Older nurses and midwives experience a range of workplace challenges including physical difficulties, tiredness and fatigue, being treated differently, and lack of respect and opportunities, a new Australian study has revealed.

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Led by Julie Denton, an RN PhD Candidate at the University of South Australia’s Health and Clinical Science Division, the study set out to identify the core challenges the demographic encounter in the workplace and organisational strategies needed to support them to continue to work to capacity.

The study was partly driven by data showing Australia’s older nurses and midwives mark the largest rising group of the healthcare workforce. Many are increasingly delaying retirement, continuing to work for numerous reasons such as financial, the camaraderie of working with others, or simply because they are not ready to step away.

Other considerations included the gradual increase of the age pension age, meaning people are increasingly working past the traditional retirement age, and potential ways to overcome the predicted future nurse shortage.

The study undertook a five-stage scoping review, examining 31 existing studies from around the world, including nine from Australia, to provide a broad framework in order to pinpoint the key challenges and strategies relating to older nurses and midwives in the workplace.

Due to ambiguity about what age a nurse or midwife is considered older, the scoping review explored studies where nurses or midwives were identified as older or referred to as mature, and not necessarily a specific age group.

Participants in the studies worked at large acute care hospitals, medical centres, community services, national health services, aged care facilities, and national nursing organisations. Nurses, registered and enrolled, midwives, and nursing managers ranging in ages from 40 to 62 took part in the studies.

Overall, the scoping review identified five key challenges specific to older nurses and midwives – physical difficulties, tiredness, fatigue, treatment difference, lack of respect and lack of educational or promotion opportunities.

Physical difficulties related to ageing was the most frequent challenge for older nurses and midwives, with nine studies highlighting mobility impairment as the most difficult challenge affecting participation in manual handling situations such as lifting patients, moving equipment, walking, standing or sitting for long periods.

“I find the busy and heavy workload harder to manage. I am more easily injured and my back gets sore more quickly,” one study participant said.

Tiredness and fatigue emerged as another common challenge, often exacerbated by heavier and more complex patient loads.

“I worry every day I come to work if I am going to be able to make it through the 12 hours. Patients are sicker and more demanding. My body is getting old, but my mind is still sharp. But after a few 12-hour shifts, my mind can get slow. I will retire when I feel I am no longer safe for the patients,” another study participant said.

Lead author Julie Denton, who stopped working clinically in 2016, knows the feeling well and watching fellow nurses struggling physically at work shaped her interest in investigating how older nurses and midwives were managing in the workplace.

“It was hard for me to continue physically,” she tells the ANMJ.

“Most of my working life was in a perioperative setting. I was working 0.8 in theatre and it just became physically impossible to continue; and yet I loved it. I didn’t want to leave nursing.”

In addition to physical challenges, the scoping review found widespread issues relating to older nurses and midwives being treated differently, shown a lack of respect, and not being afforded ongoing opportunities for education and promotion.

For example, some reported facing negative assumptions about their abilities and productivity, experiencing a lack of acceptance and recognition for their years of practice, and finding it challenging to maintain competence for practice due to limited opportunities to engage in continued professional development.

Tellingly, five studies reported promotional opportunities were often withheld, discouraged or not offered due to the perception career advancements for older workers were limited by their remaining years in the workforce.

“A manager suggested that I had a ‘short shelf life’ in terms of applying for a particular job and implied that I wouldn’t be chosen over a younger person for the same job,” a study participant said.

Mrs Denton had expected to uncover challenges relating to physical difficulties and ageing through the scoping review but was surprised to discover issues such as older nurses and midwives being treated differently to younger workers and shown a common lack of respect.

“The more and more I delve into this area, although there were some positive experiences, many participants’ stories were sad because they’re not being treated very nicely in some workplaces,” Mrs Denton says.

The scoping review indicated some of the negative experiences reported by older nurses and midwives highlights the existence of ageism, which often discourages them from continuing to work.

Mrs Denton labelled the findings disappointing and flagged a need for workplaces to offer more support for older nurses and midwives to enable them to continue to work safely and effectively.

“It’s very difficult to say that workers should be treated differently whether they’re older or younger but I think that it’s in the best interests of everybody to have an employee being supported in their job. It gives them good job satisfaction, they enjoy going to work and that reflects back on the care they give. If you have disgruntled staff, they’re going to come in and not give 100% to their patients or clients.”

Importantly, the scoping review also identified seven strategies, suggested by participants, which could support older nurses and midwives at work. They included wellness programs, redeployment to less physical roles, flexible hours, support networks, recognition of skills and experience, improved workplace ergonomics and the provision for ongoing educational opportunities.

But worryingly, findings from the studies suggest there is little evidence organisations are implementing such strategies in the workplace.

“Very few papers had programs in place to support older nurses and midwives and a couple of them only had short-lived programs they just trialled,” Mrs Denton explains.

Asked about the dangers of workplaces not providing meaningful support strategies for older nurses and midwives, Mrs Denton suspects it could ultimately lead to a loss of valuable knowledge and experience being transferred to early career nurses and midwives navigating the professions.

Notably, while older nurses and midwives called for greater support to help them continue to work to their full capacity and proposed various strategies, like ongoing education and professional development, the effectiveness of such strategies remains unknown. To help ensure healthy workplaces for all, the scoping review concluded that it could be time to re-think the role and contribution of older nurses and midwives and challenge outdated stereotypes that still in exist in healthcare workplaces.

The scoping review formed stage one of Mrs Denton’s broader three-part study into the challenges facing older nurses and midwives. Stage two, which is nearing completion, involved 50 interviews with older nurses and midwives from across Australia. Stage three will involve speaking to managers overseeing older nurses and midwives about working with them from their viewpoint.

For stage two, Mrs Denton put a callout last July for older nurses and midwives willing to share their experiences in the workplace and either choosing or being required to remain in paid work for varying reasons.

“One of the important things to note is the fact that a lot of people have to continue to work,” she says.

“They don’t have the luxury of saying ‘Oh well, I’ve hit an age I’m going to retire’ because many can’t afford to. Increasingly, there are stories about lots of women that have become single later in life. Some may still have dependents, a mortgage or have to pay rent, and they just can’t afford to walk away.”

Mrs Denton deliberately didn’t specify an age range for older nurses and midwives to be interviewed, instead asking them to self-identify if they considered themselves one.

“I asked everyone to self-identify because I wouldn’t want to be told ‘well you’re old because you’re a certain age’. Interestingly, there was a range from 46 to 74 years.”

Giving an insight into the soon-to-be published research, Mrs Denton says the interviews focused on what self-strategies older nurses and midwives are employing to continue to work to capacity and what organisational strategies are being made available to them.

In regard to the challenges older nurses and midwives face in the workplace, Mrs Denton says although there weren’t specific questions regarding challenges the research mirrors a lot of what was uncovered through the scoping review, including physical hurdles, being treated differently and being denied opportunities for further education.

“They [interviewees] wanted to attend a conference for further education go and they were actually told ‘Oh, no we’re going to send Joanne Blogs because she’s a lot younger and we’ll get better value for money’.

“An interviewee was also told ‘you’re a has-been, you were hospital trained, what do you know’. That was more from younger colleagues but it certainly hurts them when they’re being told things like that.”

Mrs Denton is now currently looking to recruit managers overseeing older nurses and midwives to conduct stage three of the research.

Unlike previous studies which have specifically focused on the challenges older nurses and midwives face, Mrs Denton hopes her research will provide a wider picture of the experience of being an older nurse or midwife in Australian workplaces and which strategies are most effective to allow them to continue to work.

“What I did want to do was create a final thesis to report the findings from the studies with a view to discover what we need to do to be able to support these and future older healthcare workers,” she says.

To access the scoping review click here

Mrs Denton is looking to speak to managers overseeing older nurses and midwives to get their views on how their workplace role is viewed and managed.

If you are keen to participate please follow the link to SurveyMonkey to leave your details

https://www.surveymonkey.co.uk/r/CSHQG68

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