Work Ability among Older Nurses

As the U.S. workforce ages, many older nurses continue to work in direct patient care. However, by 2030, an estimated 1 million nurses will have retired from the workforce (Buerhaus, Skinner, Auerbach, & Staiger, 2017). The known safety and health hazards for nurses in direct-care positions could be even more dangerous for older workers. Nursing care requires physical tasks with repeated bending, lifting, and twisting that can lead to musculoskeletal disorders (MSD). On average, nurses lift 1.8 tons during an 8-hour shift in the clinical setting, contributing to the estimated 35–80% lifetime prevalence of back injury (Nelson & Baptiste, 2004). Other occupational risks of concern for older nurses include stress, sharps injuries, violence, and shiftwork. While all workers over 50 years have shown reduced tolerance for shift work, female nurses may be at greater risk for decreased work ability and increased illness with aging (Costa & Sartori, 2007).

Given the lack of literature on aging nurses’ work ability, researchers from the NIOSH-funded New York and New Jersey Education and Research Center explored the work-related barriers and facilitators influencing work ability in older nurses. The results were published in the Western Journal of Nursing Research.

The research was guided by a NIOSH Organization of Work framework, with the questions examining both work context, which includes characteristics of the job like work tasks and roles, and organizational context, such as workplace practices and policies. In terms of work context, discussion of work-level factors and specifically individual- level factors affecting work ability received the most robust responses. Nurses revealed that the joy of direct patient care and the human connection from the patient-nurse relationship were among the top individual themes for work ability. Nurses noted that the relationships and connections to patients and families were strong reasons for staying in direct care versus working in administration or in an advanced practice role. Working a preferred shift and schedule and schedule flexibility were identified as major factors for continuing work.

Other aspects of the job that increased nurses’ ability to work included having a work environment filled with camaraderie and teamwork as well as comfort with interdisciplinary staff (e.g., attending physicians, residents, therapists). The increased use of technology and electronic medical record keeping were listed as perceived barriers to work ability, although this varied among the participants. Nurses identified health issues, such as knee replacement surgery, as one barrier to work performance—especially when it came to their desire to continue working in the future. Most said they expected to continue working for 5–10 more years.

At the organizational level, the biggest factor affecting work ability was being “heard” by management. Nurses listed a supportive management and organizational structure as facilitators to continuing to do their work. Many participants could not identify any policy or practice that was implemented in their organization to assist aging workers.

For this study, researchers interviewed 17 female registered nurses by phone or in person between August 2017 and March 2018 at one large academic medical center. Most participants were white, their average age was 59, and they had spent about 34 years on the job. Because of the limited number of participants, future research needs to reflect a wider population and range of healthcare systems. While more research is needed, these findings support the need for managers of aging nurses to focus on their schedules, workload, and enhancement of overall health to ensure that nurses can safely continue their jobs for as long as they wish to continue working.

Amy Witkoski Stimpfel, PhD, RN, is an Assistant Professor at the New York University, Rory Meyers College of Nursing.

This blog is part of a series hosted by NIOSH to commemorate nurses during the Year of the Nurse. The views expressed by guest authors do not necessarily reflect the views of CDC or NIOSH.

Other blogs in the series include:

• Year of the Nurse
• Managing Fatigue During Times of Crisis: Guidance for Nurses, Managers, and Other Healthcare Workers
• Nurses’ and Other Health Professionals’ Wellness and Safety Resource Update
• Surgical Smoke Inhalation: Dangerous Consequences for the Surgical Team
• Safety Culture and Health Care
• The Unique Occupational Environment of the Home Healthcare Worker
• Can Exoskeletons Reduce Musculoskeletal Disorders in Healthcare Workers?
• Preventing Needlesticks and Sharps Injuries: Reflecting on the 20th Anniversary of the Needlestick Safety and Prevention Act
• Celebrating Nurses

The NIOSH Education and Research Centers are funded by NIOSH through the Office of Extramural Programs.

References

Buerhaus, P.I., Skinner, L.E., Auerbach, D.I., & Staiger, D.O. (2017). Four Challenges Facing the Nursing Workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46.

Costa, G., & Sartori, S. (2007). Ageing, working hours and work ability. Ergonomics, 50(11), 1914-1930.

Nelson, A., & Baptiste, A. (2004). Evidence-based practices for safe patient handling and movement. Online Journal of Issues in Nursing, 9(3), 4.