Retaining an Aging Nurse Workforce: Perceptions of Human Resource Practices

Mary Val Palumbo; Barbara McIntosh; Betty Rambur; Shelly Naud

Nurs Econ. 2009;27(4)

Introduction

The Large Baby-Boom generation is slowly, yet steadily, aging and entering a time in which demand and utilization of health care typically increases (Garrett & Martini, 2007). The resources of health care organizations, including human resources (HR), will be strained as this large demographic cohort moves eventually into old age (Kovner, Jones, Zhan, Gergen, & Basu, 2002; Kovner, Mezey, & Harrington, 2002; Mion, 2003; Schofield, Page, Lyle, & Walker, 2006). Registered nurses are central to providing health care; thus, the retention of RNs, who are themselves aging, is a key policy imperative (Buerhaus, Staiger, & Auerbach, 2000b). This is particularly important in rural areas because of the heightened challenges of recruiting and retaining an adequate supply of rural nurses. Almost a quarter of the U.S. nurse workforce live and work in rural settings (Cramer, Nienaber, Helget, & Agrawal, 2006; University of Washington Rural Health Research Center, 2007).

To develop evidence-based older RN retention strategies, 583 RNs in 12 health care organizations that serve rural populations completed a survey entitled "Your Valuable Career Plans: Guidance for You and Your Employer." Policies and practices most important to nurses' decisions to remain in their organization and the extent to which their organizations currently engaged in these practices were identified. As such, this study provides an indicator of progress or lack of progress in addressing older nurse recruitment and retention and also offers guidance for differentiating policies and practices for younger and older nurses.

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Table 1. Demographics
Gender
95% female
Position
76% reported their major activity was patient care
Hours
53% worked full time
Mean hours per week:32 hours
Age
Average 49.7 years
55+ years	33%
40–54 years	51%
< 40 years	16%
Education
Highest nursing degree
Diploma	19%
Associate's	42%
Bachelor's	34%
Master's	5%
Doctorate	0.1%
Highest non-nursing degree
Diploma	10%
Associate's	11%
Bachelor's	17%
Master's	4%
None	57%
Employer
Hospital	61%
Nursing home	1%
Home health	38%
Mean years in organization	12.6 years
Mean years in position	8.8 years

Table 2. Intent to Stay
Intention to stay working			13.9 years (Mean)
Intention to stay working as a nurse			12.4 years (Mean)
Intention to stay with present organization			8.8 years (Mean)
Intention to stay in current position			7.5 years (Mean)
Age of planned retirement			63.9 years (Mean)
Do you plan to continue working in nursing after retirement?
Yes:16%	Maybe:42%	No:19%	Don't know:22%
If yes: Full time 4%	Part time 86%	Paid 57%	Unpaid 16%

Table 3. **Organizational and Unit-Level Culture Regarding Older Nurses** (All questions answered on a 5-point Likert scale with (1) negative to (5) positive, means are reported.)
1.	How important is the issue of the aging of the nursing workforce for your organization? (Mean 3.72;1 = Not at all important)
2.	How effective do you feel your hospital/agency is in recruiting of nurses over 50 years? (Mean 2.458;1 = Not at all effective)
3.	Rate how well your hospital/agency is doing in retaining nurses >50 years. (Mean 3.161;1 = Very poorly)
4.	How active is your unit in recruiting/retaining nurses >50 years? (Mean 2.547;1 = Not at all)
5.	How actively is your unit working to retain nurses age >60? (Mean 2.236;1 = Not at all)
6.	How open are individuals in your unit to working with nurses age 50–59? (Mean 4.316;1 = Not at all open)
7.	How open are individuals in your unit to working with nurses age >60? (Mean 3.973;1 = Not at all open)

Table 4. Nurses'Perceptions of Human Resource Practices and Policies
Importance to Your Decision to Remain (Mean response on a 3-point Likert scale:1 = Not at all, 2 = Some, 3 = Highly)
1.	Recognition and Respect (2.712)
2.	EmployeeVoice (2.710)
3.	Performance Evaluation (2.60)
4.	Compensation (2.57)
5.	Employee Health and Safety (2.56)
6.	Job Design (2.475)
7.	Training and Development (2.41)
8.	FlexibleWork Options (2.31)
9.	Retirement Options (2.13)
10.	Recruitment of Older Nurses (1.68)
Practices Currently Being Done (Mean response on a 3-point Likert scale:1 = Not at all, 2 = Some, 3 = Highly)
1.	Employee Health and Safety (2.30)
2.	Performance Evaluation (2.25)
3.	Recognition and Respect (2.18)
4.	EmployeeVoice (2.17)
5.	Training and Development (2.07)
6.	FlexibleWorking Options (2.00)
7.	Job Design (1.92)
8.	Compensation (1.74)
9.	Recruitment of Older Nurses (1.72)
10.	Retirement Options (1.63)
Greatest Difference Between Importance and What Is Being Done (All specific practices in the broad area of compensation.)
1.	Offering incentives for continued employment (2.54/1.65)
2.	Increasing financial compensation (2.63/1.82)
3.	Improving benefits:More vacation (2.53/1.65)

Table 5. Areas to Consider for Improving Recruitment and Retention of Older Nurses
Staffing. Are older nurses actively brought into the organization? Are older nurses actively being encouraged to stay? Are staffing levels appropriate to reduce the stress on all nurses? Development. Are older nurses encouraged to not only update job skills but also explore new areas? Are there opportunities to advance or change specialties? Are nurses encouraged to make 5-year career plans and set goals for accomplishing these plans? Work design. Are jobs designed for maximum effectiveness and efficiency? Are nurses encouraged to examine their job responsibilities and propose adjustments or redesign? Are flexible working options available? Are pre and post-retirement options available? Feedback/Recognition. Are nurses regularly told by administration how they are performing on the job? Are they recognized for their achievements? Compensation. Are reward systems competitive? Are benefits regularly reviewed for attractiveness to different age cohorts? Culture. Are nurses given voice? Are experienced nurses recognized? Do older nurses, in turn, demonstrably support the unique contributes and values of their younger colleagues? Are recognition and respect valued and reinforced in and throughout the organization?

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