1. Nursing and Health Policy Perspectives
The ageing of the nursing workforce: what lies
ahead and what we can do
When I turned 60 last May, like many nurses who have histori-
cally in their mid to late fifties considered retirement, I ques-
tioned whether it was time to retire. I was no longer in clinical
practice so I didn’t have to deal with the physical demands of
nursing but I thought, isn’t this the time when one slows down?
Instead I moved half way around the world and took a new job
with the International Council of Nurses (ICN). After over 20
years in the trade union movement in Canada, I was intrigued
by the opportunity to utilize my skills at an international level.
In my first week on the job, I read with interest an article
telling the stories of three nurses, all of whom had retired but
decided they still had passion for nursing and could make a dif-
ference (Snell 2012). The one who really caught my attention
was a 74-year-old nursing student who had just completed the
first year of a three-year degree course. His view was that when
he graduated at 76, he would work for 14 years and then retire
gracefully at age 90.
Nurses like the rest of the population are living and working
longer. Older nurses, whether new graduates or seasoned veter-
ans, have much to offer and can be a vital component of our
current and future health care system. Given the global work-
force shortages, retaining older nurses could result in their
becoming a substantial and growing component of the work-
force. We must work together to have a realistic, safe and sup-
portive vision and plan for every stage of a nurse’s career.
Health care workers, particularly nurses, are remaining in the
workplace well beyond traditional retirement age at higher rates
than ever before. Workers 65 years and older constitute more
than 20% of the U.S. workforce today and represent the fastest
growing demographic of American workers. Thirty-five percent
of all workers envision working into their 70’s and beyond.
People who don’t retire or return to work after trying retire-
ment can be financially motivated, bored with doing nothing or,
as in the case of many nurses, motivated by the reward of
helping and caring for people. The majority of nurses are female
and the average life expectancy for women in more than 40
countries is over 80 years of age. This leaves many productive
years for nurses to contribute to health care systems beyond
age 65.
Changes in mandatory retirement age such as raising the age
limit, and in some countries the elimination of mandatory
retirement entirely, provides opportunities to continue working
well beyond the historical retirement age of 65. Increased lon-
gevity, overall improvement in health status and a decline in the
number of jobs requiring hard physical labour have resulted in
longer working lives. However, nursing is still emotionally and
physically demanding with increasing stress due to high work-
loads and shifts in care delivery. Patients are much more acute
in today’s health care settings, adding to the workload and stress
of the nurse.
Declining health status is often cited as a disadvantage of
employing older workers. While age-related changes in health
and functioning do occur, considerable evidence suggests that
the impact of these changes on the ability of the worker to
perform is minimal (Alpass & Mortimer 2007). One can
develop adaptive tactics to compensate for the decline in cogni-
tive functioning, particularly in areas related to processing com-
petencies, that occurs with normal ageing. Knowledge, skills,
abilities and motivation also can mitigate the decline. It is some-
times suggested that older workers are more likely to experience
the effects of work-related stress due to the increasingly
complex nature of the work environment. However work-
related stress may be experienced by workers of any age for
many reasons.
What are some of the issues to be considered and addressed if
we continue to work into our seventh and eighth decade?
Research suggests that, due to a decreased resistance to physi-
cal stress, older workers suffer more from fatigue, take longer to
recover from injury and do not tolerate shift work (Graham &
Duffield 2010). Although studies reveal that older workers suffer
similar or even lower rates of workplace injuries compared to
younger workers, the severity and recovery time from those
injuries increases drastically with age. Musculoskeletal injuries
and disorders account for a large portion of work-related inju-
ries in the health care industry, primarily due to the unpredict-
able physical demands of patient handling (Conn & Cosentino
2011).
Redesigning the work and workplace will go a long way in
addressing the physical changes of older workers. Wellness pro-
grams to assist workers in maintaining a good level of fitness
will help to offset the physical changes of ageing. Other recom-
mendations are shorter shifts and no shift rotation, more ancil-
lary staff to deal with the physical aspects of the work, and
mechanical lifts. Minimizing or eliminating manual lifting of
patients by care providers is a first step in addressing the
number one on-the-job injury, musculoskeletal back problems.
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© 2013 International Council of Nurses 277

2. In fact, implementation of a no-lift policy will benefit all
workers regardless of age.
Studies point to the need for the training of supervisors in
age-related issues, implementation of appropriate age-related
ergonomics and workplace exercise programs, and introduction
of tailored training in newer technologies for older workers
(Ilmarinen 2001).
Today, with four generations of nurses in the workplace, age
discrimination is a growing concern. While age discrimination
is not new, some fear that it will gain prominence as the work-
force ages, and may result in older workers retiring due to
discrimination.
We need to stop blaming the ageing employee for perceived
shortcomings and look at what needs to happen in the work-
place to keep older workers gainfully employed. We need
evidence-based education about the capabilities of ageing
workers. Employers need to recognize that older workers bring
with them extensive knowledge and experience which offsets
physical changes.
Following are ideas to assist in retaining ageing nurses in the
workplace to care for the world’s population as it grows and
ages:
• address professional development needs
• consider flexible work options
• guarantee that pensions are not impacted by flexible work
options
• redesign jobs to address heavy workloads and stress
• address issues of employees’ health and safety
• create specific roles focusing on aspects of the job such as
admission and discharge roles/clinic work/mentoring and pre-
ceptor roles
• implement sufficient decision-making latitude
• guarantee adequate support from superiors and colleagues
• ensure predictability and meaning of work
• encourage participatory management style which leads to rec-
ognition and respect of older workers
• devise salary structures that reward experience
• introduce benefit programs that hold value for an ageing
workforce, for example ‘elder care’
• provide retirement planning.
In closing I leave you with a quote from Betty Friedan that
resonates with me at age 60: Aging is not lost youth but a new
stage of opportunity and strength.
Lesley M. Bell RN, MBA is an ICN Nurse Consultant, focusing
primarily on socio-economic issues (SEW). Before joining
ICN, she was the Chief Executive Officer of the Ontario
Nurses’ Association in Canada.
References
Alpass, F. & Mortimer, R. (2007) Ageing Workforces and Ageing Occupations:
A Discussion Paper. Massey University, Wellington, New Zealand, ISBN
0-478-28087-4.
Conn, E. & Cosentino, C. (2011) OSHA and the ageing nurse workforce:
challenges and opportunities for health care employers. BNA Health Law
Reporter, 20 HLR 1305.
Graham, E. & Duffield, C. (2010) An ageing nursing workforce. Australian
Health Review, 34, 44–48.
Ilmarinen, J. (2001) Aging Workers. Occupational and Environmental
Medicine, 58, 546. Available at: http://oem.bmj.com (accessed April 12,
2013).
Snell, J. (2012) Beating the age barrier. Nursing Standard, 27 (14), 18–19.
278 Nursing and Health Policy Perspectives
© 2013 International Council of Nurses