The ageing of the nursing workforce: what lies ahead and what we can do

When I turned 60 last May, like many nurses who have historically in their mid to late fifties considered retirement, I questioned whether it was time to retire. I was no longer in clinical practice so I didn't have to deal with the physical demands of nursing but I thought, isn't this the time when one slows down? Instead I moved half way around the world and took a new job with the International Council of Nurses (ICN). After over 20 years in the trade union movement in Canada, I was intrigued by the opportunity to utilize my skills at an international level.

In my first week on the job, I read with interest an article telling the stories of three nurses, all of whom had retired but decided they still had passion for nursing and could make a difference (Snell 2012). The one who really caught my attention was a 74-year-old nursing student who had just completed the first year of a three-year degree course. His view was that when he graduated at 76, he would work for 14 years and then retire gracefully at age 90.

Nurses like the rest of the population are living and working longer. Older nurses, whether new graduates or seasoned veterans, have much to offer and can be a vital component of our current and future health care system. Given the global workforce shortages, retaining older nurses could result in their becoming a substantial and growing component of the workforce. We must work together to have a realistic, safe and supportive vision and plan for every stage of a nurse's career.

Health care workers, particularly nurses, are remaining in the workplace well beyond traditional retirement age at higher rates than ever before. Workers 65 years and older constitute more than 20% of the U.S. workforce today and represent the fastest growing demographic of American workers. Thirty-five percent of all workers envision working into their 70's and beyond.

People who don't retire or return to work after trying retirement can be financially motivated, bored with doing nothing or, as in the case of many nurses, motivated by the reward of helping and caring for people. The majority of nurses are female and the average life expectancy for women in more than 40 countries is over 80 years of age. This leaves many productive years for nurses to contribute to health care systems beyond age 65.

Changes in mandatory retirement age such as raising the age limit, and in some countries the elimination of mandatory retirement entirely, provides opportunities to continue working well beyond the historical retirement age of 65. Increased longevity, overall improvement in health status and a decline in the number of jobs requiring hard physical labour have resulted in longer working lives. However, nursing is still emotionally and physically demanding with increasing stress due to high workloads and shifts in care delivery. Patients are much more acute in today's health care settings, adding to the workload and stress of the nurse.

Declining health status is often cited as a disadvantage of employing older workers. While age-related changes in health and functioning do occur, considerable evidence suggests that the impact of these changes on the ability of the worker to perform is minimal (Alpass & Mortimer 2007). One can develop adaptive tactics to compensate for the decline in cognitive functioning, particularly in areas related to processing competencies, that occurs with normal ageing. Knowledge, skills, abilities and motivation also can mitigate the decline. It is sometimes suggested that older workers are more likely to experience the effects of work-related stress due to the increasingly complex nature of the work environment. However work-related stress may be experienced by workers of any age for many reasons.

What are some of the issues to be considered and addressed if we continue to work into our seventh and eighth decade?

Research suggests that, due to a decreased resistance to physical stress, older workers suffer more from fatigue, take longer to recover from injury and do not tolerate shift work (Graham & Duffield 2010). Although studies reveal that older workers suffer similar or even lower rates of workplace injuries compared to younger workers, the severity and recovery time from those injuries increases drastically with age. Musculoskeletal injuries and disorders account for a large portion of work-related injuries in the health care industry, primarily due to the unpredictable physical demands of patient handling (Conn & Cosentino 2011).

Redesigning the work and workplace will go a long way in addressing the physical changes of older workers. Wellness programs to assist workers in maintaining a good level of fitness will help to offset the physical changes of ageing. Other recommendations are shorter shifts and no shift rotation, more ancillary staff to deal with the physical aspects of the work, and mechanical lifts. Minimizing or eliminating manual lifting of patients by care providers is a first step in addressing the number one on-the-job injury, musculoskeletal back problems. In fact, implementation of a no-lift policy will benefit all workers regardless of age.

Studies point to the need for the training of supervisors in age-related issues, implementation of appropriate age-related ergonomics and workplace exercise programs, and introduction of tailored training in newer technologies for older workers (Ilmarinen 2001).

Today, with four generations of nurses in the workplace, age discrimination is a growing concern. While age discrimination is not new, some fear that it will gain prominence as the workforce ages, and may result in older workers retiring due to discrimination.

We need to stop blaming the ageing employee for perceived shortcomings and look at what needs to happen in the workplace to keep older workers gainfully employed. We need evidence-based education about the capabilities of ageing workers. Employers need to recognize that older workers bring with them extensive knowledge and experience which offsets physical changes.

Following are ideas to assist in retaining ageing nurses in the workplace to care for the world's population as it grows and ages:

  • address professional development needs
  • consider flexible work options
  • guarantee that pensions are not impacted by flexible work options
  • redesign jobs to address heavy workloads and stress
  • address issues of employees' health and safety
  • create specific roles focusing on aspects of the job such as admission and discharge roles/clinic work/mentoring and preceptor roles
  • implement sufficient decision-making latitude
  • guarantee adequate support from superiors and colleagues
  • ensure predictability and meaning of work
  • encourage participatory management style which leads to recognition and respect of older workers
  • devise salary structures that reward experience
  • introduce benefit programs that hold value for an ageing workforce, for example ‘elder care’
  • provide retirement planning.

In closing I leave you with a quote from Betty Friedan that resonates with me at age 60: Aging is not lost youth but a new stage of opportunity and strength.

Lesley M. Bell RN, MBA is an ICN Nurse Consultant, focusing primarily on socio-economic issues (SEW). Before joining ICN, she was the Chief Executive Officer of the Ontario Nurses' Association in Canada.