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No time to lose

Hader, Richard RN, CNA, CHE, CPHQ, PhD, FAAN; Saver, Cynthia RN, MS; Steltzer, Theresa

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Nursing Management (Springhouse): July 2006 - Volume 37 - Issue 7 - p 23-29,48
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Take a look around you at work. Chances are that the staff nurses and managers you see will fade into retirement over the next several years, creating a crisis in the nursing workforce. According to the first-ever Nursing Management Aging Workforce Survey, in partnership with Bernard Hodes Group, more than 55% of respondents, predominantly managers, will retire between 2011 and 2020, combined with a rising exodus of nurse employees during the same time. Considering that 2011 is a mere 5 years away and it takes 2 to 4 years to educate nurses, not to mention the time it takes to develop good managers nurse leaders need to heighten efforts to retain the current workforce while still attracting others into the profession.

Recent reports showing increasing numbers of RNs may have lulled nurse leaders into a false sense of security, but the shortage is far from over1 and will continue to escalate, as our survey shows. Thanks to the 978 of you who responded to the survey, we now know the scope of the coming crisis and the plans to retain the aging workforce.

Unfortunately, aside from a few bright spots particularly related to magnet hospitals retention efforts in the areas of technology, flexibility and benefits, preventive care, and education seem to be the standard attempts nursing has made for many years, and innovation is lacking.

Decade of decline

Brace yourself if you'll still be a manager in 2010 and beyond. The number of respondents who plan to retire increases each year, with a dramatic jump in 2011 (See “Time of retirement for respondents.”) From 2011 to 2020, more than half (55.3%) of respondents plan to retire from nursing. The bad news continues after 2020 when 25.5% of respondents plan to retire.

At the same time, employees will be leaving the profession in increasing numbers. (See “Time of retirement for employees.”) The number of employees planning to retire increases from 2006 to 2020, and 19.1% of respondents say that more than 30% of their nurse employees plan to retire in 2020.

These declining numbers are consistent with other reports. Nurses will retire in large numbers after 2010, and the gap between the supply and demand of RNs is expected to increase to between 400,000 and 800,000 by 2020.2

Time of retirement for respondents.
Time of retirement for employees.
Age of respondents and employees.
Average age of nursing employees by managers' clinical practice.
Average age of nursing employees by managers' work setting.
Current and projected environment/technology.
Flexibility, options, and benefits for employees*
Education and training for employees*
Preventive care for employees*
Comparison of magnet vs. nonmagnet facility support for nursing*

Patterns of aging

The number of retirees is understandable given the age of today's nurses. The average age of a nurse has ranged from 42.1 to 46.8 in recent years.1,3 In our survey, 30.7% of respondents said their employees are ages 41 to 45. Among managers, age was even more dramatic: 28.7% of respondents, most of whom hold management titles, are 51 to 55. (See “Age of respondents and employees.”)

According to the survey, the operating room (OR) and postoperative anesthesia care unit (PACU) have the oldest employees and are therefore at highest risk for a staffing crisis. For example, more than a quarter (26.5%) of the respondents' nurses in the 51 to 55 age group work in the OR or PACU. Although a small percentage in this age group work in critical care (2.9%), 28.1% of the respondents' nurses who are 41 to 50 years old work in critical care. It follows that given the high physical and psychological demands of the critical care environment, many of these nurses will plan to leave the speciality once reaching age 50. (See “Average age of nursing employees by managers' clinical practice.”)

The majority of survey respondents in all age categories work in a hospital or health system. A significant number of respondents' nurses between 20 and 25 (28.6%) work in an academic or university setting. (See “Average age of nursing employees by managers' work setting.”) It may be that younger nurses are seeking more education and therefore are working in areas convenient to their academic schedules.

Although recent reports note an easing of the shortage, clearly this is a short-term trend. In fact, two-thirds of the recent growth of RN employment between 2002 and 2004 came from RNs over the age of 50.4 In addition, researchers have reported that about one-third of older RNs (50 and over) plan to leave their current nursing position within 3 years, with only 29% intending to take another position in nursing.5 So what are respondents doing to retain their aging workforce?

Technology to the rescue

Facilities are making efforts to use technology and other means to help nurses in their work, or plan to do so in the future. (See “Current and projected environment/technology.”) The most common strategies to assist nurses are electric beds, mechanical patient lift devices, ergonomics training, and bariatric equipment or accommodations. Twenty-eight percent of facilities have yet to implement lift devices to ease the burden for something nurses do everyday, and more than one-third don't offer ergonomics training, a simple intervention. Other technology in place included computer-based documentation and medication administration, as well as wireless phones for nurses.

Facilities plan to offer more interventions in the next 5 years, with electric beds, lifting devices, bariatric equipment, and ergonomics training topping the list.


Strategies related to flexibility and benefits have long been touted as effective in retaining nurses. However, while nearly two-thirds (62.9%) of respondents' facilities offer self-scheduling, fewer than half (49.7%) offer flextime. (See “Flexibility, options, and benefits for employees.”) Sadly, too few facilities use innovations such as redesigned roles for mature nurses, full health benefits for part-time employees over a certain age, and phased retirement.

One respondent offers various shifts from 10, 12, 8, and 4 hours. Others reported self-scheduling, shared governance, fewer weekends, or rotating shifts for senior staff and no weekends for RNs who have more than 20 years of service. Perhaps the most unusual benefit was reduced cost bariatric surgery for eligible nurses.

Prevention begins at home

Preventive care can help keep aging nurses on the job longer. The most common intervention in this area is back care and safety training (71.4%). (See “Preventive care for employees.”) Only slightly more than half of facilities offer wellness programs or onsite/subsidized gym membership. Interestingly, 28.4% offer massage or other alternative therapies, such as acupressure.

A common strategy to retain nurses has been support for continuing education, so it's not surprising that 87% of facilities offer scholarship and tuition reimbursement, and 78.1% offer support for continuing education, such as time off. (See “Education and training for employees.”) Less than 10% of facilities have formal succession programs, which is alarming given the number of managers who will be retiring.

Magnet attracts more solutions

In general, magnet hospitals provide more support for their nursing staff. (See “Comparison of magnet vs. nonmagnet facility support for nursing.”) The results didn't surprise Elaine Scherer, RN, BSN, MA. “Magnet hospitals provide innovative programs for their nurses to thrive,” says Scherer, director of the Magnet Recognition Program of the American Nurses Credentialing Center.

Environment/technology. Magnet hospitals are more likely to have technology available to ease nurses' work. In some cases the differences were striking. For example, bariatric patient equipment/accommodations were available in 84.7% of magnet facilities but only 47.8% of nonmagnet facilities. More than 70% of magnet hospitals have a transport team compared to only 33.4% of nonmagnet hospitals. This carried over with items planned to be in use within 5 years, although the differences were less dramatic.

Flexibility/options/benefits. In every case except one, magnet hospitals were more likely to offer benefits. For example, flextime was offered in 58.2% of the magnet hospitals compared to 49% of nonmagnet. The exception was full health benefits for part-time employees over a certain age: 18.5% of nonmagnet facilities offered this compared to 16.5% of magnet facilities.

Preventive care. Nonmagnet hospitals were more likely to offer annual physicals and back care/safety training at orientation with annual refreshers, but magnet hospitals were more likely to offer wellness programs, massage and/or alternative therapies, onsite or subsidized gym membership, and stress reduction. Scherer notes that the community setting may play a role in what a facility can offer employees. For example, alternative therapy may be less available in rural areas.

Education/training. In every case, magnet facilities outperformed nonmagnet facilities, and again, these differences were dramatic in some areas. For example, 63.1% of magnet facilities offer career ladders compared with only 30.1% of nonmagnet hospitals. Interestingly, a career ladder isn't required to attain magnet status, but Scherer notes that magnet hospitals are often creative in how they form clinical ladders, including those that help nonnursing staff become nurses.

More respondents in magnet hospitals were BSN graduates (29.1% compared to 19.5%). Although respondents in the Nursing Management survey were primarily managers, this finding reflects the magnet program's data on education levels of RNs, which reports that 44.7% of direct-care RNs hold a bachelor's degree.

Additionally, nonmagnet hospitals tend to have fewer beds than magnet hospitals. Only 6% of magnet facilities reported fewer than 100 beds compared to 33.2% of nonmagnet facilities.

Ideas for innovation

More focus is needed on retention efforts. In one study, most respondents observed just one of several retention strategies presented to RNs: mentoring programs for new graduates.4 Although some facilities in the Nursing Management study provide a few exciting solutions, innovation is in short supply. (See “Innovation in action.”)

Nursing Management recommends leaders take action in several of the following areas.

Scheduling. Many of the comments from the respondents noted offering flexibility in work schedules, but more is needed. For example, divide 12-hour shifts into two 6-hour shifts to accommodate the aging nurse and those who want more flexibility. Providing this type of scheduling will also help reduce errors. A 2004 study of working hours found that 40% of reported shifts exceeded 12 hours, which significantly increased the risk of making an error.6 Technology has also increased the opportunity for the nurses to schedule themselves by accessing the Internet in their homes.

Programs. Leaders also may want to consider innovative programs to support nurses who have functional restrictions, which can be an issue with aging nurses. A report from the Warren G. Magnuson, Clinical Center of the National Institutes of Health (NIH) found that one such program potentially saved the organization $731,763 over 3 years in overtime and agency staff.7

Benefits. Provide healthcare insurance even when hours are reduced. Also, consider basing benefits on years of service. Again, flexibility is key. In facilities that face seasonal variations, it may be beneficial to offer full-time benefits even to those who work only 6 months. Continuing education also remains an important retention tool.

Work environment. Some, but not enough, facilities are paying attention to the physical work environment. Strategies mentioned by one respondent included arranging the nurses' work schedule to decrease walking distance between patients, placing supplies close to patient care areas, and hiring more certified nursing assistants to do physical work such as lifting and pulling. Designing ergonomic workplaces will help reduce injuries in older nurses. For more information, see the American Nurses Association's position statement on this topic.8

Staff and patients can also benefit from holistic healing environments, a trend discussed by Bishop and Griffin in this issue's continuing education article, “Holistic healing methods positively advance patient care,” on page 30. It's not enough to simply designate a “restful place,” however. Hospitals need to plan space based on research. Bishop and Griffin's article includes the role of the Center for Health Design, which focuses on designing environments that benefit both patients and nurses: “There's a triangle of focus: address the needs of patients, their family members, and the staff caring for both.”

Environment also includes the attitudes of those who work in the facility. Creating an environment where nurses are respected and listened to will promote job satisfaction and retain nurses. One respondent mentioned the importance of nurse involvement in councils and shared governance, and another said, “It's the cohesiveness of the staff that helps retain staff.”

It's clear that work environment is a worthwhile investment. One survey found that RNs believed the most important factor in solving the nursing shortage was to improve the work environment.6 One resource for standards in this area is the American Association ofCritical-Care Nurses Standards for Establishing and Sustaining Healthy Work Environments.9

Magnet status. In this survey, magnet hospitals offered more services and benefits for employees. This is consistent with other research findings that link magnet status to lower turnover and greater job satisfaction.10 Even if hospitals don't have the resources to attain magnet status, they can benefit from putting the magnet principles into practice.

Succession planning. The future loss of managers makes succession planning essential. Bonczek and Woodard note in Nursing Management's upcoming August continuing-education article, “Who'll replace you when you're gone?” that “given the numbers of nurse leaders approaching retirement, succession planning becomes an imperative.” In their literature review, they found minimal or no entries about succession planning. Approximately 38 (28%) of 138 healthcare recruiters indicated they had a long-term workforce plan in place.11

Prepare to innovate

As this survey shows, it's likely that another critical phase in the nursing shortage is a mere 5 years in the future. It's crucial that nurse leaders act now to design innovative solutions to retain aging nurses while they maintain their recruitment efforts. Only by paying attention to both sides of the equation can you keep your workforce in balance.

About the respondents

  • Predictably, most respondents were female, but 7.2% were male, higher than the national average of 5.7%.3 This further indicates a higher percentage of men in administrative positions.
  • About one-third of the respondents (29.9%) were nurse managers who managed fewer than 50 people (58.7%) and had been in nursing for 26 to 30 years.
  • Hospital/healthcare setting was the most common work setting for respondents, who work in small- to moderate-sized facilities: 37.4% said their number of beds was 100 to 300, while 25.2% worked in facilities with fewer than 100 beds.
  • Respondents were from all areas of the United States, and some were from other countries including Australia, Canada, Egypt, Kuwait, Thailand, Italy, and Saudi Arabia.

Innovation in action

Respondents reported the following innovations at their facilities:

  • Alternative services such as yoga, acupuncture, meditation classes, and monthly “teas for the soul”
  • Regular schedule of body energizing activities such as stretching and physical exercise
  • Terrific Teammate: Each month peers select a staff nurse who shows team spirit and supports staff and patients. The nurse's picture is posted on the unit and he or she receives a certificate.
  • Wisdom Works: Nurses work with specific populations, such as geriatric and pediatric patients.
  • Promotion of metabolic syndrome management through a variety of interventions such as an annual diabetes workshop

About this survey:Nursing Managemen's Aging Workforce Survey was published in this year's January through April issues and was available online through Bernard Hodes Group at from February 1 to April 30. The authors acknowledge Karen A. Hart, RN, BSN, senior vice president, Bernard Hodes Group, Health Care Division, for partnership on survey hosting, data tabulation, and market expertise.


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© 2006 by Lippincott Williams & Wilkins, Inc.