By Elizabeth Matters FACN
As long as I have been a nurse, concerns about the challenges of nursing an ‘ageing population’ into the future have been a recurring theme. How will we meet the health needs as the Baby Boomers grow older? How will the costs of healthcare be contained as more of the population lead longer lives? How many nurses will be needed to care for an increased number of very old members of our population with complex health needs? The depiction is one of a team of young nurses valiantly battling on to provide care to an increasingly overwhelming number of older ‘non-nurses’. Yet there is another question which perhaps receives fewer headlines: how do we support our own nursing colleagues as they age?
A discussion of this question is essential within the broader issue of an ageing population because we nurses are part of this trend as much as anyone else. 48% of Australian nurses and midwives in 2018 with an active registration were over the age of 45 (NMBA, 2018, p.10). The aged care sector is the most frequent employer of both registered and enrolled nurses in comparison with any other single specialty (DOH, 2014, p.17). Many mid-to-late career nurses do double-duty as a professional carer and as an unpaid carer of their own ageing parents as well. Therefore our own ageing and the ageing of our families has a direct effect on our ability as a profession to meet the challenges of healthy ageing for all.
An innovative project in Germany (where all the same demographic issues apply) has recently spent three years studying and addressing the impact of age and gender issues on the longevity and robustness of the nursing workforce with a particular emphasis on the aged care sector. The aim was to support and strengthen healthcare facilities by developing strategies which would retain staff through acknowledgment of their personal needs. The study was based on research which found that nurses frequently leave their profession early due to illness, work-related stress, shiftwork and personal caring commitments (i.e. to relatives in an unpaid capacity) (AGAP, 2019, p.40). There was also data which showed that the two most common health issues which troubled nurses were musculoskeletal injuries and psychological issues, both chronic conditions which are exacerbated by age and continued exposure to the same working conditions (AGAP, 2019, p.4). The project recognised that in order to be able to provide carers to the ageing population and keep nurses employed until retirement, the workplace must be made appropriate to the nurses’ own health needs. In other words, the system needed to change so that nurses were no longer put in a situation where they were forced to choose between their own health and wellbeing and their working lives.
In practical terms, the project involved training and health promotion for nursing staff to reduce their risk of workplace injury or burnout. Perhaps more unusually, it also involved training nurse managers in ways to identify and reduce workplace stressors by allowing their systems to be more flexible. Ways were identified in which older nurses could be supported to continue to contribute meaningfully to their workplaces, for example, through further training for leadership positions or roles as clinical experts in a particular area. Alternative rosters were also discussed in which shorter shift patterns or rotation between different tasks/roles from shift to shift were considered (AGAP, 2019, p.39). Of course, many individual nurses have been using these strategies for years to balance their personal needs with their work by discreetly moving into less physically demanding roles or arranging specific roster patterns on an informal basis. What was novel about this project was that it acknowledged that it was the responsibility of the employer to meet the health and ageing needs of their nursing workforce openly and willingly and not the responsibility of the individual nurse to manoeuvre his or her way through an unforgiving system to find a role in which it was more possible to keep going.
It requires flexibility, new ideas and balanced discussion to develop solutions that meet the organisational needs of health institutions while still acknowledging that nurses, and especially older ones, are humans with health needs too. It is nice to see, however, that these issues are beginning to be acknowledged to be part of institutional duty of care and not just as difficult problems which overstressed nurses need to work out for themselves by whatever means.
With the recent whistleblower stories of the working conditions some of us experience in the health system, it is clearer than ever that health professionals have to draw a line and that a martyr-like sacrifice of our own health is not a solution. We should not have to fight against our own health needs to continue to serve those of others. We should not have to be examples for poor lifestyle practices and unhealthy ageing because we have no other option. We should be able to provide the care to those we love in our personal lives without collapsing under a double emotional burden from two competing groups of people requiring our help. In other words, as a profession, as managers, as nursing leaders and as humans, we need to find creative ways in which all nurses, regardless of age and life stage, can continue to strengthen the workforce and contribute what they can. If we don’t, not only are we ignoring the tenets of healthy ageing which we are trying to promote, but we are supporting a system where people work until they break. This is neither morally defensible nor financially sensible. It is refreshing to know that some employers are beginning to see the moral and financial value in supporting the healthy ageing of their nurses. Let us hope that acknowledgement of these issues will soon be a routine element of workforce planning and no longer an innovation.
Health Workforce Australia (2014). Australia’s future health workforce – Nurses detailed. Canberra: Department of Health.
Kleiner G. & Weber, E. (2019). Erfolgreiche Personalbindung in der Altenpflege. Pflegearbeit alterns- und gendergerecht gestalten. Berlin: Bfw GmbH.
NMBA (2018). Nursing and midwifery Board of Australia: registrant Data 1. July 2018- 30 September 2018. Melbourne: AHPRA.