The impending retirement of RN baby boomers is now a workforce reality that could have a profound impact on U.S. healthcare.1–3 The CDC and the National Institute for Occupational Safety and Health projected that in 2010, middle-aged and older workers would outnumber younger workers.4 Thus, baby boomer RNs (those born between 1948 and 1964) are now in what has been traditionally known as the retirement years. Nurse administrators and educators are challenged with the task of retaining these knowledgeable, skilled nurses while aggressively recruiting generation X and millenial nurses.
Developing initiatives to retain nurses in the workforce and recruit young people into the profession is an urgent national priority, especially with the healthcare reform bill that will add approximately 32 million newly insured patients into the healthcare system.5 However, if the U.S. healthcare system continues to lose aging RNs, Americans could be facing a major public health crisis. The lack of qualified nurses increases the risk of poor patient outcomes that can have a direct effect on increased hospital costs. More important, nursing shortages have been linked to increased mortality, staff violence, accidents/injuries, cross infection, and adverse post-op events.6
The more urgent and preventable crisis is the population imbalance in the nursing workforce. A recent study indicated a 62% increase in the number of young nurses entering the workforce between 2002 and 2009, a rate not seen since the 1970s.7 If the recent surge in recruiting younger nurses continues, Americans can anticipate a much larger group of novice nurses. As baby boomer RNs continue to age and leave the workforce, the greater loss for nursing is the intellectual capital and clinical expertise that serves to improve quality patient outcomes, educate new nurses, and inform the discipline of new clinical problems that warrant investigation. Therefore, it's imperative that nurse leaders and educators make commitments to develop and implement innovative strategies to retain older, experienced nurses while continuing to recruit younger people into the profession.8,9
What happens when nurses age?
There's been little research about what it means to be an aging nurse in a physically, emotionally, and mentally challenging profession.10 What we do know is that the natural aging process and extraordinary physical demands of nursing can be taxing. Although most people enter middle age in good health, middle age also marks the possible onset of chronic disease, insomnia, mood disorders, and peri-menopause/menopause and hormone imbalances for most female nurses. It's common knowledge that the risk of chronic disease increases with age, and aging women are susceptible to weight gain, obesity, cardiovascular disease, diabetes, hypertension, and cancers.10
Aging nurses are reported to have higher workload demands than other professions. Increased workloads and challenging work environments also increase the risk of stress, poor health, and injury.10 Unfortunately, nurses are reported to have higher rates of injuries than construction workers.11 Chronic pain aggravated by nursing duties and excessive tiredness has also been noted.10 The demands and rigor in providing nursing care can take their toll over time.
RNs are experiencing the physical, cognitive, and emotional challenges of growing older while the demands of nursing are increasing.6 The tasks of nursing have become more difficult for aging nurses due to the frequent introduction of new technologies and the phenomenon of complexity compression—what nurses experience when expected to assume additional, unplanned responsibilities while simultaneously conducting multiple responsibilities in a condensed time frame.12 Aging nurses have expressed higher levels of stress and overwork as one of their top three health and safety concerns.13
Management and aging nurses
As healthcare demands increase and the nursing shortage continues, healthcare employers will rely more on an aging nurse workforce. Aging nurses offer invaluable experience and knowledge, yet they're also at increased risk for serious workplace injuries.14 It has been reported that over one-third of 308 hospital-employed older RNs reported job-related health problems.15 The most commonly reported injuries include needle sticks and back strains.3
Employers should consider providing classes in body mechanics, training employees in safe-lifting techniques, and providing back belts if necessary.14 Other common recommendations to reduce ergonomic risk factors include designing work stations or procedures to avoid twisting of the torso, restructuring job duties and tasks to match the capabilities of each worker, providing flexible hours, allowing for regular breaks, and performing job safety analyses.14
Nurses over age 50 may also experience intergenerational tension that should be addressed by nursing administrators with the clear message that nurses of all ages are needed and valued. Nurse managers of all age groups may need increased support and assistance to make intergenerational and multicultural respect and understanding cultural norms in the workplace.16,17
The top three management practices that may affect a nurse's decision to remain in the workforce are ones that nursing administrators can control: recognition and respect, having a voice, and receiving ongoing feedback regarding one's performance.18 These are more important than compensation, indicating that personal values are significant to aging nurses.
Creating new career paths that cater to the needs of an aging workforce will help healthcare facilities recruit and retain older nurses. This will help ease the nursing shortage in the next decade. More important, it will allow time for nurse administrators, academicians, and nurse researchers to work collaboratively to develop innovative, evidence-based, and effective practices to promote a self-sufficient and sustainable workforce.
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