Aging of RN work force raises concerns of injury, future nursing shortages

By 2010, 40% of nurses will be over 50

The work force of registered nurses is aging rapidly, a demographic shift that raises the stakes for occupational injuries. Older nurses are more prone to back injuries and chemical sensitivities, nursing experts say. Moreover, they will face the usual effects of aging, including reduced muscle strength, changes in vision, and possible worsening of chronic conditions.

Within 10 years, the average age of registered nurses will rise to 45.4, with 40% of the work force older than 50, according to an extensive review of population data that was published recently in the Journal of the American Medical Association.1 The gradual aging of the work force won’t reverse until about 2020, when older RNs begin to retire — at which time hospitals may encounter significant shortages, researchers found.

"There’s been a big shift in a short period of time," says lead author Peter Buerhaus, PhD, RN, associate dean for research at the Vanderbilt Univer-sity School of Nursing in Nashville, TN. "The proportion of RNs under the age of 30 has declined from roughly a third of the work force to about 10%. The number has dropped by 41%, while for all other occupations in the country, the number of workers under 30 has dropped by just 1%."

The reason for the shortage, says Buerhaus, is that younger women are opting for other careers and are not entering nursing programs. Expanded associate-degree nursing programs largely have attracted women in their 30s who were starting second careers, says Buerhaus. He notes that although more men are entering nursing, the field remains more than 90% female. Therefore, the analysis of the changes in the work force largely focuses on women.

Those patterns were apparent in a study of the Minnesota Nurses Association (MNA) Pension Plan, which covers about 7,000 nurses in Minnea-polis and St. Paul. In 1977, two-thirds of RNs in the pension plan were under the age of 35. By 1998, 79% were older than 35, and almost 40% were 45 or older. (See charts, pp. 111 and 112.)

"We were pretty startled when we saw those numbers," says Andrew Calkins, a data analyst with the MNA. "It was only five years ago that most of the hospitals in the twin cities were telling new grads not to bother applying [due to restructuring and downsizing]."

Muscle mass, strength decline with age

Older nurses are likely to be highly experienced and skilled in specialties. They are mentors and leaders. Yet they also may be more vulnerable to the occupational hazards in health care.

After age 40, muscle mass and strength begin to decrease, with a significant decrease in the 50s. One study found marked decreases in the strength of knee and hip joints, making it virtually impossible for half of older women in the study to lift any weight from certain postures. A change in posture increased the weight limit, but their lifting capacity remained much lower than for younger women.2

Such findings highlight the importance of ergonomic programs, including lift teams and special equipment, says Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester and a leading ergonomics expert. "It’s been well-documented that low back pain and injury prevalence rates increase
as people get older," says Fragala. But there are other consequences of reduced physical capacity, as well, he says.

"The same population is going to fatigue much more rapidly, which can result in additional stress in the workplace," he says. "As we consider ergo-nomics and the redesigning of patient handling and lifting tasks, this will become more important as the work force ages."

Injuries caused by patient handling already present a tremendous burden, notes Fragala. In 1998, according to data from the Bureau of Labor Statistics, 10.5% of all occupational back injuries were associated with patient handling.

"We know we have a major problem right now," he says. "We can project that, with an aging work force, if we continue to do things as we’re doing them now, the problem is going to get worse."

Improved posture only increases the potential lifting strength modestly. The better answer lies with new devices that in many cases make lifting unnecessary, Fragala says.

For example, special beds allow patients to move to a sitting position without manual assistance. Standing is also easier from this sitting position. "We can reduce the risk to the worker, and we can improve the situation in the future for this aging work force," he says.

While muscle strain and back injury are the most obvious hazards that rise with aging, they are certainly not the only ones. A host of bodily changes that begin in the 40s and 50s can cause subtle or more substantial impairments.

Time itself has an impact. The longer an individual is exposed to chemical substances, such as latex, the greater the likelihood that she will develop a sensitivity, says Marie Mangino, MSN, CRNP, CS, a gerontological nurse practitioner and president of Vincent Healthcare,
a clinical education specialty firm based in Erdenheim, PA. "Some people build up an allergy to latex over time due to prolonged exposure to a variety of latex-containing products in health care."

At the same time, other chemicals, such as cleaning solutions, can become more irritating. "Many people develop multisensitivities," says Susan Wilburn, RN, MPH, senior specialist for occupation safety and health with the American Nurses Association in Washington, DC. "The older you are, the more exposures you will have had."

Meanwhile, physical changes gradually make day-to-day tasks more difficult.3 For example, with changes in vision, bright fluorescent lights can cause a lot of glare, and the tiny print on medication labels may be more difficult to read. "It would be a very good idea to have a lamp on the cart to provide a light" as nurses read labels, says Mangino. "The light shines down but doesn’t shine on her face, producing glare. It’s a simple solution." Better lighting along with larger print on forms and labels could cut down on the risk of errors, she says.

After years of long hours on their feet, older nurses may suffer leg or feet pain and may fatigue more easily. Then there is a host of other health problems that can emerge, from high blood pressure to stress incontinence — or an urgency to urinate frequently.

While those may not be specifically work-related, employee health services can provide education and wellness programs that will improve the health and productivity of older workers. For example, blood pressure can be controlled through frequent monitoring, diet, and medication; stress incontinence can be managed with biofeedback and medication.

Exercise, whether it’s in a gym in the hospital or a simple lunch-hour walking program, can improve stamina and promote other health benefits, says Mangino. "It’s a fallacy to think that because we’re older we can’t rebuild that muscle. Even into the old, old years you can regain muscle."

Keeping older workers healthy ultimately will be cost-effective for hospitals, nursing experts say. These experi-
enced, committed workers will become even more valuable amid a looming nursing shortage. The nursing work force is not projected to be large enough to meet the increased health care needs of an overall aging population, says Buerhaus.

"In the future, we’re actually seeing a reduction in the supply of nurses at the same time that demand will be increasing," he says. "This hasn’t happened before."

Staffing concerns can’t be separated from the issues of employee health and patient safety, asserts Cheryl Peterson, RN, ANA senior policy analyst. "We need a culture change in our hospitals. We need a whole new culture of care — one that values nurses, values their occupational safety and health, and values patient care." 


  1. Buerhaus PI, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. JAMA 2000; 283:2,948-2,954.
  2. Chaffin DB, Woolley CB, Buhr T, Verbrugge L. "Age effects in biomechanical modeling of static lifting strengths." In: Rogers WA, ed. Designing for an Aging Population. Santa Monica, CA: Human Factors and Ergonomics Society; 1997, pp. 61-64.
  3. Mangino M. The aging employee: Impact on occupational health. AAOHN Journal 2000; 48:349-357.