The global nursing and midwifery workforce is undergoing a profound demographic shift, with an increasing proportion approaching retirement age.1
This trend is pronounced in high-income countries like Australia, where an ageing population is simultaneously increasing demand for healthcare.2 In Australia, 38% of nurses and midwives are over the age of 45 years.3 Older nurses and midwives bring extensive expertise, clinical judgement, and mentoring; however, they also face unique challenges.4 These challenges are gendered as 89% of nurses and 93% of midwives are women.5 This article explores some of the social, health, and wellbeing challenges that are experienced by older female nurses and midwives.
Lifestyle
There is evidence of increasing obesity, decreasing physical activity, poor diet, smoking, and excessive alcohol intake among nurses and midwives.6 Fatigue after work is regularly reported as a barrier to engaging in regular physical activity.7 Further, nurses and midwives report that shift work makes healthy eating difficult.8 Older female nurses and midwives may be drinking at levels that may pose a significant risk to their health and wellbeing which is complicated by a “culture of permissibility”.9
Mental health
Internationally, the midwifery workforce is in crisis – with 20% of midwives suffering severe symptoms of depression, anxiety, and stress.10 A similar picture exists in nursing where the rates of anxiety and depression are increasing.11 Concerningly, there is evidence that nurses and midwives are at a higher risk for suicide compared to the general population.12 Pre-existing mental health conditions can be exacerbated by work patterns, and older nurses report poorer mental health resulting in earlier retirement.13
Perimenopause and menopause
Available evidence indicates that during perimenopause and menopause, nurses’ quality of life is negatively impacted by high stress levels and unstable work patterns.14 One quarter of nurses and midwives in Australia fall into the age for perimenopause and menopause,3 therefore greater attention is needed to support them to manage the myriad of difficult symptoms and co-morbidities. For example, the often-unrecognised collective of musculoskeletal symptoms15 needs greater attention given already high rates of carer-limiting work-related musculoskeletal injuries sustained from years of accumulated manual handling16 and increasing patient obesity.17
Intimate partner and family violence
Nurses and midwives experience higher rates of abuse and violence from intimate partners.18 Older women are more likely to be victims/survivors of both intimate partner and family violence.19 Nurses and midwives often prioritise the care of others over their own wellbeing, which can delay recognition of abuse/violence or seeking assistance, reinforcing cycles of harm.20 Nurses and midwives who experience intimate partner or family violence are more likely to end up quitting.21
Divorce and financial security
Divorce rates among older women are increasing, and older divorced women face economic disadvantage due to systemic gender pay gaps, career breaks for caregiving,22 and underfunded superannuation for lower-paid positions.23 Additionally, women returning to the workforce seeking flexibility for caring responsibilities may opt for part-time work, further contributing to this gap. A report from Super Members Council23 found that older women’s super-balances are also disproportionally impacted by events later in life, including early retirement to care for elderly family members. Nearly 60% of older women who rent live below the poverty line, therefore, older female nurses and midwives may find themselves resiliently working longer for a secure and dignified retirement.24
Caring responsibilities
Known as the ‘sandwich generation’, older women are caught between meeting the needs of growing children, ageing parents, grandchildren, and work.25 The squeeze is felt more by women due to the gendered nature of care at both work and home; women, aged between 50-69, are the biggest providers of unpaid, ongoing care at home.26 Time away from work for caring contributes to their financial disadvantage. In addition, caregiving may impact the health and wellbeing of the caregiver, increasing their risk of other health conditions.27,28
Cancer and survivorship
Almost one in two Australians will be diagnosed with cancer by the age of 85.29 Nurses and midwives are no exception – the International Agency for Research on Cancer has classified rotating shift work as ‘probably carcinogenic to humans’.30 Studies suggest that long-term circadian disruption may play a role in rectal31 and breast cancer32 development. Nurses and midwives working rotating shifts are less likely to undertake bowel and breast cancer screening than people who work office hours.33 In addition, nurses have reported mental distress following a cancer diagnosis as they switch between being a provider and recipient of healthcare.34
Conclusion
Older nurses and midwives are essential to the health of the nation – our healthcare system could not function without their skills, knowledge, compassion, and mentorship. Yet, they face complex social, health, and wellbeing challenges that threaten their ability to remain in practice. These realities highlight the urgent need for a fundamental rethink on how workplaces support older nurses and midwives.
References
1 Rodwell J. Prospective Drivers of Nurses’ Partial or Complete Retirement Seven Years Later: Work Ability and Physical Functioning Going against the Tide of Age. International Journal of Environmental Research and Public Health. 2022;19(18):11159.
2 Australian Institute of Health and Welfare. Older Australians: Demographic Profile 2024 [Available from: https://www.aihw.gov.au/reports/older-people/older-australians/contents/demographic-profile.
3 Nursing and Midwifery Board. Nursing and Midwifery Board of Australia: Registrant Data 2025 [Available from: https://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx.
4 World Health Organization. Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster 2022 [Available from: https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb–without-immediate-action–health-and-care-workforce-gaps-in-the-european-region-could-spell-disaster.
5 Nove A, ten Hoope-Bender P, Boyce M, Bar-Zeev S, de Bernis L, Lal G, et al. The State of the World’s Midwifery 2021 report: findings to drive global policy and practice. Human Resources for Health. 2021;19(1):146.
6 Perry L, Gallagher R, Duffield C. The health and health behaviours of Australian metropolitan nurses: an exploratory study. BMC Nursing. 2015;14(1):45.
7 Blake H, Malik S, Mo PKH, Pisano C. ‘Do as I say, but not as I do’: Are next generation nurses role models for health? Perspectives in Public Health. 2011;131(5):231–9.
8 Zhang Q, Chair SY, Lo SHS, Chau JP-C, Schwade M, Zhao X. Association between shift work and obesity among nurses: A systematic review and meta-analysis. International Journal of Nursing Studies. 2020;112:103757.
9 Schluter PJ, Turner C, Benefer C. Long working hours and alcohol risk among Australian and New Zealand nurses and midwives: A cross-sectional study. International Journal of Nursing Studies. 2012;49(6):701–9.
10 Bayram Deger V. Editorial: Anxiety, burnout, and stress among healthcare professionals. Front Psychol. 2023;14:1348250.
11 Maharaj S, Lees T, Lal S. Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses. International Journal of Environmental Research and Public Health. 2019;16(1):61.
12 Petrie K, Zeritis S, Phillips M, Chen N, Shand F, Spittal MJ, et al. Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades. Australian & New Zealand Journal of Psychiatry. 2023;57(7):983–93.
13 Montayre J, Harris C, Li W, Tang L, West S, Antoniou M. Older nurses and work-related factors that impact their mental health and wellbeing: a qualitative systematic review. Contemporary Nurse. 2024;60(5):537–54.
14 Theis S, Baumgartner SJ, Janka H, Kolokythas A, Skala C, Stute P. Quality of life in menopausal women in the workplace – a systematic review. Climacteric. 2023;26(2):80–7.
15 Wright VJ, Schwartzman JD, Itinoche R, Wittstein J. The musculoskeletal syndrome of menopause. Climacteric. 2024;27(5):466–72.
16 Stanchev V, Vangelova K. Musculoskeletal Disorders in Nurses in Hospitals. Open Access Macedonian Journal of Medical Sciences. 2022;10(E):439–43.
17 Huang SL, Cheng H, Duffield C, Denney-Wilson E. The relationship between patient obesity and nursing workload: An integrative review. Journal of Clinical Nursing. 2021;30(13-14):1810–25.
18 Kafle S, Paudel S, Thapaliya A, Acharya R. Workplace violence against nurses: a narrative review. J Clin Transl Res. 2022;8(5):421–4.
19 McLindon E, Hegarty K, Diemer K. ‘You can’t swim if there is a weight dragging you down’: Report into family violence against Australian nurses, midwives and carers. 2022.
20 Lyons K. Older women allegedly killed by family members a ‘silent crisis’, experts say. The Guardian. 2025.
21 Dheensa S, McLindon E, Spencer C, Pereira S, Shrestha S, Emsley E, et al. Healthcare Professionals’ Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences. Trauma Violence Abuse. 2023;24(3):1282–99.
22 Chomik R, Piggott J. Australian Superannuation: The Current State of Play. Australian Economic Review. 2016;49(4):483–93.
23 Super Members Council. Securing a dignified retirement for more women. 2023.
24 O’Keeffe D. One in three older women living in income poverty in Australia: study 2016 [Available from: https://www.australianageingagenda.com.au/clinical/social-wellbeing/one-in-three-older-women-living-in-income-poverty-in-australia-study/.
25 Eeles S. Meet the ‘Sandwich Generation’ — the growing sector of women caring for their children and their parents. ABC News. 2023.
26 Council on the Ageing NSW. Submission: Inquiry into the recognition of unpaid carers. 2023.
27 Desai A, Chibnall JT. Chronic stress in elderly carers of dementia patients and influenza vaccine. The Lancet. 1999;353(9168):1969–70.
28 Bouchard K, Greenman PS, Pipe A, Johnson SM, Tulloch H. Reducing Caregiver Distress and Cardiovascular Risk: A Focus on Caregiver-Patient Relationship Quality. Canadian Journal of Cardiology. 2019;35(10):1409–11.
29 Cancer Council. Facts and figures: Current statistics in Australia n.d. [Available from: https://www.cancer.org.au/cancer-information/what-is-cancer/facts-and-figures.
30 International Agency for Research on Cancer. Known and Probable Human Carcinogens 2024 [Available from: https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/known-and-probable-human-carcinogens.html.
31 Papantoniou K, Devore EE, Massa J, Strohmaier S, Vetter C, Yang L, et al. Rotating night shift work and colorectal cancer risk in the nurses’ health studies. Int J Cancer. 2018;143(11):2709–17.
32 Fagundo-Rivera J, Gómez-Salgado J, García-Iglesias JJ, Gómez-Salgado C, Camacho-Martín S, Ruiz-Frutos C. Relationship between Night Shifts and Risk of Breast Cancer among Nurses: A Systematic Review. Medicina (Kaunas). 2020;56(12).
33 Nicholls R, Perry L, Gallagher R, Duffield C, Sibbritt D, Xu X. The personal cancer screening behaviours of nurses and midwives. Journal of Advanced Nursing. 2017;73(6):1403–20.
34 Bonnamy J. Holding Multiple Identities: a Personal Narrative of Young Onset Colorectal Cancer. Journal of Cancer Education. 2020;35(6):1261–6.
Authors:
James Bonnamy RN MNurs, GradCertHlthProfEd, BN(Hons), BNurs, FHEA, AFANZAHPE, Advanced Life Support Registered Nurse, Authorised Nurse Immuniser, Research Fellow and PhD Candidate, School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia and Patient Services Manager, Peninsula Health, Victoria, Australia
Viktorija Bonnamy RN Grad Dip Occupational Health and Safety, Grad Dip Counselling (Grief & Loss), Teaching Associate, School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia and Acting Manager Health, Safety and Wellbeing, Clinical Nurse Consultant, and Patient Services Manager, Peninsula Health, Victoria, Australia
Dr Bethany Carr RM PhD, Master of Clinical Midwifery, BMid, Research Fellow, School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
17 Responses
Not all nurses are women.
I was reading this with the expectation that it may reflect some of my challenges as a nurse who is a male but unfortunately it fell well short of my expectation.
Thanks for your comment. You’re absolutely right, about 10% of the nursing/midwifery workforce are men and we recognise the important role they play across the professions. This particular piece was submitted by a group of researchers, one of whom is a male, so I expect they are aware of the range of challenges faced but focus more on women due to available evidence and women making up the majority of the workforce. Please feel free to share your challenges here to add to the discussion on this important topic.
“These challenges are gendered as 89% of nurses and 93% of midwives are women.”
I would be interested in research that spoke of the particular experiences of male nurses. I expect some of the research quoted from here would also apply to men, for example the cancer rates that are influenced by shift work and musculoskeletal effects from manual handling and the increase of obesity in patients. The tone of your comment was petulant Anthony, something women put up with with monotonous regularity. Please feel free to complete your own research into the particular effects of being male in the nursing field, your female colleagues will welcome it.
Interesting article that rings true in areas of my lived experience as an older nurse in public health. Shift patterns, menopause issues, access to required annual leave without a struggle and lack of direct support from management compounded my reasons for leaving early. Line Managers are too busy trying to save money, move older staff on and impress their managers.
Is this group of researcher going to do any further work to address the issues that they have raised?
We certainly hope so. Another researcher, Julie Denton, was also doing some interesting work in this space – https://anmj.org.au/the-importance-of-supporting-older-nurses-and-midwives-in-the-workplace/ and may be more advanced in strategies workplaces can implement.
As a 71 year old nurse working part time in mental health and also recently (aged 68) having been diagnosed with ADHD, I have started to understand just how much decades of shift work which has made forming regular exercise, sleep and eating patterns impossible for me. My physical health has definitely been negatively affected by this. My social health has too, I would have loved to join a choir, but attending group practice on a regular basis has been too hard to maintain. I still work all the different shifts including night shift and have found taking medication at the same time each day almost impossible and easy to forget. I am fortunate that my genetic inheritance has kept me pretty fit, hence I can still work. I would like to retire and spend the rest of my life getting up at the same time each morning and going to bed at the same time each night, what a dream that would be.
Workcover – the elephant in the room. Until you need it, it’s an abstract concept. Particularly for those nurses who were injured at work in 2020 you have had a little support to return or are simply unable to….. there is a wealth of clinical knowledge being pushed out of the system.
At the same time, we are trapped in a Workcover nightmare, wages with penalties removed, frozen in time before the historic pay rises. We fought beside our comrades for decades for better care, yet have been left behind.
As a nurse who was not able to go to part time due to the position held, I felt forced to retire following the death of my mother and requesting some leave (3 months) which required my resignation attached to the request as I had said I would consider my options closer to the end of my leave. I have tried now for 8 months to return to work in a part time/casual capacity and have been rejected from MH positions where one ND cited recency as the issue, despite working with MH agencies, providing clinical supervision, and indirectly supporting MH patients in the last 10 years. I even successfully undertook an interview for casual and was progressing until he pulled the offer. There is no way to address this or get the ‘recency’ he insists on if you can’t get a position. Even to return to the service I left in a lesser position I was not even afforded an interview.
The reality of this article is not being addressed by health services in Australia even though the aging population of staff had been predicted many years ago.
Recognising everyone working across this sector is so important. Men, ageing workforce with a lifetime of experience and contributions that can be shared. This goes right back to our aged care Nursing workforce as well. Never recognised as a real Nursing workforce because of the division that has come about over to many years, separating older people and disability from our health care system as individual areas. Sadly, not combined under a one umbrella of health care service delivery system. We now have a very big gap with workforce. Many, including myself are no longer working due to injuries over many years. Many are in a ‘gap’ where they are not old enough to actually retire but still have to survive.
older nurses are targets for bullying. Nursing Management want younger ‘Yes’ staff without the questions when things dont make sense. Older nurses are not valued for their knowledge, rather, judged by their appearance or a limpy knee by Nursing Management & younger nurses.
I found thus article very interesting, i retired of 67 and I am now 79 and realise I could have stayed in the work force longer but this is the value of hindsight .
Retired midwife, loved my career but mandatory rotating night duty drove me away in my early 60’s, literally to save my life. It would be interesting to see stats on nursing staff accidents driving home after night duty.
Ex-ICU nurse now working in nurse education and research because shift work almost cost me my life (and potentially someone’s life) too. Falling asleep at the traffic lights with my foot on the brake (fortunately) after a winter day shift despite home being only 30mins away. Another driver stopped and knocked on my window to wake me up. I was in my early-30s then.
There must be a better way to care for our patients at the bedside. Why would 4 – 6 hour shifts not work in acute care? It may not be everyone’s choice and probably a rostering nightmare but shorter shifts would allow parents with caring responsibilities to continue working in hospitals (if they choose to). Shifts in PACU allowed me to maintain my critical care skills when my 2nd child was very young and my 1st child was in primary school. However, it was an intentional sacrifice of financial security by working casually. Eventually, I pivoted and applied for permanent roles in research/data coordination as some offered flexible hours.
Is it not time for the nursing workforce to do things differently and still achieve the same outcomes?
I found this article very sad. I was hoping for some positive inspirations. I am 64 years old & working part time (3 days per week) in a small rural aged care facility. I returned to nursing at 40 years of age after a 15 years away from nursing. I love working in aged care but do find it very challenging in many different aspects. I totally related with the part about Sandwich generation. My husband and I looked after my parents in their later years while our son was going through a very distressing breakup. We walked & talked & fought & prayed & continued to work. Good healthy eating, time with family & friends, praying, special time for myself and exercise(yuk!!!) are so helpful for a happy life and therefore I can give my best (mostly!) to our precious elderly.
Current rostering is ridiculous. Give nurses a choice by self rostering and you will get a happier healthier workforce. The best rostering system I worked was in a QLD private hospital. We got to input our preferred shifts on a computer system. It would then get tweaked a little by the manager to ensure all shifts were covered with a good skill mix. The result was nurses got most of their shifts by choice. Enough rest and a good routine creates a lifestyle people can enjoy.