Why doesn’t experience pay?

Hospitals should pay more attention to older nurses

There’s a nasty story going around in the Youngstown, OH, area. Nurses at an area hospital found out that new hires were getting paid more than those who had considerable experience. "They threatened to resign en masse so that they could hire on and get the higher salary," explains Dorcas Fitzgerald, DNSc, RN, CNS, professor and RN track coordinator at the Department of Nursing at Youngstown OH State University. "But the administration said if they tried to come back, they would have to start at the salary at which they left. These women weren’t asking for more money, just for parity with what the new hires were getting."

It’s not the only such story about how hospitals are neglecting their older more experienced nurses in the pursuit of new graduates. "I took a poll of hospitals in our area and administrators just don’t have this on their radar," says Fitzgerald. "New grads are getting $21.26 per hour, but experienced nurses are only getting $23 per hour. Only one hospital has realized that the other nurses are hurting because of these issues. They are offering the same kinds of bonuses to existing nurses that they give as signing bonuses to new hires."

It’s not just the monetary differences that hurt experienced nurses, although Fitzgerald emphasizes that such lack of parity or reward for experience hurts both financially and emotionally. Hospitals are also slow to recognize that older nurses may have a great deal to offer at the bedside, but increasing difficulty in meeting the physical demands of that work. They can’t work three 12-hour shifts in a row any more, they can’t see as well as they used to, they can’t lift as much as they used to be able to lift. "A recruiter told me that two nurses who had retired were allowed to come back at reduced hours during busy times and it was working well. But no one thinks about using the older nurse as a part time worker."

What is the risk of having only a new nurse on the floor? Susan Letvak, PhD, RN, an assistant professor of adult health nursing at the University of North Carolina in Greensboro tells another nightmare story of three new grads working in an ICU when the patient went into cardiac arrest. "They all looked at each other," she says. "None of them knew what to do. That could be you or your family member. The knowledge a nurse has after years of experience is lost when they aren’t at the bedside."

The beds are all filled and the acuity level of patients is so high in hospitals, Fitzgerald says, that "experience is an absolute necessity to provide high-quality care."

Not doing anything to keep older nurses happy and employed could certainly come back to haunt a hospital, says Letvak, who has done research on the plight of older nurses. "At around 50 to 55, nurses stop working. By 2010, the average age of a nurse will be 50. But if we don’t want to have serious shortages, we need to keep them working until they are 65."

Hospitals need to stop thinking that "a nurse is a nurse is a nurse," says Letvak, with no recognition of the value of experience or the problems an older nurse may face in staying at work. "Older nurses feel that by and large, administrators would rather have them gone: they cost too much, they are more vocal, and they are more resistant to change." But with a long shortage ahead and research continuing to link the quality and level of nurse staffing to errors, morbidity and mortality, and outcomes for patients, keeping those older nurses on staff is increasingly important, Letvak says. "To prevent an immediate crisis, enrollments at nursing schools have to increase by 40% immediately. But that’s not going to happen. We don’t have the funding or the places for those applicants. So we have to retain our existing nurses past the age of 50."

Answers are at hand

What to do is relatively simple, Fitzgerald says. "It wouldn’t be hard or even expensive to do some things that keep those nurses working. Give them recognition. Give them parity. If you don’t, you are just proving you don’t value them."

Find ways to reduce their hours without reducing benefits, continues Fitzgerald. "That way, you lower turnover." Look at the work environment and see how it meets or doesn’t meet the physical needs of your nurses.

"It’s funny because international recruitment and traveling nurses cost so much," says Fitzgerald. "Why don’t hospitals take that money and use it to find ways to help existing nurses stay in their job? Maybe older nurses aren’t interested in on-site childcare. But they probably have an opinion about elder care. They might be interested in what academic institutions they work for can do in terms of tuition reduction for their college-age children."

In her research, Letvak says while nurses always say that money is one of the top things to keep nurses working, it’s not the number one item. "Respect and value are number one, and unless an older more experienced nurse is in administration or education, they don’t feel they get any respect. They could have worked at a hospital for 30 years, but they still work every other weekend, they don’t get any more vacation than their new grad counterparts, and they don’t even have a better parking spot. They’re still stuck taking a shuttle bus on a wintry morning."

Letvak says shorter shifts — four or five hours — or giving older nurses days off between longer shifts can help improve working conditions for them. Offering benefits for part-time hours can also keep them working. "In industry like GE and Ford, you see a trend towards part-time retirement where once workers reach age 62, they can work part time and still get some of their retirement benefits. I’d like to see that in health care, but it’s unlikely to happen unless it’s mandated."

Letvak’s research finds a real disconnect between the inaction of hospitals and what hospital executives say about older nurses. "Ninety percent of them say they want those older more experienced nurses to stay on staff, but 96% say they have no plan in place to do that and aren’t even thinking about it."

Perhaps the best thing a nursing manager, supervisor, or director can do is talk to their older nurses, find out what they need and what they want, says Donna McNeese-Smith, RN, EdD, Associate Professor and Coordinator of Nursing Administration Graduate Program at UCLA. Her research of older nurses has found that nurses seem to become more disengaged from their job the longer they are in it. While that might be due to a lack of respect or poor pay, McNeese-Smith says her research indicates that nurses like to have variety in their job.

Statistics aside, McNeese-Smith thinks that there are a lot of unique situations among individual nurses. "Organizations have to create situations that makes it desirable to sustain more experienced nurses in their positions," she says. "Young kids require different needs than someone who is 60 with health care problems."

Every nurse executive and manager should see the satisfaction of every nurse as a primary responsibility, she says. "If we are going to have good quality patient care at reasonable cost, then we have to focus on the needs of our nurses. Organizations have to believe that one of the most important jobs of the nurse executive and managers and directors is to create an environment in which it is enjoyable to work and possible to give good care."

Which brings McNeese-Smith to her catch-all solution for meeting the needs of older nurses: talk to them and find out what they want and need. "I recommend that managers meet regularly with each nurse — every quarter at least — to help the nurses set goals and plan for their future. That should be a major responsibility of every manager."

Further reading

  • Age, developmental, and job stages: Impact on nurse outcomes. McNeese-Smith DK, van Servellen G. Outcomes Management for Nursing Practice, 2000;4(2), 97-104.
  • Job stages of entry, mastery, and disengagement among nurses. McNeese-Smith, DK. J Nurs Admin, 2000;(3), 140-147.
  • The experience of being an older staff nurse. Letvak S. West J Nurs Res 2003 Feb;25(1):45-56.
  • Retaining the older nurse. J Nurs Adm 2002 Jul-Aug;32(7-8):387-92.
  • Myths and realities of ageism and nursing. AORN J 2002;75(6): 1101-7.


• Dorcas Fitzgerald, DNSc, RN, CNS, Professor and RN Track Coordinator, Department of Nursing, Youngstown State University, One University Plaza, Youngstown, OH 44555. Telephone: (330) 941-1794.

• Susan Letvak, Ph.D., RN, Assistant Professor of Adult Health Nursing, The University of North Carolina at Greensboro, Box 26170, 207 Moore Building, Greensboro, NC 27402. Telephone: (336) 256-1024.

• Donna McNeese-Smith, RN, EdD, CNAA, Associate Professor and Coordinator of Nursing Administration Graduate Program, UCLA. Telephone: (310) 794 2142.