Saturday August 23rd 2014

“The go-to nurses”
Finding ways to keep long-time RNs

Until several weeks ago, Kathryn DeSenze, BSN, RN, worked full time as a staff nurse on a 36-bed telemetry unit. A nurse for 32 years, she often served as the resource (charge) nurse during her shift while carrying a full patient-load. She also helped case managers with patient discharges and consulted on wound care when needed.

She never envisions herself completely retiring from nursing, but currently is looking for a less physically taxing, less stressful role — perhaps as a legal consultant.

“I wish facilities would do something more for older nurses,” said DeSenze, an Ohio Nurses Association member. “Zero in on our talents and experience, open more doors for us to different opportunities.”

Kentucky Nurses Association (KNA) member Carol Komara, MSN, RN, actually did retire from her job as a staff development specialist at the University of Kentucky Medical Center in 2006. That was after a nursing career that also included working in labor and delivery, establishing her own prenatal education practice, and serving in management and then nursing education roles.

“I retired one day and had offers for five different jobs within a week,” said Komara.

But she resisted those possibilities.

Then about two years ago, Karen S. Hill, DNP, RN, NEA-BC, FACHE, vice president and nurse executive at Central Baptist Hospital in Lexington, KY, and KNA member, called Komara with an offer she couldn’t refuse.

Now Komara uses her own experience and knowledge to counsel nurses at Central Baptist who want to alter their career paths.

It’s a win for everyone. The hospital gets an experienced nurse to lead a program that helps retain nurses at every stage of their careers. Staff nurses get solid career counseling and help making job changes. And Komara stays involved in nursing, generally working only a few hours a month.

Yet she knows that there are health care facilities that don’t make it easy for older nurses (also called seasoned, long-term, mature, or veteran nurses) to continue in the profession or move on to other roles.

And that could spell trouble considering the future needs of the nation and its aging population.

Shifts in the older workforce

The average age of the all licensed RNs increased to 47 years old in 2008, from 46.8 in 2004, according to the National Sample Survey of Registered Nurses issued September 2010 by the Health Resources and Services Administration. Further, nearly 45 percent of RNs were 50 or older in 2008, a sharp increase from 33 percent in 2000 and 25 percent in 1980.

Renowned nurse researcher Peter Buerhaus, PhD, RN, FAAN, reported that between 2001 and 2008, 77 percent of the increase in total RN employment were nurses over age 50, a group that is the fastest growing in the profession.

He also projected a nursing shortfall of 260,000 RNs by 2025 in the same study published in Health Affairs in 2009. And he addressed the impact of the current recession, saying it’s led older nurses to delay retirement and others to re-enter the workforce.

“People are postponing retirement, especially those who were within two years of retiring, because of the economy,” said Patty Lowe, MBA, BSN, RN, NE-BC, director of nursing at Grant Medical Center, Ohio Health. The average age of the RN workforce at her facility is 54, and nurses in critical care areas tend to be among the older staff.

Lowe added that Grant generally has little turnover. But when vacancies do arise, they will retrain experienced nurses interested in coming back into the workforce.

Lowe also has noticed a couple of trends. First, nurses in their 50s seem to be more geared toward taking better care of themselves so they can continue working. Second, their career wants have changed.

“Older nurses previously wanted to transition to OB or migrate toward roles in education,” Lowe said. “Now I’m seeing older nurses going into critical care and the ER.”

Deb Stock, vice president for member relations at the American Hospital Association, said, “The economy has had a high impact in terms of staffing patterns. We expected big numbers of nurses to begin to retire last year, but many did not. That also has had a huge impact on new grads, who couldn’t find jobs.

“When the economy improves, there is going to be a large number of older nurses leaving. And we’ve been talking with hospital [administrators] for a long time about implementing strategies to keep older nurses working as long as possible. Older nurses are repositories of deep, practical knowledge about how to care for patients and about the organization. When they leave, the knowledge leaves with them — creating a deep void.”

Central Baptist’s Hill agrees that there is likely to be a big spike in older-nurse departures once the economy picks up.

“But in today’s environment, I think administrators need to rethink recruitment and retention,” Hill said. “We hired a 51-year old nurse who is a novice. So when looking at how to retain our staff, we shouldn’t be looking at age but where nurses are at in terms of the stage of their careers.”

That means developing programs and roles for beginner, mid-career, and long-time nurses, she explained.

Stock noted that replacing nurses at any level is costly to facilities — and not only the financial outlays for recruiting and orienting new hires.

“It takes a while for even experienced nurses to be fully up to speed at a new hospital,”  Stock said.

Lowe said that her facility — like many others nationwide — has no formal way of capturing veteran nurses’ clinical and institutional wisdom, including “what has worked and what hasn’t.”

That inability to capture seasoned nurses’ wisdom before they retire is a real problem, according to Virginia Nurses Association member Terri Gaffney, MPA, RN.

“Currently when experienced nurses leave, we give them a card and say ‘good luck,’” Gaffney said. “We’re not asking them, ‘What critical knowledge do you hold that keeps the unit working?’ We don’t consider how we will retain the quality of care and what our health care system will look like once [these experienced nurses] are gone.”

Gaffney, who earlier worked on other mature workforce-related issues with the Center for American Nurses, wants to determine best practices for capturing seasoned nurses’ knowledge that can be shared with health care facilities nationwide. A best practice might include creating a video library comprised of long-time nurse interviews on a range of unit-based and system-wide issues.

Maintaining expertise

Hill was on the team that developed the Robert Wood Johnson Foundation (RWJF)-commissioned white paper, “Wisdom at Work: The Importance of the Older and Experienced Nurses in the Workplace,” which was released in June 2006. The team defined older nurses as those 45 and older (though some define it as young as 40).

Team members determined that few facilities nationwide had comprehensive programs that focused on retaining older nurses, according to Hill. So in the white paper, they recommended that RWJF invest resources to identify, describe, and evaluate best practices for recruiting and retaining older nurses.

Team members also recommended that individual facilities take incremental steps to keep older workers, including creating expanded roles for experienced nurses and preparing them for those roles; encouraging workplaces that respect and appreciate staff; and equipping managers and supervisors to understand and support an older workforce.

In 2009, the foundation supported a follow-up study called “Wisdom at Work: Retaining Experienced Nurses.” It specifically found that a number of health care organizations lowered turnover rates of experienced nurses by making a concerted effort to improve nurse morale and productivity. Successful strategies included innovative approaches to staffing; employee health and wellness programs; and training and development opportunities for veteran nurses, according to RWJF. (More information on both documents is available at www.rwjf.org.)

Nursing consultant Adrienne Ames, MSN, RN, oversees several committees that are part of Vanderbilt University Medical Center’s “Be the Best, Keep the Best” initiatives. These committees, which include leader development, shared governance, clinical workforce, and nurse wellness, give many long-term nurses the opportunity to identify and address key issues.

Ames also helped launch the Retired Nurses Advisory Group, which is comprised of retirees who are developing a program to better prepare nurses for retirement.

A retired nurse herself for 10 years and a Tennessee Nurses Association (TNA) member, Ames strongly believes in the value of experienced nurses.

“They bring the experience of clinical nursing — the technical, critical thinking, and assessment skills, a maturity and perspective to the health care team, knowledge of the culture and history of the workplace, and a loyalty to the institution,” she said.

Keyed into their value, Ames also works closely with the Maturing Workforce Group, comprised of nurses 50 and older who are focused on helping Vanderbilt develop strategies to retain long-time nurses. Identified strategies so far include flexible work schedules, job redesign, an ability to transfer more easily, and the creation of new roles, such as an admission or discharge nurse. Older nurses additionally expressed a desire to be respected and appreciated for their wisdom.

Ames noted that Vanderbilt has created fellowship programs for experienced nurses who are considering changing to a specialty area, such as women’s health. The program goals are to assist these nurses in making informed decisions and experiencing a smoother transition to the new practice area.

Wanting to stay

TNA member Edie Vaughn, RN-4, has been a nurse at Vanderbilt for 36 years and is a member of the Maturing Workforce Group. For most of her tenure, she worked full time on a general care-surgical floor where she provided expert care to many patients who underwent liver transplants, laryngectomies, and radical neck dissections.

“I like a challenge and complicated procedures that need a lot of patient teaching,” she said.

Eight years ago, Vaughn reduced her full-time work schedule by one shift. More recently, she cut way back. She now works one day a week on the unit taking care of patients, and additionally teaches trach workshops and does special projects as needed. For example, when the hospital gets new equipment or a new system, such as electronic documentation, she attends a special class to become a super-user and then teaches other staff house-wide.

The new role and schedule have worked well for Vaughn, who was feeling the accumulated effects of being on her feet and physically providing care to very ill patients for 12 hours at a stretch.

“Patients just kept getting sicker,” Vaughn said. “Someone who would have been in the ICU when I started years ago is now on a general care unit.

“I realized I didn’t want to wake up one day and not be able to do the things I wanted to do because I was wearing my body out.”

Vaughn knows how fortunate she has been to have management support for her job change.

“My manager and supervisor bent over backwards, because they wanted me to stay,” Vaughn said. “I wish every hospital would have a CNO like ours at Vanderbilt. She doesn’t look at older nurses like a burden or a problem.”

Looking at the national scene, Hill said “In reality, we [in health care] haven’t been flexible in meeting the needs of the older workforce.”

However, Hill has been making some headway on innovative staffing at her own hospital. For example, in Komara’s role as a career coach, the 40-year nurse helps other nurses think through new roles and how best to get there, such as through advanced education, certification, or shadowing experiences. Hill also employs another nurse to perform pre-surgical physicals when that nurse is back in Kentucky for the summers. And Hill brought back a retired nurse to fill in for a nurse manager who was deployed to Iraq, and she is considering other ways to fill those temporary assignments.

Facilities should consider other ways to support older nurses who want to remain at the bedside, such as making physical changes to the work environment, including unit layout and ergonomic investments, AONE’s Stock said.

More work needs to be done to document the value of older nurses, Hill said. She addressed some of their positive impact on the quality and patient safety in an article, “Improving Quality and Patient Safety by Retaining Nursing Expertise,” she wrote for the September 2010 issue of the Online Journal of Issues in Nursing (www.nursingworld.org/ojin).

Komara, who also is president of the Kentucky Board of Nursing, said she often encounters other nurses statewide who would not have left the workforce had there been other roles for them or phased-retirement programs.

“There are many older nurses who are feeling burned out or feel stuck,” DeSenze added. “Some are afraid to change jobs, but others have been overlooked for other positions or don’t see any opportunities.”

Nurses say it’s time to implement a range of strategies to retain older nurses, because it’s inevitable that they will retire or just leave the workforce at some point. It’s much better for patients, employers, and their less-experienced colleagues if their departure is gradual — and not a crushing tidal wave.

— Susan Trossman is the senior reporter for The American Nurse.

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