Tackle nursing shortage by attracting senior nurses

Options encourage nurses to put off retirement

As baby boomers age so does the national workforce and so does the need for health care. Both factors increase the challenge of recruiting new employees and retaining experienced employees. Although nursing school enrollment increased by 5% in 20061 home health managers look for nurses with experience as opposed to new graduates, so they must find ways to attract or keep experienced nurses.

One tactic to address the nursing shortage and the increasing workforce age is to offer employment programs that provide senior employees a reason to continue working past the age they might retire or to return to work after retiring, according to experts interviewed by Hospital Home Health.

Lee Memorial Health System in Fort Myers, FL, doesn't just claim to be a good place to work for employees over the age of 50, the health system has been recognized three years in a row by the American Association of Retired Persons (AARP) as one of the best employers for workers over the age of 50 due to innovative programs that address the needs of senior workers. Lee Memorial is one of five hospitals or health systems included in the AARP's top 10 best employers for mature workers for 2007. (For complete list, see AARP link in resource list, below.)

"We make a special effort to recruit senior nurses throughout the health system, including our outpatient surgery departments," admits Kristy Rigot, system director of human resources for Lee Memorial.

The recruitment begins with a specially designed brochure for distribution to the 3,000 volunteers throughout the health system, Rigot says. "We have found that our volunteers are an excellent source of referrals of new employees," she says. Not only have volunteers referred friends or family to Lee Memorial but many times volunteers with health care backgrounds will decide to re-enter the workforce when they see the variety of flexible employment plans offered by the health system, Rigot says. Lee Memorial also uses senior placement agencies to recruit mature workers or retirees, she adds. (See list of agencies in resource list, below.)

Flexibility is a key concern for working seniors, so Lee Memorial offers job-share positions, flex pools for nurses who want to select the number of hours they work, and 36-hour weeks that pay 40 hours of salary, points out Rigot. "If a nurse is physically unable to work three 12-hour days to make up the 36 hours, we adjust the schedule to include six- to eight-hour shifts that total 36 hours," she says.

"We have an educator position that is filled by two nurses who share the job," says Cindy Christman RN, director of Lee Memorial's home health agency. "They know the responsibilities of the position and the agency's expectations for job performance and they work out their schedule and their individual responsibilities between them," she says. It is important that if you set up a job-share situation that both employees work well with each other and that you let them decide how the job will be performed, she adds.

Programs should fit organization's needs

About 35% of Lee Memorial's workforce is over the age of 50, "primarily because we are located in an area that attracts seniors because of our weather and our quality of life," Rigot says.

To appeal to snowbirds who live in the area only six months of the year or seniors who don't want to work full-time the entire year, two seasonal employment options enable employees to work full-time during the health system's busiest months for six months, then either take six months off to return to their homes in the north or just reduce hours for up to six months to enjoy vacations, gardening, or other hobbies, she says. Both options offer employees a chance to continue receiving full benefits at the same cost as employees working full-time throughout the year, Rigot adds.

The ability to attract senior nurses or other employees might be related to your location, admits Kathy Harris, vice president of human resources at Mercy Health System in Janesville, WI.

"Our geographic area is somewhat rural, and many of our clinics are located in small communities in the southern Wisconsin and northern Illinois areas," she says. "We do compete with Madison and Milwaukee and some of the Chicago suburbs for workforce talent."

Because Mercy Health System is a large organization, there are several approaches to attract or keep mature nurses, she says. One key approach to the needs of older nurses is the low-lift program, in which equipment is provided so that there is less physical lifting, Harris says. "We offer specific education opportunities for nurses to learn about the special lifting equipment and safe patient handling," she adds. (For a list of vendors that offer special lifting equipment, see resource list, below.)

Another key program is the work-to-retire program, in which longer-term nurses can reduce hours and transition into retirement, while staying eligible for benefits, says Harris. The program allows employees age 50 and older with five years of service the opportunity to work reduced, pooled, or work-at-home schedules, she says. It also allows employees age 55 and older with 15 years of service to work seasonally, for 1,000 hours in a year at their discretion, while maintaining full part-time benefits such as health and dental insurance for the entire year, she explains.

Work-at-home options feasible for some positions

There are some positions in a home health agency that nurses with many years of experience can easily handle from home, points out Christman. "Our agency procedures require that the first contact with our agency is with an RN," she says. This means that home health nurses, not an answering service, must answer after-hours calls, she explains. "We have two senior nurses with many years of experience who handle the after-hours calls from their homes," she says. "In most cases, the nurses who are past retirement age would have retired from any other job because home visits are too strenuous but their diagnostic abilities and knowledge make them perfect for this job."

The after-hours nurses will take phone calls in which they offer support and advice to patients, make referrals to emergent care if necessary, schedule the patient for a home visit the following day, or just talk the patient through their symptoms and answer questions, says Christman. There is no need for the after-hours nurses to come in to the office; they check in the following morning to let the supervisors know which patients require home visits or update supervisors on patient or physician calls, she explains.

Having the after-hours nurses work at home has enabled them to enjoy a more relaxed, semi-retired life without fully retiring and without giving up benefits, says Christman. "The benefit to our agency has been the ability to retain existing nurses with a great deal of knowledge," she adds.

Christman's staff represent more mature nurses, with the majority of nurses between the ages of 50 and 60, having at least 10 years in home health.

"The experience is critical," says Christman. "We only hire nurses with some home health experience and most have a long history of acute care nursing prior to their home health positions," she adds. "We don't have time to train a new graduate, so we want to offer a variety of options that will help us retain the experienced nurses we have."

Ask employees to ID important issues

Because it is important to find out what is important to employees before developing retention strategies, Lee Memorial conducts both a health system-wide annual employee survey and monthly surveys with employees chosen at random.

"Results of both types of employee surveys show that, regardless of age or experience, salary levels are not an indicator as to whether an employee will stay at Lee or not," says Rigot.

"Salary levels do attract new employees, but our employees say that input into decisions affecting their jobs, resources that enable them to do their job effectively, and the opportunity to grow and develop are the reasons they choose to stay," says Rigot. To address their interest in furthering their education or developing new skills, Lee Memorial offers three types of educational assistance that appeal to senior workers, she points out. "We reimburse tuition for nurses who are going back to school to earn another degree; we also pay for a nurse refresher course for nurses who want to re-enter the workforce after time off, and we offer educational grants for one-time courses," she explains.

As you evaluate your employment options for senior employees be sure to keep their specific needs in mind, suggests Rigot. "Our senior nurses want meaningful work, the ability to set their own schedules, a position that matches their lifestyle, and the opportunity to maintain benefits," she says. In fact, managers work with senior nurses to ensure that they don't lose social security benefits while they work, Rigot says.

"We have nurses who are job sharing and must keep track of their hours so that they don't work over the limit allowed for retention of social security benefits," she says. "When one of the employees gets close to the limit, managers rearrange schedules to help the employee avoid going over the limit."

It isn't difficult to develop employment options that are attractive to experienced employees, Harris says. "One very important tip is to ask the staff what kind of programs would help them stay in the work force longer," she says. "The answers to this will give you a great foundation to design programs that meet the needs of your staff."

While it is important to look at best practices and identify many different options that are being used by other employers, pick the ones that fit your organization, Harris suggests. (For ideas from other employers, see AARP link in resource list, below.) "Not all best practices work in all settings," she says. "Always ask employees what is important to them."


1. American Association of Colleges of Nursing's Annual Survey of Institutions with Baccalaureate and Higher Degree Nursing Programs, December 2006.


For more information about recruiting and retaining senior nurses, contact:

  • Kathy Harris, vice president of human resources, Mercy Health System, Janesville, WI. Phone: (608) 756-6000.
  • Kristy Rigot, system director of human resources, Lee Memorial Health System, 2776 Cleveland Ave., Fort Myers, Fl. 33901. Phone: (239) 772-6578. E-mail: kristy.rigot@leememorial.org.

To learn more about recruiting older employees, contact senior placement agencies such as:

  • Experience Works, a national agency that pairs low-income seniors with employers. 2200 Clarendon Blvd., Suite 1000, Arlington, VA 22201. Phone (866) 387-9757. E-mail: info@experienceworks.org. Web site: www.experienceworks.org. Operation ABLE: Coaching and referral service; provides counseling to employers interested in retaining and attracting older workers. ABLE stands for "ability based on long experience." 131 Tremont St., Suite 301, Boston, MA 02111. Phone: (617) 542-4180. E-mail: able@operationalable.net. Web site: www.operationable.net. Senior Community Service Employment Program (SCSEP), part of the AARP Foundation, helps financially eligible individuals 55 and older remain in or re-enter the workforce. Provides training for workers and referrals for employers. National office phone: (202) 434-2020; state SCSEP offices located nationwide. To find a local office, visit the AARP SCSEP web site at www.aarp.org/scsep.

For a free complete listing of AARP Best Employees for Workers Over 50 as well as descriptions of innovative programs, go to: www.aarp.org/money/careers/employerresourcecenter. Under "Best Employers for Workers Over 50," click on "Honored in 2007."


For more information on low-lift products, contact the following manufacturers:

  • Hovermatt patient repositioning products. Manufactured by HoverTech International, D.T. Davis Enterprises, 513 S. Clewell St., Bethlehem, PA 18015. Phone: (800) 471-2776. E-mail: hovermatt@earthlink.com. Web site: www.hovermatt.com.
  • EZ Lift battery/electric patient lifting systems. Manufactured by Kinetic Concepts, 8023 Vantage Drive, San Antonio, TX 78230. Phone: (800) 275-4524. Web site: www.kc1.com. For information on EZ Lift, select "bariatric support" in the left navigational bar.
  • Ergo Slide no-lift patient transfer systems. Manufactured by ErgoSafe Products. 2351 Grissom Drive, St. Louis, MO 63146. Phone: (866) 891-6502. Web site: www.ergosafe-products.com.