association with grant funding from the Center for American Nurses. At our organization, the survey was administered by the Professional Development Council and Nursing Research Council. We felt it would help to identify strategies to recruit and retain mature nurses.
After obtaining institutional review board approval, the survey was made available for two weeks via the hospital intranet. All RNs and LPNs 45 years and older were invited to participate. Responses were voluntary and anonymous. Over the two-week period, the survey was advertised on video communication boards, via e-mail, and verbally by council members. This multipronged approach resulted in a response rate of approximately 45%.
Analysis of the data identified recognition of longer-service employees as having a high impact on retention of the mature nurse. This finding correlates with studies on the general baby-boomer generation that show that recognition is highly valued.6 At all seven hospitals participating in the MNRS, more than 50% of the respondents believed that this recognition influenced whether a nurse would stay with his/her current employer. At our organization, recognition was a stronger predictor of whether a nurse would stay than either salary or benefits. Twenty-three percent of respondents identified recognition as a reason to stay, whereas 18% and 12% identified, respectively, salary and benefits.
When looking at the overall results of the MNRS survey, two categories of retention strategies emerged-those requiring little or no financial support and those requiring substantial financial commitment. The first category can be initiated with current resources such as personal recognition and flexible scheduling. However, the second category, which includes phased retirement, enhanced benefit programs, support for continuing education,larger computer monitors with the capability to enlarge the font and choose colors that are easier to read, and improved unit design, requires a greater degree of organizational change and financial commitment.
The S.A.G.E. Initiative to Date
The S.A.G.E. initiative brings attention to the unique skill and needs of our mature nurses by identifying strategies to recruit and retain experienced professional nurses. We are striving to build an attractive future for our nurses as we create a S.A.G.E.-friendly environment. This concept, relatively new to our organization, is moving forward. The Nursing Professional Development Council determined it to be imperative to follow up this survey with actions that showed commitment to the project. First, it was important to share the survey results as a way of recognizing the participants' willingness to participate. The council, in partnership with the principal investigator of the MNRS multisite survey, Sue Letvak, PhD, RN, and the organization's nursing research consultant, Gregory Bechtel, PhD, RN, analyzed the results of the survey data and held a "lunch and learn" to present the findings. More than 50 nurses attended. Attendees responded with interest, but not surprise, in the fact that recognition emerged as a retention strategy with high impact. At our organization's 2009 Nursing Staff Recognition Week Celebration in May, a breakfast to recognize and celebrate "the commitment, knowledge, and expertise of S.A.G.E. nurses" was held. At the breakfast, attendees received packets of sage seeds and a note thanking them for their commitment to the organization. The language was carefully chosen to reflect senior leadership's appreciation and recognition of the contributions of S.A.G.E. nurses.
The impact of the recognition event was very gratifying. One nurse said, "The breakfast demonstrated that our employer values its mature workforce and recognizes their contributions. Designating a special event with an opportunity for refreshments and conversation with nurses from many generations was a plus." Another said, "Your committee did this event up right! The food was good; there was great interaction, and the thank-you card was thoughtfully worded. Oh, how us baby boomers love attention to details!" A third added, "I left the celebration feeling proud to be a nurse and happy to be recognized for my experience and service."
Another form of recognition, the Celebrating Commitment Posters, has been in place for several years. On each poster, a mature nurse is highlighted for his/her commitment to the organization. The nurse is selected by the Nursing Retention Committee, and a poster is made that includes the nurse's photograph, work location, length of commitment to the institution, and a pearl of wisdom about why they continue to stay at the organization. These are posted on units and in general public areas across organization for all to see.
In 2008, the Nursing Professional Development Council sponsored the First Annual Aspiring Nurse Leaders' Week to recognize and honor staff nurses from each nursing service who demonstrate leadership qualities through initiatives that improve patient care or the workplace environment. Beginning in 2009, there will be a category for a S.A.G.E. nurse who is not aspiring but "inspiring." It is an opportunity to recognize a S.A.G.E. nurse who has mentored an aspiring nurse leader. Future brainstorming sessions are also planned to solicit the ideas of S.A.G.E. nurses regarding recognition strategies that could be implemented using current resources.
Recognition is one of the easiest and most cost-effective strategies that can be used to retain experienced mature nursing staff. The S.A.G.E. project has raised the awareness of this issue, and feedback, so far, has been positive. To comprehensively address the issue of retention of mature nurses, healthcare organizations will need to implement long-term planning strategies. Information gained by this survey and the continued evaluation of the S.A.G.E. initiative, along with creativity, flexibility, and commitment of resources, will be required to enhance retention.
The authors thank Susan Letvak, PhD, RN, and Dennis Sherrod, EdD, RN, for developing the survey instrument and providing support for this study. The authors also thank Marilyn Morales, MSN, RN-BC, FNP-BC, Sue Lannon, MA, RN-BC, and Jeff Strickler, MA, RN, for their assistance with the preparation of the article.
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