The healthcare sector is experiencing unprecedented challenges. There is an increasing demand for healthcare services partially attributed to the global ageing population (1); however, healthcare services worldwide are grappling with nursing and midwifery shortages.
Many countries struggle to train and retain enough nurses to meet the growing demand, leading to overworked staff and compromised patient care (2). According to the World Health Organization (WHO) (2), the global nursing and midwifery shortage is projected to reach over 5.7 million by 2030. This looming crisis calls for innovative strategies to support and retain older nurses and midwives to maintain the status quo. Research has shown that they are experienced and knowledgeable (3), but their skills are frequently discounted in the workplace (4, 5). It is vital to recognise the value older nurses and midwives can bring to healthcare by addressing their unique challenges and fostering an environment to encourage them to remain in the workforce for as long as possible. Their years in the workforce equip them with historical and organisational knowledge (6), a deep understanding of patient care, critical thinking skills, and the ability to mentor younger colleagues (3). Supporting older nurses and midwives means investing in their ability to transfer their expertise to the next generation, ensuring continuity of care and knowledge within the profession.
Older nurses and midwives
Literature does not provide a straightforward definition of older. The term ‘older’ generally refers to nurses and midwives in their mid-to late-career stages, often aged 50 and older. However, some identify as ‘older’ as early as their 40s (5). Therefore, being older does not refer to a homogenous group, as older nurses and midwives span a wide age range. Older nurses and midwives often find their work fulfilling, and others see the rising costs of living, insufficient retirement savings, or the need to support family members make them choose to stay in the field as long as they are able. With an increased life expectancy and good health, many nurses and midwives remain capable of working longer. Those in their 40s and 50s have the potential to continue working for another decade or two; however, this is difficult if they are experiencing age-related challenges in the workplace; therefore, having a support policy to extend their working lives is vital.
Challenges
All nurses and midwives experience the physical and emotional challenges that can make the demands of their jobs more difficult to manage. However, older nurses and midwives also experience age-related challenges such as mobility difficulties relating to an ageing body, loss of vision and hearing acuity and increased fatigue levels (7). Older nurses and midwives have reported experiencing ageism in the workplace with a perception they are not respected and valued as skilled workers. It is well documented that older nurses and midwives are often treated differently from younger colleagues, mainly because of a lack of opportunities for ongoing education and promotion (7, 8). Older nurses and midwives feel undervalued due to a lack of understanding or appreciation of their contributions to the healthcare workplace (4, 5). Older nurses and midwives bring experience, knowledge, and compassion to the healthcare workplace. Their years of experience often translate into an ability to handle complex clinical situations calmly and confidently and mentor younger colleagues. While they may face challenges related to physical difficulties or adapting to rapidly changing technologies, their wisdom and emotional resilience remain invaluable assets. Their presence in healthcare fosters a supportive environment for patients and colleagues, enhancing the overall quality of care (9).
Support structures
Many older nurses and midwives would like to remain in the workforce but say they cannot cope with the demands of their jobs; without support, they will be forced to leave prematurely, and their loss could exacerbate the skill shortage crisis (10). This looming crisis calls for innovative strategies to retain older nurses and midwives. Rather than allowing this experienced cohort to exit the workforce en masse, it is crucial to implement policies that encourage them to stay through wellness programs, redeploy to less physical roles, flexible work hours that accommodate their needs, support networks, recognition of skills and experience, workplace ergonomics and provision for ongoing educational opportunities (11). Healthcare organisations should create inclusive policies that emphasise the value of older nurses and midwives through promoting age diversity in hiring, offering retraining opportunities, and ensuring that older nurses and midwives are not sidelined in favour of younger, less experienced staff.
Conclusion
Fostering an age-friendly work environment means recognising the strengths and unique perspectives that come with experience and combating any biases against ageing nurses and midwives. By addressing the physical toll of nursing and midwifery on older workers, we can extend their careers and preserve their well-being (12, 13). Implementing policies that focus on work-life balance can help prevent premature exits from the workforce. Although the challenges older nurses and midwives encounter have been discussed for decades, research has shown that little workplace support has been implemented (14). Healthcare organisations should adopt an individualised approach rather than making assumptions based on age assess the strengths, goals, and needs of each older nurse or midwife. Supporting older nurses and midwives is not just about helping them extend their careers; it is about preserving the healthcare workforce as a whole.
REFERENCES
1. United Nations. World Population Ageing 2019. Department of Economic and Social Affairs Population Division; 2019. Report No.: 978-92-1-148325-3.
2. World Health Organisation. The State of the World’s Nursing. 2020. Report No.: ISBN 978-92-4-000329-3 (electronic version) ISBN 978-92-4-000330-9 (print version).
3. Fackler CA. Retaining older hospital nurses: Experienced hospital nurses’ perceptions of new roles. Journal of Nursing Management. 2019;27(6):1325-31.
4. Denton J, Evans D, Xu Q. Managers’ perception of older nurses and midwives and their contribution to the workplace—A qualitative descriptive study. Journal of Advanced Nursing. 2022.
5. Denton J, Evans D, Xu Q. Being an older nurse or midwife in the healthcare workplace- A qualitative descriptive study. Journal of Advanced Nursing. 2021.
6. Mion L, Hazel C, Cap M, Fusilero J, Podmore M, Szweda C. Retaining and Recruiting Mature Experienced Nurses A Multicomponent Organizational Strategy. Journal of Nursing Administration. 2006;36(3):148-54.
7. Ang SY, Ayoob SBM, Hussain NBS, Uthaman T, Adenan H, Chiang P, et al. Challenges faced by older nurses in Singapore: a mixed method study. International Nursing Review. 2016.
8. Clendon J, Walker L. The juxtaposition of ageing and nursing: The challenges and enablers of continuing to work in the latter stages of a nursing career. Journal of Advanced Nursing. 2016;72(5):1065-74.
9. Reinhardt AC, Leon TG, Amatya A. Why nurses stay: Analysis of the registered nurse workforce and the relationship to work environments. Applied Nursing Research. 2020;57(2):1-9.
10. Buchan J, Catton H, Shaffer F. Ageing well. Policies to support older nurses at work ICNM 2020.
11. Denton J, Evans D, Xu Q. Older nurses and midwives in the workplace: A scoping review. Collegian. 2020.
12. Markowski M, Cleaver K, Weldon SM. An integrative review of the factors influencing older nurses’ timing of retirement. Journal of Advanced Nursing. 2020;76(9):2266-85.
13. Soderbacka T, Nyholm L, Fagerstrom L. Workplace interventions that support older employees’ health and work ability – a scoping review. BMC Health Services Research. 2020;20(1):472.
14. Montayre J, Knaggs G, Harris C, Li W, Tang LM, de Almeida Neto A, et al. What interventions and programmes are available to support older nurses in the workplace? A literature review of available evidence. International Journal of Nursing Studies. 2023;139:104446.
26 Responses
We wouldn’t have problem with lack of nurses if they were employed full-time instead of this part-time employment that they are offered once they have finished training and become a nurse. The only nurses I see getting full time employment are overseas nurses (I work in a major private hospital in Melbourne).
I am an older nurse working 0.8fte and do not want to work full time! 0.8fte brings home a similar wage to full time but less tax and better lifestyle. I think you missed the point of the article. The article was about older nurses and recognising their needs to allow them to stay in the workforce to share and pass on their knowledge as well as still have the ability to grow their career and receive the training others are able to access.
I am on the “wrong side of 60”, yet the expectations of my participation in all shifts are equivalent to those who are a third of my age! I think people have forgotten the difference between equality and equity!
But lots of those nurses and midwives have young children and don’t want to work full time. I work 0.6FTE and that is right for my family. I previously worked full time on our labour ward and it affected my mental health significantly.
I know aging colleagues, who may have had a marriage breakdown and need to remain in the workforce experience bullying after getting a certificate from a medical practitioner that states they can no longer manage night shifts after many years of doing night shifts. Some of the much younger nurses just have no compassion or understanding
Unfortunately horizontal violence remain prevalent
As we should, we now make many provisions for younger nurses having children, returning to work with flexible rosters and working arrangements to support them in continuing their nursing career while raising a family. We should also afford the same flexible arrangements and support for nurses transitioning towards the end of their career to support them in continuing their nursing career while still able without bias and discrimination. Sadly this is often not the case and discrimination and ageism is definitely an issue for “older” nurses in the workplace.
Well said
Very well said. I am the other side if 65 now. Definitely experienced ageism in my workplace. There is plenty of room made for our working mums & I know they need that But no flexibility for the older generation, I love my nursing & don’t want to leave but I know my colleagues are waiting for my shifts
45 years experience.
Hospital training where accommodation, food and uniforms were subsidised.
We worked a hard forty hours but were supervised.
We built comrades
Nurses did nursing.
Observations
Wound care
Medications etc etc
Now
It’s take the blood, order the X ray, insert the cannula.
Those with medical degrees wait for the results before they get off their arsses.
What about basic nursing care.
Comfort, positioning, pain relief, nutrition,skin care, relative relationship.
So much is heaped onto the nurse whilst the medical profession takes the cusps and money !!!!
Absolutely
Older nurses have ageing bodies and we may need to take more sick leave to manage this. Sometimes the appropriate strategy is a couple of days resting our sore backs/knees etc to reduce pain and disability and enable us to keep working. Current sick provisions do not accommodate this so it’s often LWOP at a time when we are desperately trying to build our retirement nest eggs while we still can.
Finally there’s acknowledgment that older nurses, with years of valuable experience, are being deprived of opportunities for training and support. It would be great to see organisations working to break down the generational by supporting older nurses, acknowledging their experience, through promotions, training and support. This process would create respectful working partnerships across generations, The development of nursing skills comes through experience and should be acknowledged. The core skills of Nursing is care, expressed through kindness, that is learned through experiences.
So true!
I’m not a nurse but have worked in the health care sector for many years My observation that the rigidity of rosters start and finish times and no short shifts restricts flexibility. This is balanced against safe patient care act and enterprise agreement in Victoria and leaves nurses and midwives for few options for a flexible work arrangement except to work part time or have a doctor give you a medical certificate to not work night shift and this can lead down a different path Financial impact hard for many
Some nurses want to work night shift but I’m not sure if that is allowed these days.
Our workplace , does not allow
A very well thought presented article and this is definitely becoming a complex issue in Australia, an aging country with negative population. I totally agree that there should be a lot more support and incentives provided for mature age nurses/midwives all over Australia. The suggestions and recommendations presented in this article are very relevant, helpful and useful for the mature aged nurses/midwives. I hope that our politicians and workforce organisations are listening
I am nearly 60 and transitioning to retirement. Nonetheless, I recognise that I still have a lot of oooommpphh within me: still passionate about my career and patients. I still have a lot to offer and I am so fortunate to be working with a private organisation (Qld) that accepted me as a valuable (casual employment) member of the team.
I’m an ‘old school’ trained Psych EN with 42+ years in a range of roles. I’m currently working in aged residential mental health and I’m wearing out fast.
What to do?
Older nurses do not receive the recognition they deserve due to ageism. This is why they are leaving the profession. I was discriminated against when I missed out on a job to 2 inexperienced younger nurses when I hold post graduate certification in the specialty as well as years of experience. They had none but were friendly with the manager. My work ethic and attendance was much better but they still got the jobs. The manager said that I was not a good fit!
I am 72 and working.8 this year. I love the patients I work with. I am also fortunate to not have to work shifts now and I am also in a position which allows me to be independent and self directed .
I have seen other nurses who are in their late 50’s and early 60’s who have faced ageism in the workplace.
I must say that in my workplace it is the management that are the hardest to deal with. Many of them are very naive in managing staff.
Thank you for this article. I have 50 yrs + nursing and 45 yrs as a midwife and still enjoy working.
This issue has been brought to the forefront my workplace. It has been brought to our NSWNMA Branch attention of age discrimination and the unclear if not very difficult pathways to address this issue with employers. Therefore, our branch is in the process of tabling this with the Ministry of Health and have clear guidelines and education sessions discussing Age Discrimination in the workforce and the Australian Humane Rights Commission guidelines for employers and workforces.
When I left my department at a major Womens Hospital towards the end of the pandemic, 180 years of combined Midwifery experience left with me. Conditions were untenable, management were bullies and all 5 of us were treated as disposable after many years of keeping the place going by sheer goodwill.The complete and arrant disregard for the Mental and physical health of all midwives( not just older ones)and the whole culture of borderline abuse of the workforce needs to change if midwives and nurses are going to persist with this profession. I am 63, no longer in Mid but still nursing as it suits me.
I am almost 68, working in midwifery.
Worked all shifts, no choice.
Ended up resigning, as unable to work age appropriate hours.
Age related issues is very real in the workplace.
I loved the women and colleagues.
Management is the main issue.
As an older nurse in my sixties I recognised I no longer wanted to work in hospitals anymore after being there since I was 19. I still wanted to nurse and felt as long as I was able to physically and mentally and sharp enough would do so. I looked at many different areas outside of hospital nursing and finally settled on nursing in a medical centre.. The second job I applied for was successful and after 2 years was a good fit. I do find the digital world a challenge but am lucky enough to have younger colleagues who are patient and willing to teach and share their knowledge.
I’m a phlebotomist over 60 . I work in the public system. There have been nurses who wish to work towards retirement but have been told no can’t.
There happy to use our knowledge, but not the respect off listening some young ones.
It’s hard now, started when I was 18, very green. 61 now and counting down my days