Work environment may hasten nurse retirement

Flexibility, accommodations would help

Work stress and dissatisfaction with the work environment may hasten the retirement of aging nurses, according to a study by the Center for American Nurses, an Austin, TX-based affiliate of the American Nurses Association. Almost half (47%) of 4,000 nurses surveyed said the relationship with nursing management or administration caused them to think about leaving. Nurses also cited staffing concerns and "the effect of organizational shift from patient to finance or other [issues]" as reasons they might leave.

Yet nurses said they would consider postponing retirement if they could have flexible schedules or a phased retirement with shorter hours or fewer days worked. More than one-third (37%) of the nurses surveyed said they plan to retire between 2015 and 2020.

"Most nurses retire from the bedside at 52 and from the profession at 62," says Claire Jordan, RN, MSN, president of the Center for American Nurses, noting that the average age of nurses now is 46. "We are barely six years away from looking at 50% of the nurse work force leaving the bedside."

To retain nurses, hospitals need to alter the work environment to make it more suitable for older workers, she says. "Nurses have jokingly said to me, I guess we’ll keep working if it’ll pay for our total hips and our total knees,’" she adds. "The lifting issue is a big issue for nurses."

The need for accommodations came out in focus groups conducted by the Center for American Nurses. But most nurses said administration had not made any changes in scheduling or work environment to take into account the aging work force. "Twelve-hour shifts in nurses over 52 just becomes almost impossible," Jordan points out.

Meanwhile, hospitals won’t be able to fill their nursing needs just with new recruits, she cautions. "Obviously, one of the best ways to prepare for this shortage is to prolong the working life, to change the plans for retirement. We are trying to work up an agenda for all the acute-care employers [to retain nurses]."

The aging work force also has a major impact on nursing injuries and workers’ compensation.

Here are three common ailments associated with aging — near-vision loss, arthritis, and back injuries — and examples of how hospitals can approach them:

1. Near-vision. Nurses need to see the fine print — on ID bracelets, orders, prescriptions, and labels. Yet as they age, near-vision suddenly may become a problem. At Pitt County Memorial Hospital in Greenville, NC, nurses have a vision screening every year with their TB skin tests, bloodborne pathogen education, and immunization update. In fact, the hospital is expanding the screenings into a health screen, offering glucose and cholesterol testing and a health risk appraisal.

Pitt County Memorial uses the Titmus Vision Screener to check near-vision, although a simple screen also could be accomplished with a Jaeger chart, says Pat Dalton, RN, COHN-S, occupational health project specialist. "[The screens] do help us to identify people who are beginning to have problems. We are able to identify the near-vision problems that you begin to get with aging," she says.

The job duties determine the near-vision requirements, Dalton notes. At the first sign of decreased near-vision, employee health will simply ask the employee to check on it. If the problem is more significant, it may reach an action point. Employee health would alert the manager to make sure that the vision check occurred.

Meanwhile, a quality improvement team is reviewing the use of abbreviations, such as "qid." Some will be eliminated to prevent confusion, Dalton says. The use of computers to relay orders also has reduced the risk of miscommunication. "The reading is much more legible," she adds.

2. Arthritis. Chances are, many of your employees already suffer from arthritis. And as the work force ages, those numbers increase dramatically. In 2002, some 43 million Americans had a diagnosis of arthritis, according to the Centers for Disease Control and Prevention (CDC). Another 23 million report chronic joint pain but don’t have a diagnosis, says Teresa J. Brady, PhD, OT, senior behavioral scientist with CDC’s arthritis program. "Arthritis is already in the workplace; employers don’t need to wait for the aging of the population," she explains. "But we do predict that the problems related to arthritis are going to increase dramatically over the next 25 years."

That is especially true for nurses, with an average age of 46. Osteoarthritis commonly develops between the ages of 45 and 64. "The nursing population is aging themselves into the most common point of onset for degenerative, or osteoarthritis," Brady notes.

What can you do about it? Here are some basic steps, she advises:

Minimize repetitive bending or lifting. Overuse of a joint, particularly after an injury, can increase the risk of osteoarthritis, she says. For example, repetitive knee-bending has been linked to osteoarthritis, she says.

Refer employees for evaluation if they have chronic joint pain. Rheumatoid, or inflammatory, arthritis responds well to early, aggressive medical treatment.

Offer education on arthritis. The Arthritis Foundation in Atlanta offers an Arthritis Self-Help Course at locations around the country — or (800) 283-7800. Contact the arthritis coordinator in your state health department, which has federal grant money for arthritis activities (

Encourage weight control. People who are overweight or obese have an increased risk of developing osteoarthritis.

3. Back injuries. When JoAnn Shea, MSN, ARNP, director of employee health and wellness at Tampa (FL) General Hospital, met with the senior management to ask for lift teams to reduce patient-handling injuries, she had a compelling argument. About half of the hospital’s nurses are older than 40. The hospital’s most severe injuries occurred among employees older than 45.

She presented four cases of patient-handling injuries, which cost the hospital between $350,000 and $500,000 each. Only one of the four was able to go back to work, and she had to take a non-nursing job. The others were totally disabled. All were older than 40.

The worst injury was to a nurse who was trying to move a 500-pound bariatric patient with the help of just one other employee. "It’s sad, because she was a very good nurse," Shea adds. "She tried to get help but there wasn’t enough help. She was moving the patient over to a stretcher." The nurse suffered a herniated disc, had three back surgeries, and remains disabled.

The administration approved the lift team. It costs about $200,000 in salaries and benefits per year, and Tampa General has spent about $750,000 on ergonomic equipment. The hospital has ceiling lifts in the rehab unit, skilled nursing facility, and half the rooms in the rest of the hospital.

But the investment has paid off. Workers’ compensation costs declined 29% last year. In two years, patient-handling injuries dropped by 62%. "Our lost workdays went down, our restricted workdays went down," Shea says.

Tampa General also will be able to retain nurses who may have left because of the physical demands of the job. Shea surveyed nurses to see how they felt about the lift teams. "A lot of them said, I don’t think I could continue to work without the lift team at my age. Now, my back doesn’t hurt every day when I go home.’

"If you want to keep your experienced nurses in clinical nursing, which is where the shortages occur, then we have to provide the tools for them to be able to do their job safely," she adds.