As the average nurse age increases, Lisa Hitchen looks at what can be done to keep older nurses – and their wealth of experience – in the profession and the NHS
The average nurse age is increasing. NMC figures for 2007 reveal that 64% of nurses were over the age of 40 and 30% over 50, compared with 61% and 27% respectively in 2004. Numbers of younger nurses continue to fall.
With a shortage of young blood and a greater number of older people requiring nursing care, the need to retain older, experienced nurses within the profession has never been greater.
Josie Irwin, the RCN’s head of employment relations, is well aware of this and of the competing attraction of voluntary early retirement for many nurses approaching 50. ‘This is very urgent. We know that 180,000 nurses are set to retire in the next 10 years. We are starting to brainstorm [with employers] on approaches that might be possible.’
One positive workforce factor is the increased flexibility built into the amended and the new NHS pension scheme, both of which came into force in April this year.
As nurses approach retirement, they can now ‘step down’, which allows them to work more flexibly without compromising their final salary pension. This pension is frozen and a new pension, based on their stepped-down pay, is begun. Both are combined on retirement.
To qualify, nurses must have reached 50, have at least two years’ pensionable service and confirm they will stay in the ‘step-down’ role for at least 12 months. The new scheme raises the retirement age from 60 to 65, the voluntary retirement age from 50 to 55.
Steps have also been taken to attract retired nurses back into employment. By working in a different capacity, they can continue to draw a pension, as long as their job does not pay more than their pension.
‘The advantages are continuity, their expertise is kept in the service, they can balance retirement with still keeping their hand in and younger nurses can get the benefit of their expertise,’ says Ms Irwin.
Facing longer working lives and an ageing patient population means that it will be more important than ever for older nurses to keep their skills up to date.
However, research suggests that many are struggling to do this. A survey of 510 UK nurses and midwives in 2005 found that those over 50 had taken fewer CPD courses than younger nurses – although this was not necessarily linked to age discrimination.
‘Nurses said courses were available but were not appropriate for their needs,’ says Jane Wray, research fellow and lead author of the A Wealth of Knowledge survey from the University of Hull.
‘There were courses that they had already done before but not ones that were specific to their needs at that point in their lives.’
Only seven out of the 22 older nurses interviewed said their experience of training has been positive. They reported pressure from managers to take unnecessary or irrelevant training.
Another concern – not specific to older nurses – was that most CPD had to be self-funded and carried out in nurses’ own time.
‘The valuable resource of the older nurse is in danger of being lost to the NHS particularly in the current climate where there is a lack of jobs for nurses in some areas. They are a ready-made resource that can be used,’ adds Ms Wray.
In 2003 Alan Brown, professor of training, education and employment at the University of Warwick, published Old Nurses with New Qualifications are Best.
This explores managers’ attitudes on recruitment of healthcare staff in five European countries.
While the title of the research reflects the views of Estonian managers, the seven UK managers interviewed made significant comments on returners and on bringing older individuals into nursing.
‘They [said] that, in some cases, they required substantive retraining but they did make the point that, when a nurse is trained or retrained after 40, she is likely to stay in nursing, whereas some younger nurses were more likely to be feel that they had a range of alternatives – they saw themselves as having skills that could be transferred to a range of settings,’ explains Professor Brown.
He says that as people live longer, employers should accept that more and more people will want to change career direction during midlife rather than stay in one profession for the whole of their lives. They should accept this if they expect people to comply with legislation directing longer working lives, he adds.
In his forthcoming publication with labour market researcher Jenny Bimrose, Older Workers’ Transitions in Work-Related Learning, Careers and Identities, he calls on employers and colleges to identify learning strategies to assist older people to work and learn. Fourteen current and former nurses aged 45–65 were interviewed during the research.
Jan Draper, the Open University’s director of nursing, says the flexibility of OU nursing courses maintains their attractiveness for student nurses of all ages.
Its pre-registration course is popular with older HCAs who have never had the opportunity to train as nurses, she says. The course is part-time, distance learning.
Post-registration courses include diploma, degree and master’s – all distance learning. ‘We also have bite-sized chunks of CPD,’ says Professor Draper. ‘These are tasters for people who want to get back into study.’
Age discrimination is now illegal. The Employment Equality (Age) Regulations 2006 state that staff up to the age of 65 cannot be discriminated against on grounds of age. Employers are no longer able to specify that a recruit should be a particular age, sack staff for being older or deny employees training opportunities because they perceive they are likely to retire soon.
So is the legislation, now two years old, making a difference?
Unison reports that no cases of age discrimination involving nurses have come to its attention. Ms Wray suspects she knows why. ‘With all legislation, it takes time to be able to use it or challenge it,’ she says.
Academics have recommended that employers should be fairer and more supportive of older nurses to encourage them to stay on, and given examples of the measures that should be successful.
In 2003 the Joseph Rowntree Foundation report, Nurses Over 50: Options, Decisions and Outcomes, found that a focus on the needs of the over-50s nursing workforce would go a long way to retaining, recruiting and attracting back older individuals.
The project lead, Roger Watson, then of the University of Hull, recommended that NHS employers do more to help older staff work part time while retaining pension benefits. More advice on such options should be given, as should more measures to help overcome older nurses’ stresses, he said.
One such stress is the long, round-the-clock-hours rota system. Scottish researchers found shortening shifts helped older employees. Sarah Wise, formerly at Napier University in Edinburgh, researched the views of 1,084 nurses and midwives at Lothian University Hospitals NHS Trust in 2003, of whom 13% were over 50.
The Older Nurses and Working Hours paper showed that older nurses were more likely to work in theatres where shifts were shorter and less on nights and weekends.
They were also more likely to work in medicine for older patients, where a bigger variety of shifts was available. They were less likely to work in regular wards, ICU or high-dependency units, which usually have 12.5-hour shifts.
Some managers were aware of difficulties that older staff experienced with longer shifts, so allowed them to work core shifts.
NHS Employers aims to increase awareness of older workers’ needs and, in 2007, it produced a guide for trusts on developing an age strategy.
‘It highlights the negative impact of discrimination on the older worker and provides examples of good practice to make the NHS workplace friendlier for older staff,’ says Sian Thomas, joint acting director.
‘These include setting up a workplace health programme, making workplace adjustments for those with long-term conditions or those returning to work and providing flexible retirement arrangements.’
The paper includes two case studies.
One of these, Hertfordshire Partnership NHS Trust, is offering flexible retirement options. These include a ‘wind down’, where staff can work fewer days or hours, and a ‘step down’, where they can opt for a less demanding position. They can register for the staff bank after taking retirement. Or they can stay in their current post.
The RCN’s biannual employment survey asks members about retirement plans. In 2007, 36% of the 4,500 nurses who replied said they did not know at what age they would retire. But, of the other 64%, 40% said they planned to retire before the age of 60, 40% at 60 and the remaining 20% later than 60, with 13% saying 65.
When asked if they would continue working after retirement age, 43% did not know. Of the remaining 57%, around half said they did expect to continue working.
‘There is a willingness to stay,’ says Ms Irwin. ‘We just have to make sure that the conditions are right so that they enjoy continuing to work after retirement age.’
Lynn Young, the RCN’s primary care adviser, adds that employers have to be honest about what annoys nurses and why they leave. ‘Two district nurses I know were fed up with organisational change every year, no continuity in management and with people being made redundant. They just got utterly disillusioned and said: “I’m jacking it in.”’
Ms Young makes the case that while nurses may be less able to do strenuous physical jobs as they age, they can still perform intelligent and challenging roles that require experience.
‘They can be mentors, supervisors and have an important role in teams coordinating services for patients,’ she says. ‘We all need to use our imagination.’
What employers can do to help older workers
From: Developing an Age Strategy: a Step-by-Step Guide, NHS Employers