Most people who read the news in the UK are likely to have read recent articles that point to the possibility that there is a shortage of nurses[i][ii][iii]. In a time when we are talking about reconfiguring the way care is offered and moving care into people’s homes it is also well documented that we have an aging nursing workforce with particular concerns in community nursing. In a report by the RCN in 2012, it was identified that almost 60% of the community nursing workforce could if they chose, retire in the next decade. Of course, it’s not just about the numbers of nurses who leave – it’s also the level of expertise that the system loses when these experienced nurses, who are likely to have up to 3 decades of experience, retire.
There are steps in place to try to attract nurses who were once registered but left the profession back into practice. This work is being led by Health Education England with a concerted public campaign to attract once registered nurses to undertake a period of updating to encourage them to return. You can read more about the campaign here.
Whilst workforce planning as a numbers game is important – we need to make sure we have an adequate flow of newly qualified nurses – what could be just as important is retaining those with the long years of experience to help to pass on their tacit knowledge and skills before they leave the profession through retirement.
Bearing this in mind a paper by Liebermann et al (2015) caught my eye. They discuss that, as well as adequately addressing the recruitment of new nurses, we also need to make sure we retain new entrants and encourage older nurses to postpone their retirement.
I am now 51 and in the last year or so I have thought about the prospect of retirement more than ever in my life. I realise this is a natural progression, that looking forward is a good thing; I also recognise that if every one of my generation does this, there could be an inevitable skill gap. There are ways less experienced nurses can be supported to offer safe care such as decision support technology but even I (as a nurse with a passion for technology) know that this can never replace decades of practice experience. So what do we know about why it is that nurses seek to leave the profession early?
Liebermann et al undertook a longitudinal study via questionnaire that sought to understand what conditions were most likely to encourage nurses to stay, with a focus on the possible differences between younger and older nurses. In other words, do we need to do different things to encourage younger nurses to stick with nursing and for older nurses to encourage them to put off an early retirement?
In some ways the conclusions are not surprising – nurses need good management support to stay and to help them to keep up to the hard demands that nursing places on us. What is perhaps more interesting is that they found differences between the younger and older nurses. The researchers concluded that ‘supervisors [managers] should foster nurses’ expectation of remaining in the same job until retirement age by providing age-specific job resources’ (Liebermann et al 2015).
![By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons](https://anniecoops.files.wordpress.com/2015/03/training_queens_nurses-_district_nurse_training_at_the_queens_institute_of_district_nursing_guildford_surrey_england_uk_1944_d23118.jpg)
By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons
I think this is a fascinating thought that we may need to think about. So, it’s possible that any efforts we make to encourage people to stay in nursing, if we don’t understand the needs of particular generations, may fail. My final point is are we just addressing a numbers game, when we need to start to focus in some detail on how we can retain nurses, recognising that different generations may have different needs?
Liebermann SC., Muller A., Weigal M.,Wegge J (2015) ‘Antecedents of the expectation of remaining in nursing until retirement age’ Journal of Advanced Nursing doi: 10.1111/jan12634
With thanks to Dr Susan Hamer for bringing this journal article to my attention :0)
PS thanks to Ruth Auton for pointing out this paper from HEE http://hee.nhs.uk/wp-content/uploads/sites/321/2014/05/Growing-nursing-numbers-Literature-Review-FINAL.pdf
[i] http://www.theguardian.com/society/2014/dec/17/nhs-nurse-shortage-health-service-overseas
[ii] http://www.rcn.org.uk/newsevents/news/article/london/nursing-shortage-pmqs
[iii] http://www.telegraph.co.uk/news/nhs/11349403/AandE-units-will-be-forced-to-declare-nurse-shortages.html
anniecoops 
That is really interesting – especially the notion of providing different retention incentives for different generations. I hadn’t really given this much thought, but it makes sense. A colleague of mine is doing a three year study of student nurses and why they stay in training ( where I work we have very good student retention on our nursing progs), I shall be talking to him about looking for differences between different student age groups. Thanks to you and Susan for drawing this to wider attention.
When hasn’t there been a shortage of nurses? This is nothing new and it will continue.
Thanks for sharing this. I think it’s really important that retention is often forgotten in the drive for new. It’s something that’s struck in as being particularly noticeable in social work too. The richness and wealth of experience being lost because focus has been entirely on entry routes – of course it’s not one or other but I do worry that retention has been ignored.
Hi I am a District Nurse of over 25 years I am 55 yrs old and wished to reduce my hours to part time after working full time for around 30 years to do this I had to reduce my role to Community Staff Nurse as I was not allowed to hold a caseload on part time. This made me feel under valued as a District Nurse and unappreciated by my employer. I am more than capable of working as a Community Staff Nurse but still feel I have a lot of experience as a District Nurse to offer. I feel it is issues such as these that are affecting retention of staff. Many District Nurses in their 50’s no longer have to work full time and are wanting to balance their Work/Life relationship. I urge all employers to bear this in mind and value the knowledge and experience of the staff who have been with them for a long time.
Thank you everyone for your comments; Margaret you have exemplified exactly why this matters. In the study control of work, which I took to mean issues like working hours, how you organised your work, were exactly the issues that affected the older nurses. We seem to have such ‘rigid’ rules and ‘systems’ that are actually not helping.
The research points to the fact it may be a time for a re-think.
I’ve also had tweets from others saying this may not just be a nursing issue.
Thanks again all.
Anne
Dear Annie I read this great blog early today . During my day I have been thinking about key points . I am a nurse of a different era . I undertook a hospital based training in the 1980’s between school of nursing and wards in a dress a hat a cape then went on to get a different hat and best of all at the time a buckle . I remember a wide age range within the qualified nurses I met back then . Most Sisters were more mature some seemed positively ancient and acutely fierce especially the Nursing Officers . After about seven years out of Nursing I undertook a Return to Practice at University with a clinical placement . This was in 2008 . I saw a change . Ward sisters younger . Nursing officers now Senior Nurses not scary and not in uniform and unidentifiable really . Shift patterns were changed. When I had left the longest shift was a night duty but day shifts were over 7.5 hours worked either as an Early or a late . I do recall when experiencing the odd shortage back in the 80s a Split Shift was sometimes the solution though never relished .
I’m grateful I had the opportunity to return to the work I absolutely love . However , as you know , my true role no longer exists as it once did . This too was apparent at my return . If anyone is wondering what I’m on about I trained as an Enrolled Nurse . I loved my role . There are no longer conversion courses . Are there ENs out there who feel they can’t return I wonder ? You can 😃
I also returned with health issues as I am now hearing impaired. This impacts in a variety of ways because concentrating on trying to hear or lip read is tiring . I really feel exhausted if I work a floor shift over 12 hours . I have balance issues too which are affected by fatigue . I would like to think that consideration regards to long days is given to our maturing knowledgeable and wonderful nursing workforce . It’s workable with some who choose this I manage Rotas and am able to incorporate this well. The job has changed and I would love to see more development for assistant practitioners too also regulation as I truly believe there’s a place in our modern day healthcare system for a second level nurse . I would like to see more rotation and integration of nurses and students into carehome environment as many places are caring for NHS funded patients with a variety of complex nursing needs that require excellent skills as well as fundamental care . These shouldn’t be seen as a second class working environment and have stepped in where Long Term Care of the Older Adult are no longer in a hospital . Nursing is diverse and with thought can still be lifelong for those of us who love it enough to make it so.
Nursing workforce planning: are we just playing...