Keele, Shanna MSN, FNP-BC; Alpert, Patricia T. DrPH, MSN, FNP-BC, PNP-BC, CNE, FAANP
Data indicate nurses 45 years or older constitute one-third of the current RN workforce,1 with an average age of 46.8 years.2 Evidence suggests that many RNs have not properly prepared for retirement,2,3 a challenge compounded by the housing bubble and stock market plunge starting in 2007.4 As a result, economists5 estimated that the net wealth of the baby boom generation fell 45% to 50% in 2009. To avoid a shortfall of retirement income, RNs close to retirement may have prolonged their work life3 and slowed retirement planning and thus levels of savings.1,3 The purpose of this integrative literature review was to examine the current research regarding RN retirement. The review aims are to increase knowledge and understanding of existing RN retirement preparation and identify knowledge deficits for future research.
Aims and Methods
An integrative literature review is a detailed method of research analysis summarizing previous inquiries on specific issues.6 To identify applicable literature regarding RN retirement, the following databases were accessed: Academic Search Premier, CINAHL, Psychological Information Database, PubMed, and MEDLINE. Search terms included RN retirement, RN retention, nurse retirement, nurse retention, RN workforce retention, and RN retirement planning. Additional approaches included journal hand searching, networking with retirement planners (ie, Fidelity Investments), and investigation of previous doctoral dissertations.6
Each study was systematically evaluated in ascending chronological order for research question or purpose statement, study design, review of literature, variables, sample size, study measures, limitations, and results to ensure methodological rigor.6 Major themes and conclusions were identified for each article. A total of 145 articles were initially identified. After inclusion and exclusion criteria were applied, 17 articles were included in the review. Of these, 7 were qualitative studies, and 10 were quantitative studies.
Each qualifying article was evaluated on methodological features based on criteria outlined by Alvarenga.7 These criteria demonstrate both face and content validity. Quantitative studies were evaluated on 18 criteria (See Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A258) and qualitative studies on 14 criteria (See Document, Supplemental Digital Content 2, http://links.lww.com/JONA/A259). Scored points were then summed for a grand total between 1 and 18 points. Quantitative articles with 14 to 18 points and qualitative articles with 11 to 14 points were scored as a grade 3 (high quality [n = 7]). Quantitative articles with 9 to 13 points and qualitative articles with 7 to 10 points were scored as a grade 2 (medium quality [n = 9]). Finally, quantitative articles with 1 to 8 points and qualitative articles with 1 to 6 points were scored as a grade 1 (poor quality [n = 1]).
There were more than 34,319 RN participants (of which 129 were nurse educators) in the studies that were included. One study did not list a grand total from which to calculate actual participant numbers but did list a percentage (40%). Another study listed only the facilities that responded with 42 hospitals, 63 nursing homes, and 1 facility that was quantified as both a hospital and a nursing home, but did not specify who was actually participating in the study (eg, administrators, staff RNs, etc). Six of the evaluated studies reported race, 8 studies reported gender, 7 studies reported marital status, 4 studies reported income, and 8 reported attained education level. Sampling methods included surveys (n = 6), questionnaires (n = 4), focus groups (n = 2), and interviews (n = 3) or a combination of methods.
Literature published from 1995 to 2012 was included. The search was restricted to studies from peer-reviewed journals in English. Studies were included if they provided relevant, timely information on RN retirement in the United States. Both theoretical and empirical sources were reviewed to improve understanding of RN retirement; however, only published studies were included in the written literature review. Only literature focused on RN retirement in the United States was included. Unpublished works (ie, dissertations and abstracts) were excluded. This review was conducted under the theoretical framework outlined by Whittemore and Knafl6 with stages including problem identification, literature search, data appraisal, examination, and presentation for consideration.
RN Retirement and Financial Planning
As nurses age, retirement benefit education programs are 1 approach to RN preparation for financial independence during retirement.1 Helman et al4 reported that of those old enough to retire who continue to work, 90% identify at least 1 financial reason for working, including a decrease in investments or needing money to meet expenses. Nurses often face financial challenges because of delayed or inadequate retirement savings.8 It is reported that less than half of the working women in the United States participate in pension plans.9 In addition, women live an average of 4 years longer than do males, invest more conservatively, and receive lower rates of return from their investments over time,9 all factors that negatively impact retirement funds. Data reveal that for every 10 years a person delays saving for retirement, they will need to save 3 times as much to catch up.9 Companies employing nurses working beyond traditional retirement age may continue to benefit from skilled expertise by incentivizing RNs to remain employed in their organizations rather than finding alternative employment elsewhere; however, more needs to be known to address whether financial benefits and education should be components of a successful retention strategy.
Data from the included studies were organized, categorized, and summarized. A review of the selected studies offered the following taxonomy for coding: retirement preparation, preretirement planning, retention of mature RNs, and retention policies (Table 1).
Moore and Biordi10 reported that participants heavily relied on Social Security (SS) benefits. This finding is of concern as SS income is directly dependent on lifelong income and number of years worked. Nurses often participate sporadically in the workforce and vary between full-time and part-time status, which directly impacts the SS benefits level and vesting. Also, compared with recent 2012 US statistics, 60% of workers report the total value of savings and investments (excluding home values and defined benefit plans) to be less than $25,000.3
Kowalski et al11 conducted a cross-sectional study of nurse educators from 91 US schools of nursing. Of the 129 participants, 33 strongly agreed they were financially secure, 17 strongly agreed they had sufficient funds from retirement plans, and 26 strongly disagreed they had other sources for retirement income.
Klug12 investigated barriers mature RNs face and retention strategies that could aid in retaining mature RNs. Respondents’ top priorities included flexible scheduling and role modification.
Valencia and Raingruber2 investigated motivators for experienced RNs to continue working or consider retirement. The RNs were divided into 2 groups: 31 to 49 years and 50 to 65 years of age. Both groups felt apprehensive they would not accumulate enough money and health benefits for retirement. Both younger and mature nurses were paying debts, while planning and trying to save for retirement. This was the only study that identified uncertain economic times as an influencing factor on RN retirement decisions.
These studies suggest a pervasive lack of RN retirement preparation. Common themes in RN retirement studies include a lack of retirement savings2,10 and decreased retirement fund status.11,12 Only 1 study identified RN retirement in conjunction with recent economic events.2
Wiggins and Henderson13 found RNs to have limited methods for retirement planning. Findings indicated RNs between the ages of 40 and 50 years felt it was too early to begin retirement planning. Participants who were closer to retirement were found to have more positive attitudes about retirement and were more actively engaged in financial planning. In addition, knowledge of economic issues differentiated those who had planned for retirement from those who had not. Interestingly, the majority of participants were not seeking help in retirement planning.
Kelly and Swisher identified family responsibilities, finances, access to health insurance, spouse’s employment status, job satisfaction, and health status as factors impacting retirement.14 Furthermore, early retirement as part of incentive packages resulted in less time to prepare for retirement. Some participants expressed distressing emotional and physical reactions when they lost control over the decision to retire.
Rosenfeld15 conducted a study of RNs who were also family caregivers to investigate whether the caregiving experience impacted the RNs’ plans for retirement. Participants’ average age was 50 years, with many reporting flexible work schedules. Findings indicated monetary incentives were not consistently attractive to mature (>50 years) RNs. This research suggested many organizations provide retirement services, but the locations of these services may be inconvenient or unknown to RNs.
These studies14,15 suggest a lack of preretirement planning among RNs as supported by Wiggins and Henderson.13 This phenomenon is not unique to nurses as national statistics reveal US workers are unaware how much they need to save for retirement, with 56% reporting they and their spouse have not tried to calculate how much money they will require for retirement.4
Retention of Mature RNs
Jevitt and Beckstead16 identified that recruitment and retention measures were needed. Current workforce challenges included changing work patterns. Four respondents in this study indicated they would never retire.16 The results underscore the complex responsibilities of children and elderly relatives for women and highlight the impact of these responsibilities in nursing, a predominantly female profession.
Cyr17 studied factors influencing retirement for hospital-based nurses examining RN retirement decisions in relation to 5 proposed changes to the work environment: reduction of hours, seasonal employment, ergonomic devices, miscellaneous incentives, and less work for less pay (a postretirement work program option). Of the factors affecting early retirement, financial independence was identified most frequently with financial incentives cited as a positive factor in choosing to work after retirement age. Work intensity was noted to be an influence in retention. A spouse’s early retirement was rated less often by respondents as a reason for early retirement, a finding that was inconsistent with previous research findings.18,19
In a facility where RNs received public employee benefits including pensions, Mion et al20 investigated nurses’ perceptions and thoughts on the work environment and retirement. Initiatives arising from the research included new roles for RNs, such as discharge experts, intake experts, elder life program (where mature RNs train volunteers on caring for older hospitalized adults), and education experts. Other retention strategies included improved communication between RNs and administration, expanded roles for mature RNs, ergonomic strategies, benefits, and education.
Nooney et al21 investigated attrition of the RN workforce and found very little retirement attrition (<51 years). However, in the early 60s, more attrition occurred, indicating SS benefit eligibility may be a major factor in the retirement decision. The researchers recommended a prospective, longitudinal study to increase the accuracy of professional attrition rate estimates at each life stage.
Friedrich et al22 evaluated factors contributing to RN continued practice after age of 62 years. Four major themes emerged from the study including preexisting ideas and attitudes (eg, a love of nursing, experience, and appreciation for learning); retention factors (eg, flexible scheduling); needs (eg, finances, cognitive stimulation, camaraderie); and unique contributions (eg, sharing expertise). With regard to finances, participants noted money may not be the major reason for working, but concluded it was necessary to maintain current lifestyle and health insurance and to keep up with the increased cost of living. Researchers suggested retention strategies for mature RNs to include flexible work options, mentoring, workplace ergonomics, education, increased 401(k) or 403(b) contributions, pension modification, retirement planning, and phased retirement.
Several strategies for RN retention are mentioned in these studies, including retirement benefits,20,22 suggesting administrators should consider current literature when constructing employee benefit packages. A recurring theme in the literature is the impact of family responsibility on women in the workforce16,17,21 and the subsequent financial consequences of interrupted workforce participation. These findings support the US Department of Labor findings regarding women and retirement.9
Letvak23 indicated a sizeable percentage of employed RNs to be age 55 years or older, with the majority of administrators wishing to retain mature RNs. Only 6% of facilities had special policies addressing the mature RN needs, and 87% of facilities had no forthcoming plans to implement retention programs but were concerned about the nursing shortage. Of facilities with mature RN retention plans, such programs included benefit packages geared toward mature RNs, reduced or part-time hours, flexible shifts, and retirement benefits. In a study utilizing similar methods to Letvak’s,23 McHaney and Varner24 discovered only 3.7% of surveyed facilities had retention policies, and 77.8% of facilities had no immediate plans to implement retention programs.
Norman et al25 analyzed national data, of which one-third of participants were older RNs (aged ≥50 years) who reported fewer earnings than did younger RNs. One-third of older RNs planned to leave their current position in the next 3 years, and to retain these nurses, economic incentives including enriching retirement benefits, tax-based incentives for employers of older RNs, and new salary structures are needed.
Spetz and Adams26 identified 8 types of paid benefits: paid leave, health insurance, retirement benefits, work-shift scheduling, educational benefits, child care, other health benefits (eg, health club or wellness programs), and other benefits (eg, life insurance, care for dependent elders, ergonomic interventions). The researchers recommended administrators review benefit packages to ensure RNs are receiving wanted and needed benefits as a means of RN retention, pointing out there is no-one-size-fits-all benefit package. Although fringe benefits play a role in retention, factors such as good work environments cannot be overlooked in retaining experienced RNs.
Palumbo et al27 examined RN perceptions of workplace culture, intent to remain in the employed position, and human resource practices/policies. The human resource policies affecting their decision to remain employed included recognition/respect, having a voice, and feedback about work performance. Participants noted the importance of retirement options, and recruitment of older nurses was least important. The researchers suggested staffing, education, work design, feedback, compensation, and respect are included to improve recruitment and retention of mature RNs.
Researchers have clearly demonstrated the majority of investigated facilities do not offer mature RN retention programs despite significant concerns regarding the RN shortage.23,24,27 It is unclear why little is being done to retain mature RNs despite significant concerns about their approaching age of retirement.23 In addition, there does not appear to be a standard benefit package that meets the needs of both younger and mature RNs.26
Strengths and Limitations
This integrative literature review has several strengths. The review uses a model to explore, analyze, and synthesize data on what is currently known about the status of RN retirement. The review has permitted a transparent evaluation of existing literature. It would be imprudent not to recognize the limitations of this review. First, only articles written in English and retrieved from peer-reviewed journals were included. This action may have excluded some significant and applicable studies. Second, studies conducted in other countries were not included, but these works may have information that could have contributed to the body of evidence gathered. Third, consistent data available from state boards of nursing regarding intent to retire are not available; thus, the data are not representative of inclusive or necessarily representative samples of nurses.
Implications for Nurse Executives
As leadership strives to meet the demands of budgets, staff needs, and quality patient care, they should consider the implications of this literature review. Retirement benefits or education may be helpful in retaining an experienced RN workforce. As the current economy improves, strategies to retain experienced RNs should be considered28 as RN turnover negatively impacts patient care outcomes, satisfaction, and safety.1,29 Indeed, patient safety has been directly linked to nursing expertise, a significant concern as current data indicate one-third of the current RN workforce will retire in the next 20 years.1 Experts maintain that veteran RNs have valuable workplace experience that positively impacts patient care.29,30 Furthermore, recent studies of the costs of nurse turnover have reported results ranging from about $22,000 to more than $64,000 per nurse turnover,31,32 suggesting that retention programs may be more cost-effective than replacing mature workers. Long-term cost-benefit analysis of retirement benefit programs can help identify strengths and weaknesses of a plan’s design. Ultimately, interventions to improve RN workforce sustainability must be timely, applicable, and cost-effective.
Although previous research supports that RNs are financially unprepared for retirement, newer data are needed to understand the current, volatile financial retirement situation and ensure timely retirement planning education. In addition, retirement planning education development may be aided by profiling the few RNs who are reported to be financially prepared for retirement. Therefore, understanding RN retirement knowledge deficits is a critical barrier to address before modifying retention strategies. This review has revealed 3 significant gaps in the current literature. First, only 1 study highlighted the impact of uncertain economic times and the impact on RN retirement.2 The impact of the 2008 recession appears to be lacking from RN retirement literature. However, literature indicates the most recent economic events have profoundly affected retirement among all categories of employees.33,34 The 2nd gap in the literature is a comprehensive profile of RN demographics and retirement intentions. Only 6 (35%) of the 17 studies reported race, with 8 (47%) reporting gender. The literature does not indicate which segments of the RN workforce are more or less prepared for retirement. Finally, there are no prospective longitudinal studies following RNs from initial licensure through workforce separation,21 particularly as trends of the American workforce show an increase in later retirement.34 Unfortunately, 57% of today’s seniors have assets less than $5,000 despite estimates that 60% to 80% of preretirement income is required to maintain a lifestyle similar to preretirement.35 Older RNs have also experienced a decrease in net worth due to the economic recession. Once the impact of the downturn on RN retirement is understood and demographic data investigated, interventions to improve RN retirement preparation through retirement planning education should be developed, and prospective longitudinal studies conducted as these interventions are implemented.
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