This study evaluated the impact of the late career nurse initiative on nurse perceptions of their work environment, workplace burnout, job satisfaction, organisational commitment and intention to remain.
This study evaluated the impact of the late career nurse initiative on nurse perceptions of their work environment, workplace burnout, job satisfaction, organisational commitment and intention to remain.
The Ontario Ministry of Health and Long-Term Care introduced the late career nurse initiative with the goal of improving the retention of front-line nurses aged 55 and over by implementing a 0.20 full-time equivalent reduction of physically or psychologically demanding duties, enabling nurses to engage in special projects for the improvement of their organisations and patient care.
A sample of 902 nurses aged 55 and over from acute and long-term care facilities were surveyed using valid and reliable questionnaires.
Nurses who had participated in the initiative did not differ significantly from those who had not in terms of workplace burnout, job satisfaction, length of service or intention to remain within their current organisation. The late career nurse initiative participants reported significantly higher perceptions of managers' ability, leadership and support and their level of participation in hospital affairs.
The late career nurse initiative was associated with perceived differences in nurses' work environment but not outcomes.
Leaders need to pay attention to how late career nurses are selected and matched to organisational projects.
The increasing demand for health care services due to the global ageing population will have a significant impact on the health care system (Martini et al. 2007). This burden will come at a time when a large proportion of baby-boomer nurses (nurses born in the post-World War II baby boom between 1946 and 1964) will themselves be nearing retirement and the expected loss of this cohort is predicted to push the nursing workforce below the projected need by the year 2020 (Buerhaus et al. 2005). This predicted drain on Ontario's nursing resources is exacerbated by the fact that not only is the average age of retirement for nurses lower in comparison with other professions (O'Brien-Pallas et al. 2003) but nurses tend to work fewer hours as they approach retirement (Berliner & Ginzberg 2002). Of equal importance to the loss of resources is the extensive expertise that these individuals remove from the nursing workforce when they leave (Orsolini-Hain & Malone 2007, Canadian Health Services Research Foundation 2009). It is therefore imperative that health care organisations engage, not only in the recruitment of new nurses, but also in the active retention of those in the older generation.
Studies indicate that older nurses describe both a passion and love of nursing, report positive aspects and meaning in their careers and enjoy making connections with, and caring for, both patients and their families (Spiva et al. 2011). Intergenerational studies indicate that older nurses are more inclined to regard their employment favourably than younger nurses, and report lower levels of workplace burnout, greater congruence between personal and organisational values, increased desire to share knowledge with patients and co-workers and greater participation in knowledge sharing activities as well as a generally expressed enjoyment in and satisfaction with their careers (Langan et al. 2007, Klug 2009, Leiter et al. 2009, Storey et al. 2009). These unique characteristics of older nurses suggest that there is considerable potential to retain this age cohort within the workforce.
In evaluations of career intentions, older nurses are shown to express a willingness to continue to work within nursing for an extended period of time. These intentions are, in part, predicated upon the ability of their employers to create an environment that is responsive to their needs (Klug 2009, Palumbo et al. 2009, Eley et al. 2010). As such, the retention of this experienced cohort may benefit from effective initiatives targeted specifically at the unique characteristics and requirements of the late career nurse population.
In a direct effort to stem the loss of Ontario's late career nurses, the Ontario Ministry of Health and Long-Term Care (MOHLTC) introduced the Late Career Nurse Initiative (LCNI) in 2005. The aim of the LCNI is to assist health care organisations develop approaches to retain these valuable health care professionals. This initiative involved the provision of funding to individual organisations that submitted proposals detailing a workable plan to implement a 0.20 FTE (full-time equivalent) reduction of physically or psychologically demanding duties of nurses aged 55 or over and the repurposing of this time to engage the nurses in less demanding, enriching employment activities, typically in the form of organisation projects. In order to submit a proposal each organisation had to demonstrate they had the support of their local nurses' union leadership. The nature of individual LCNI projects assessed in the course of this study varied with nurses typically engaging in projects that improve organisational policy and administration, patient care or staff training and well-being. Project selection occurred with varying levels of involvement of the participants themselves. Methods for selection of participants also differed between organisations. Nurses commonly volunteered or were identified by management and asked if they would be interested in participating. Funding for the initiative was provided over a 16 week period each calendar year and was used to cover replacement costs for late-career nurses involved in LCNI projects. As part of the LCNI, an evaluation was undertaken systematically to assess the impact of the MOHLTC LCNI on the retention of late career nurses in Ontario. This article provides an overview of the study findings from a province-wide survey conducted between 2010 and 2012. The literature reviewed above informed the questions and selection of variables for study.
The aim of this study was to evaluate the impact of the Ontario Ministry of Health and Long-Term Care Late Career Nurse Initiative (LCNI) on the retention of late career nurses, and explore the degree to which it has impacted nurses' job satisfaction and feelings of organisational commitment. The study also evaluated the impact of the LCNI on late career nurses' perceptions of their work environment. The following research questions were explored:
A cross-sectional survey design was used to evaluate the impact of Ontario's LCNI on the retention of nurses aged 55 and over and to document secondary benefits to the nursing workforce.
A total of 90 sites that indicated willingness to participate in an evaluation of the LCNI at the time of their funding application to the MOHLTC constituted the sampling frame. These sites were sent an invitation to participate in the study and follow-up by the researchers resulted in 58 participating sites, including 38 acute care and 20 long-term or complex continuing care facilities. Thirty-two sites elected not to participate in the evaluation, including 25 acute care and seven long-term care or complex care facilities. The target sample included all nurses aged 55 or older who had participated in the LCNI in at least 1 year as well as an age-matched cohort of nurses who had never participated in the initiative.
The individual survey instruments used in the study are described below and are summarised in Table 1. Instruments used included the Practice Environment Scale of the Nursing Work Index (PES-NWI) factored as five domains of the nursing work environment (Lake 2002). The five domains consisted of participation in hospital affairs, staffing and resource adequacy, nursing foundations for quality of care, nurse–physician relationships, and nurse leader ability, leadership and support (Lake 2002). The reliability of this tool was demonstrated by Lake (2002) through an overall Cronbach's alpha score of 0.82, and subscale scores ranging from 0.71 to 0.84 (Lake 2002) (see Table 1). The study survey also included Allen and Meyer's Affective and Continuance Commitment Scales factored as two domains of organisational commitment, identification with agency and costs associated with leaving (Meyer et al. 1990). The two subscales have demonstrated acceptable reliability coefficients of >0.80 in studies of nursing personnel (Gutierrez et al. 2012). Burnout was measured with the Maslach Burnout Inventory factored as three domains of workplace burnout: professional efficacy, cynicism and exhaustion (Schaufeli et al. 1986, Maslach et al. 1996). Cronbach alpha values ranging from 0.71 to 0.93 were reported for each subscale in an eight country study of nurses (Poghosyan et al. 2009). A relationship between burnout and the subscales of the PES-NWI has been established in the literature (Li et al. 2013, Van Bogaert et al. 2013). Job satisfaction was measured with a four-item, one-factor scale for overall job satisfaction (α = 0.88) (Laschinger & Havens 1996). Intent to remain in their current job was measured with a single item derived from Gardner et al. (2007). A relationship between nurses' job satisfaction, intent to leave and turnover has been well established in the literature (De Gieter et al. 2011, De Milt et al. 2011).
|Questionnaire/scale||Example item||Response format||Reliability in earlier studies|
|Organisational commitment (Meyer et al. 1990, Gutierrez et al. 2012)|
|Affective commitment (7 items)||I would be very happy to spend the rest of my career with this organisation||1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree||0.87|
|Continuance commitment (8 items)||It would be very hard for me to leave my organisation right now, even if I wanted to||1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree||0.80|
|Maslach Burnout Inventory (Maslach et al. 1996, Poghosyan et al. 2009)|
Emotional exhaustion (3 items)
Maslach Burnout Inventory
|I feel burned out from my work||0, never; 1, a few times a year or less; 2, once a month or less; 3, a few times a month; 4, once a week; 5, a few times a week; 6, every day||0.89|
Cynicism (3 items)
(Schaufeli et al. 1986)
|I have become more cynical about whether my work contributes to anything||0, never; 1, a few times a year or less; 2, once a month or less; 3, a few times a month; 4, once a week; 5, a few times a week; 6, every day||0.79|
Professional efficacy (3 items)
(Schaufeli et al. 1986)
|I feel exhilarated when I accomplish something at work||0, never; 1, a few times a year or less; 2, once a month or less; 3, a few times a month; 4, once a week||0.77|
|Practice Environment Scale of the Nursing Work Index (PES-NWI) (Lake 2002, Li et al. 2013, Van Bogaert et al. 2013)|
|Nurse manager ability, leadership and support (5 items)||A supervisory staff that is supportive of the nurses||Strongly agree, 1; Agree, 2; Somewhat disagree, 3; Strongly disagree, 4||0.84|
|Nurse participation in hospital affairs (9 items)||Career development/clinical ladder opportunity||Strongly agree, 1; Agree, 2; Somewhat disagree, 3; Strongly disagree, 4||0.83|
|Collegial Nurse-Physician Relations (3 items)||A lot of teamwork between nurses and doctors||Strongly agree, 1; Agree, 2; Somewhat disagree, 3; Strongly disagree, 4||0.71|
|Staffing and resource adequacy (4 items)||Enough staff to get the work done||Strongly agree, 1; Agree, 2; Somewhat disagree, 3; Strongly disagree, 4||0.80|
|Nurse foundations for quality of care (10 items)||Working with nurses who are clinically competent||Strongly agree, 1; Agree, 2; Somewhat disagree, 3; Strongly disagree, 4||0.80|
|Job satisfaction (4 items) (Laschinger & Havens 1996)||I feel very satisfied with my job||1, strongly disagree to 5, strongly agree||0.88|
|Retention (Gardner et al. 2007) (1 item)||Do you plan on leaving your job in the next year?||0, No; 1, Yes||NA|
|Length of service||Three items measuring length of service in current role, length of service in current organisation, and length of service in nursing||Years/months||NA|
Survey packages were sent to participating organisations to be disseminated to all late-career nurses (n = 5585) that they employed. Late-career nurses were eligible to participate in the survey if they were 55 years or older. Participating organisations distributed surveys once to their nursing staff and all potential participants were provided with the option of either returning completed paper copies of the surveys to the research team by means of postage-paid envelope or through the completion of an online version of the survey following instructions included in the survey packages. It was not possible to follow-up with non-responding participants because participation was anonymous, nor were additional reminders sent.
Between groups analysis of covariance (ancova) was used to determine whether significant differences existed between nurses who participated in the LCNI and those who did not on indexes of work environment, workplace burnout, job satisfaction, organisational commitment and intent to remain. Age was controlled for as a covariate because there was a slight difference in the average age of nurses who had participated in the LCNI and those who had not (60.4 vs. 59.1, respectively). Logistic regression models were used to evaluate the effect of participation in the initiative on the odds of nurses leaving their current job. Furthermore, descriptive statistics were compiled to provide an understanding of the demography of late career nurses. All analysis was conducted using the Statistical Package for Social Sciences for Windows 20.0 (SPSS Inc., Chicago, IL, USA).
Participation in this study was entirely voluntary with personal information collected during the course of the study kept strictly confidential. As identifiers, surveys contained a randomly generated alphanumeric code preventing identification of participants by either the research team or their respective organisations. This study was granted ethics approval by the University of Toronto, Office of Research Ethics (number 25563) as well as all relevant research ethics boards of participating organisations.
Nine hundred and two surveys were returned by late career nurses, with 791 from acute care and 70 from long-term or continuing care agencies across Ontario. Surveys returned with no sector indicated totaled 41. The overall survey response rate was 16.15%.
Of the nurses surveyed were 95% were female and 5% were male. Survey respondents had an average age of 59.5 (SD = 3.50) years. Ninety percent (90.5%) were college educated, 19.6% had Bachelor's and 1.8% had Master's degrees. Most (91.9%) worked in acute care settings, the remaining (8.1%) worked in either long-term or complex continuing care. The largest majority (91.9%) were registered nurses (RNs); there were 7.3% registered practical nurses (RPNs) and 0.9% RN(ECs). In Ontario RN(EC) is a designation conferred to RNs with a nurse practitioner diploma. Sampled nurses worked in varied programmes including medical (14.9%), ambulatory (14.1%) and critical care (12.9%). Most worked with adults (56.0%) while a large proportion (32.6%) indicated they worked with all age groups. Sixty-one percent of respondents worked full-time, 28.8% part-time and 9.8% on a casual basis. See Table 2 for demographics of study population.
|Characteristic||No. (and %) of nurses|
|Bachelor's degree||172 (19.6)|
|Master's degree||16 (1.8)|
|Work sector||Acute care||791 (91.9)|
|Non-acute care||70 (8.1)|
|Professional designation||RN||805 (91.8)|
|Primary work programme||Medical||129 (14.9)|
|Ambulatory care||122 (14.1)|
|Critical care||111 (12.9)|
|Mental health or psychogeriatric||64 (7.4)|
|Emergency department||36 (4.2)|
|Palliative care||13 (1.5)|
|Primary patient type||Adults||451 (56.0)|
|All age groups||263 (32.6)|
|Children and adolescents||33 (4.1)|
|Employment status||Full-time||541 (61.4)|
Five hundred and sixty-seven (62.9%) nurses surveyed indicated that they had never participated in the LCNI, 274 (30.4%) indicated that they had participated in at least 1 year, 40 (4.4%) were unsure and 21 (2.3%) did not indicate any choice. Approximately 45% of those who participated indicated that they participated in more than 1 year.
Sixty-eight percent of the nurses expressed high, 22% moderate and 10% low levels of professional efficacy. In contrast, ratings on cynicism showed 46.7% of nurses expressed low levels of cynicism, with 30.3% moderate and 23% high. Scores for exhaustion were more evenly distributed with 33.4% high, 37.8% moderate and 28.7% low. To evaluate the effect of participation in the LCNI on workplace burnout, age-adjusted mean scores for each domain were compared for LCNI participants and non-participants. The comparison groups were found not to differ significantly in terms of professional efficacy (P = 0.692), exhaustion (P = 0.565) or cynicism (P = 0.699). Table 3 shows the means scores on all domains of workplace burnout for participating and non-participating nurses.
|Study variable||Age-adjusted mean (95% CI)||P-value|
|Non-participation in LCNI||Participation in LCNI|
|Nursing practice environment|
|Nurse participation in hospital affairs||2.32 (2.26–2.38)||2.50 (2.41–2.58)||<0.001|
|Nursing foundations for quality of care||2.71 (2.66–2.75)||2.74 (2.67–2.81)||0.404|
|Nurse manager leadership and support||2.53 (2.45–2.60)||2.70 (2.59–2.80)||0.008|
|Staffing and resource adequacy||2.45 (2.38– 2.52)||2.51 (2.41–2.60)||0.343|
|Collegial nurse–physician relationships||2.76 (2.69–2.83)||2.82 (2.72–2.91)||0.378|
|Professional efficacy||5.12 (5.04–5.20)||5.09 (4.97–5.21)||0.692|
|Exhaustion||2.34 (2.21–2.46)||2.40 (2.21–2.59)||0.565|
|Cynicism||1.62 (1.49–1.75)||1.57 (1.38–1.76)||0.699|
|Affective commitment||2.76 (2.71–2.80)||2.82 (2.75–2.89)||0.134|
|Continuance commitment||2.63 (2.58–2.68)||2.58 (2.51–2.66)||0.352|
|Job satisfaction||3.58 (3.50–3.65)||3.55 (3.44–3.66)||0.706|
|Length of service|
|Years of service in nursing||34.39 (33.82–34.95)||34.88 (34.07–35.69)||0.329|
|Years of service with current organisation||23.54 (22.60–24.48)||24.94 (23.59–26.28)||0.098|
|Years of service in current role||29.30 (28.33–30.27)||30.33 (28.95–31.72)||0.233|
Measured characteristics of the work environment included nurse participation in hospital affairs, nursing foundations for quality of care, nurse manager leadership and support, staffing and resource adequacy and collegial nurse–physician relationships. Age-adjusted mean scores for each domain of work environment were compared between nurses who had participated in the LCNI and those who had not. The LCNI participants had higher age-adjusted mean scores for nurse participation in hospital affairs (P < 0.001) and nurse manager leadership and support (P = 0.008). Participants and non-participants did not differ significantly on measures of nursing foundations for quality of care (P = 0.404), staffing and resource adequacy (P = 0.343) or collegial nurse–physician relationships (P = 0.378) (see Table 3).
Age-adjusted mean scores for the two domains of organisational commitment (affective and continuance commitment) as well as overall job satisfaction were similarly compared for LCNI participants and non-participants. No significant between-group differences were observed in terms of affective commitment (P = 0.105), continuance commitment (P = 0.343) or job satisfaction (P = 0.706) (see Table 3).
As a final measure, nurses' age-adjusted mean years of service in nursing, with their current organisation and in their current role were compared between LCNI participants and non-participants. Again, no significant between-group differences were observed for length of service in nursing (P = 0.329), with their organisation (P = 0.098) or in their current role (P = 0.233) (see Table 3).
Six hundred and sixty-seven (79.9%) respondents did not intend to leave their current job in the coming year and 167 (20.1%) indicated they intended to leave. It is important to note the majority of respondents indicated they intended to remain in their job with 76.0% of nurses who participated in the LCNI initiative indicating they did not plan to leave in the next year. The effect of participation in the LCNI on the age-adjusted odds of nurses leaving their current employment were evaluated by logistic regression. Odds of leaving were not found to be significantly predicted by participation in the initiative (participant/non-participant odds ratio = 1.221, 95% confidence interval = 0.841–1.775, P = 0.294).
In previous studies older nurses often cited stressful work environments as driving factors in their decision to leave. They reported the need to cope with heavy clinical and administrative workloads, lack of support, limited staffing, inflexible scheduling, the need to be on-call (particularly important for remote or part-time nurses), difficulty with time constraints and constant change including the frequent introduction of new technologies (Langan et al. 2007, Klug 2009, Storey et al. 2009, Spiva et al. 2011, Collins-McNeil et al. 2012, Voit et al. 2012). In addition, past research has reported older nurses experience a variety of personal factors that influence their decision to exit the profession. These included high levels of stress, frustration, poor health, injuries, chronic pain, excessive tiredness, concern over being able to provide quality care, and coping with the physical, mental and emotional challenges of growing old while the demands of their work are increasing (Spiva et al. 2011, Collins-McNeil et al. 2012).
As a retention initiative the LCNI aims, in part, to address these difficulties by providing older nurses with the opportunity to take a break from their normal duties and engage in less physically demanding alternate roles. The study's finding that there was no statistically significant effect on the three domains of workplace burnout between the LCNI and non-LCNI nurse respondents suggests that participation in the LCNI did not impact workplace burnout. This may in part be explained by the overall finding that the nurses sampled generally indicated high levels of professional efficacy and low levels of cynicism thus limiting the potential for impact in these areas. Furthermore, the finding that approximately one-third of nurses reported high levels of workplace exhaustion suggests continued efforts are required to target nurse fatigue in this population. Issues relating to nurse fatigue are commonly addressed in empirical literature and are often associated with the shift-work schedule common in nursing practice (Winwood et al. 2006, Moseley et al. 2008). The current study findings are also consistent with previous studies on workplace burnout in nursing practice in which late career nurses commonly report lower levels of burnout when compared with their younger counterparts (Winwood et al. 2006, Leiter et al. 2009).
Similarly, study investigators found no evidence that an increase in affective commitment (identification with organisation), continuance commitment (costs associated with leaving organisation) or overall job satisfaction were associated with participation in the initiative. It is not surprising that no improvement in continuance commitment was indicated as the initiative is not expected to contribute to improved financial security or reduced costs associated with leaving. Additionally, while improvements to nurses' levels of affective commitment and/or job satisfaction could theoretically be derived from participation, the current study did not reveal a statistically significant difference between the LCNI and non-LCNI cohorts on these measures. One explanation is that late career nurses already report enjoyment and satisfaction with their careers (Langan et al. 2007, Klug 2009, Leiter et al. 2009, Storey et al. 2009) again limiting the potential impact of the initiative.
Relationship factors are amongst the most common themes leading to attrition. These include intergenerational tensions involving younger colleagues, lack of appreciation and recognition, a perception of being undervalued, and failure of management to consult with senior nurses (Klug 2009, Spiva et al. 2011, Collins-McNeil et al. 2012). The study's results suggest that the initiative is most effective at improving older nurses' perceptions of their working relationships with managers, whereas no differences in collegial nurse–physician relationships were observed between LCNI participants and non-participants. In particular, nurses who participated in the LCNI perceived their managers as providing greater leadership and support and assessed their level of participation within their organisations as higher compared with nurses who did not participate. The initiative may address relationship concerns expressed by older nurses by providing the sense of recognition and importance to their respective organisations that they feel they deserve.
The study finding of no statistically significant difference between the LCNI and the non-LCNI nurses' length of service or intent to leave their current job warrants further attention. Interestingly, other studies have reported that older nurses already express an anticipation, desire and willingness to continue to work within nursing for an extended period of time and that many nurses do intend to return to work post-retirement in both paid and voluntary capacities (Neal-Boylan et al. 2009, Palumbo et al. 2009, Eley et al. 2010).
The potential for the initiative to improve the retention of older nurses may be mitigated by several factors. In particular, the short duration and limited exposure to the LCNI are likely to hamper prospective benefits. Nurses participating in the LCNI spent only 0.20 FTE over the course of 4 months engaged in special projects. In addition, yearly participation rates of sampled nurses were low (e.g. 10.8% for 2011) indicating that participation in any given year was highly unlikely. Other factors including the specific nature of projects and the characteristics of the nurse engaging in the initiative also represented sources of potential variability in resultant outcomes. Future programme evaluation of the LCNI needs to address the role of project characteristics in determining the programme's effectiveness.
An important limitation of this study is the low response rate from late career nurses (16.15%). The low level of response presents doubts as to the generalisability of the results where sample characteristics may not be representative of the late career nurse population as a whole. We know from statistics on the general population of Ontario nurses (College of Nurses of Ontario 2012) that the survey sample had similar proportions of males (5 vs. 5.4%), was older (59.5 vs. 45.5) which was to be expected because the LCNI is only available to nurses 55 years or older, and had slightly lower numbers of nurses working full-time compared with the general Ontario nurse population (61% vs. 68.3%). An additional limitation was that only a proportion (274; 30.4%) of the total sample had actually participated in the initiative at least once limiting the availability of data pertaining to experiences with the LCNI. Finally, a longitudinal design would enable a more accurate assessment of the impact of LCNI on nurses' intentions to remain employed than a cross-sectional design. This was not possible because there was no control over which nurses participated in any given year of the initiative.
Our evaluation of the initiative provided mixed evidence of programme success. Participation in the LCNI initiative was associated with nurses' positive perceptions of their organisation's leadership and of their own sense of involvement in hospital affairs. However, the initiative did not impact levels of workplace burnout, organisational commitment, or job satisfaction experienced by late career nurses. Similarly, participation in the initiative did not appear to impact the nurses' length of service or intention to leave their current job.
It is important to note that the investigators observed a wide range of variability in the content of individual projects funded by the LCNI. One potential mitigating factor to account for the initiative's lack of influence on these measures is the overall length of time that a nurse typically spent engaged in LCNI-related projects. The relatively short and inconsistent exposure is not likely to be conducive to the realisation of the long-term gains anticipated. The LCNI projects lasted no longer than 4 months with nurses spending only 0.20 FTE engaged in the initiative. Therefore, the provision of longer, possibly year-round, projects to fewer late career nurses may improve the benefit accrued through participation in the initiative. While expanding the LCNI to increase exposure for all participants may not be financially feasible, reorganisation of the scope and timing of the initiative could potentially provide a more stable and consistent experience for those late career nurses who are involved. It is recommended that in designing initiatives for late career nurses, leaders pay attention to how nurses are selected and matched to organisational projects, the ideal length of exposure for late career nurses, and the degree to which nurses have the opportunity to select and/or design projects of interest to them.
We gratefully acknowledge Ontario's Ministry of Health and Long-Term Care for their support of this research. The opinions, results and conclusions are those of the authors. No endorsement by the Ministry of Health and Long-Term Care is intended or should be inferred.
The authors received funding from the Ontario Ministry of Health and Long-Term Care.
Ethical approval was obtained from University of Toronto Research Ethics Review Board (number 25563).