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Dealing with reality: Confronting the global nursing shortageRetaining older nurses: One key to easing the nursing shortage by Jennifer Joynt Everyone is struggling with how to maintain wisdom in the organization. —Linda Burnes Bolton, chief nurse executive
A critical driver of forecasted nursing shortages throughout the United States is the large wave of nurse retirements expected to affect hospitals significantly over the next 20 years. As with the rest of the U.S. population, the nursing workforce is aging at a rapid rate. The average age of registered nurses employed in hospitals has risen from 41 in 2002 to 48 in 2006. Even more troubling, 45 percent of hospital-employed RNs in 2006 were at least 50 years old, and only 12 percent were 34 or younger (Buerhaus, Donelan, Ulrich, Desroches, & Dittus, 2007). Analysis conducted by the U.S. Bureau of Labor Statistics (BLS; 2003-2004) shows that, starting at age 50, nurses begin to leave the workforce permanently in large numbers. The permanent separation rates reported by the BLS, by age group, are as follows: 17 percent for the cohort aged 50 to 54, 29 percent for age 55 to 59, and 60 percent for age 60 to 64. To discourage large numbers of experienced nurses from retiring, many hospitals are beginning to ask what would help extend employment of older RNs. A couple years ago, the University of Pittsburgh Medical Center (UPMC) Health System in western Pennsylvania conducted an internal survey of nurses age 40 and above to learn what would make them want to work to an older age. From the responses given by the 900 nurses who completed the survey, two main themes emerged. First, nurses wanted changes to the physical environment. Nursing is a physically demanding job that traditionally requires lifting and moving heavy patients, lots of bending over and significant walking during a shift. All these elements become more difficult as nurses age. Second, nurses noted the importance of scheduling flexibility and phased retirement options for extending their working years. In terms of scheduling, many nurses and nurse executives think the typical 12-hour shift is too long for older nurses, and they worry about the ability of older nurses to focus and deliver high-quality patient care for 12 straight hours, especially during the night shift. Retaining wisdom: Strategies to keep and optimize older nurses 1. Changing the physical work environment. To make the job of nursing less demanding physically, many hospitals are deploying lift teams and lift devices to move patients. In response to high numbers of back injuries and worker compensation costs resulting from patient-handling injuries, Central Baptist Hospital in Lexington, Kentucky, installed patient lift devices over each patient bed in two pilot units. The Seton Family of Hospitals in Austin, Texas, is in the process of implementing a “no lift” environment based on the O’Shea program developed in Australia. See http://www.nolift.com/nolift.htm Some hospitals are decreasing the distance nurses walk each shift by creating more nurse stations.When planning a new hospital, the executives of Memorial Hospital for Children in Colorado Springs, Colorado, designed a hospital that offered a better work environment for older nurses. The average age of nurses at Memorial is 47. Memorial CNO June Chan explains, “Rather than the traditional ‘racetrack’ of a nursing unit, our new facility was designed based on the concept that a nurse (or family member) will not have to walk more than the length of one Suburban [a sport utility vehicle] from the nurse’s station to a patient’s room. 2. Allowing for flexible scheduling and phased retirement. To increase older-nurse retention, many hospitals are offering shorter shifts—most commonly eight hours but sometimes four hours—and different start times. UPMC Health System is piloting a phased retirement program—“Life Stages”—to increase retention of nurses nearing retirement age. Life Stages gives nurses a reduced work schedule (28 hours of direct care and four hours of indirect care), full-time benefits, preference of work shifts and optional six-week breaks. To be eligible for the program, nurses must be 60 years or older, have 20 years of service at UPMC and a good performance record. Ten nurses are currently enrolled in the program at two pilot hospitals, and UPMC is beginning to evaluate the impact of the program. Preliminary feedback suggests that enrolled nurses are pleased with the program, especially the ability to get the shifts they want. In addition, nurses in the 54-to-59 age group have expressed significant interest in the program. 3. Rewarding experience and loyalty. After years of focusing financial incentives on newer, younger nurses, some hospitals are beginning to create incentives and rewards for long-term employees. One has created financial incentives for nurses to work beyond their retirement eligibility age; nurses receive a bonus for each additional year of service. Another has expanded its compensation bands to allow nurses to receive additional increases in compensation after 10 years of employment. This policy helped increase retention by directly addressing older-worker concerns that pay increases were going to younger nurses. 4. Keeping the job interesting. For those individuals with a long career in nursing, job burnout is a real possibility. To encourage nurses to stay with their organization for many years, some hospitals are developing programs to keep nurses engaged and challenged in their jobs. Cedars-Sinai Medical Center in Los Angeles, California, offers Career Float, a program for all benefit-receiving workers that allows nurses to rotate to three or more areas around the hospital. Float nurses first attend an immersion program that trains them in both theoretical and clinical aspects of given units and roles. With this program, Cedars-Sinai is able to spread the wisdom of experienced nurses throughout the hospital, and the nurses benefit by learning new skills and working in new environments. Cedars-Sinai also offers a modified work-duty program that allows nurses to work on short-term projects such as collecting data and performing observations for a medication safety study. Beyond simply retaining older nurses, forward-thinking hospitals are also focusing on how best to leverage the knowledge and experience of these nurses. Interesting strategies here range from using seasoned nurses as mentors and teachers to bringing back retired nurses to staff special projects. At Cedars-Sinai Medical Center, older nurses can serve in a mentor role to novice nurses or nurses in transition. Using this model, the standard patient caseload of one nurse is handled by two nurses, enabling the more experienced nurse to provide hands-on training and guidance for the less experienced one. This program not only offers a great way for Cedars-Sinai to train new nurses, it also helps the center reduce its new-graduate turnover rate from 22 percent to 2 percent (during the first year of employment). Shands Hospital at the University of Florida offers a post-retirement program—SAGE Nurses—through which Shands hires retired nurses with at least 15 years of experience on a contract basis to help with special programs and projects. The SAGE Nurses program allows Shands to benefit from the knowledge of these workers while also reducing the time staff nurses need to devote to these projects. A multipronged approach
Nurses are individuals who value incentives and programs differently, so the best approach to retaining older nurses involves development of a variety of programs and initiatives. At a minimum, all hospitals should consider changes to their physical environments as well as implementation of part-time schedules and shifts, financial incentives, and mentoring and teaching programs. As Melanie Heuston of UPMC Health System put it: “There’s not one answer to this problem. There’s a whole bunch of answers.” The negative impact of older RNs exiting the workforce is only going to become more evident over time, so hospital administrators must immediately begin developing strategies to retain these nurses. As nurse staffs become younger and less experienced, retention of older, more experienced nurses to mentor and develop the newer nurses becomes critical. And there’s a bonus for hospitals that address these issues: Many of these strategies benefit not only older nurses, but younger nurses as well, and increase retention of nurses in all age groups. RNL Jennifer Joynt is a senior consultant at Health Workforce Solutions, LLC, in San Francisco, California, USA. She may be reached by e-mail at jenj@healthws.com. References: Bureau of Labor Statistics. (2003-2004). Occupational projections and training data. |
Do you know your nurse-retirement vulnerability? What is the average age of your nursing staff? How does your staff break down by age group?