Gray matters
Despite the challenges of aging in a demanding profession, seasoned nurses find that experience counts
By Ed Frauenheim
January 22, 2001
Photo: Comstock

Leslie Wiggin, RN, 54, isn’t as physically or mentally fit as she used to be – which makes her 40-hour-a-week job as a staff nurse constantly exhausting.

A single woman earning roughly $50,000 a year, she imagines she will have to work until she’s 67. That prospect alarms her.

"That’s a little disconcerting," said Wiggin, a nurse at Exempla St. Joseph Hospital in Denver. "To have to think about working 13 more years at this pace."

Wiggin is part of a growing legion of nurses confronting the challenge of growing older in a profession that seems to demand more and more. The 12-hour shifts so common to nursing take a toll on aging bodies. What’s more, nurses in their mid-40s, 50s and 60s often are hit with increasing numbers of family burdens, making the spiritually and emotionally taxing work of nursing all the more difficult.

But not all is grim about the graying of nurses. Years of experience carry priceless wisdom in the workplace and the ability to mentor younger members of the profession. Maturing nurses also may be able to find niches that aren’t as grueling. This can be beneficial for nurses and their bosses.

Older nurses who take on stimulating jobs can combat the unhealthy boredom frequently found in retirement, while the health care industry can benefit by cutting into the nursing shortage with seasoned veterans.

Finally, there are calls for reforms to accommodate the aging nursing population. These include shorter shifts, more flexible scheduling and allowing nurses to advance in status without giving up patient contact.

A simple demographic fact is driving these suggestions: Nurses are getting older.

In California, for example, just 36 percent of RNs were 45 or older in 1980. By 1996, that figure had jumped to 53 percent, according to research by the Center of Health Professions at the University of California, San Francisco. This trend has something to do with the broader graying of America, but also may reflect the difficulty the nursing profession has had attracting young people.

That recruitment problem may stem in part from a phenomenon that’s challenging for aging nurses – the workplace has been getting more intense.

Thanks to downsizing in hospitals and health care systems in the 1990s, staffs with fewer nurses and more unlicensed assistants have had to do more, said Jean Ann Seago, Ph.D., RN, a researcher at the Center for the Health Professions at UCSF. What’s more, she added, nurses found that mandatory overtime became more frequent.

Rigorous responsibilities
These changes, along with an earlier move toward 12-hour shifts, are hard on middle-aged people for a variety of reasons. One is that many nurses are the primary family managers. As nurses, most of whom are women, advance into their late 40s, 50s and 60s, they may have to care not only for their own children, but also grandchildren and their own elderly parents, Seago said.

"As they have more and more responsibilities, they’re going to have to manage family issues that young nurses may not have to," Seago said.

Such family obligations can be hard on nurses, given that nursing is already a caregiving profession. Erin Brown, RN, a 43-year-old charge nurse at University Medical Center in Tucson, Ariz., describes the profession as "emotionally, spiritually, and mentally exhausting."

Besides becoming emotionally spent, older nurses face physical fatigue. Brown and her colleagues work 12-hour shifts, which, for Brown, exacerbates a sore knee and leads to days off spent recovering.

"They’re marathon days. You’re on your feet the whole [time]," Brown said. "If I work two or three straight shifts, I’m history for the next two days."

Brown said RNs shoulder some of the blame for today’s 12-hour shifts because nurses initially pushed for them in the 1970s and ’80s to snag four-day weekends.

But now those long stretches seeing patients and filling out paperwork are exacting their price from an aging RN workforce. Brown knows older nurses who have chosen to work part time because the 12-hour shifts are too much.

Physical fatigue is only part of the problem for Wiggin. The 32-year veteran nurse finds that her ability to troubleshoot on the job has declined as she’s aged. She said that it’s because her thinking ability has lost a step.

"I don’t think it’s quite as quick as it was 20 years ago," she said.

Wisdom and cool
On the other hand, Wiggin believes she still has much to offer as a nurse. For example, she’s developed a close rapport with her physician colleagues, having worked at the same hospital for 26 years.

Wiggin also has become ever more cool under pressure. She applies that calmness to her job in an outpatient surgery setting.

"I don’t think I tend to panic as much as I used to," she said. "Experience is a good teacher."

Charge nurse Marie Cronk agrees. Cronk, RN, a certified operating room nurse, is 61 and has spent the last 10 years in the operating room at Good Samaritan Hospital in Puyallup, Wash.

"Experience is invaluable," Cronk said. "I feel I have a lot of knowledge and I’m able to use it. And I try to pass it on to the younger people."

One piece of knowledge Cronk may want to impart is how to develop the stamina she has. Cronk works 12-hour shifts, going to the hospital weekly, Monday through Wednesday. Does that wipe her out? Hardly. She typically wakes up the next morning and does chores around her 20-acre farm, such as fixing fences that surround cows, chickens and turkeys.

Cronk credits her impressive energy partly to a healthy diet and a thrice-weekly walk on the treadmill.

"Every day I go to work, I work out for an hour," she explained. "I go in an hour and a half early."

Exploring options
For less superhuman maturing nurses, there are alternative ways to thrive in the profession. Unlike some fields, nursing has numerous opportunities to try a new specialization or management role. These diverse career paths can prevent burnout and allow for a less taxing job. Cronk, for example, became an OR charge nurse to try a new challenge and to make sure she worked days rather than nights.

Pat Huffman, RN, has similar reasons for choosing her position. Huffman, 65, works as a case manager for a California home visit program that aids medically vulnerable infants. It’s more social work than nursing per se, but allows Huffman to pursue her personal goals.

"I’m more interested in the relationship caregiving than the technology [of medicine]," said Huffman, who lives in Los Angeles County.

Huffman also said her work, in which she does nothing more physically demanding than weigh and measure infants, is best for her body.

"At this point," she said. "I don’t think the physical demands of hospital nursing would be appropriate for me."

Nursing education is another option for older RNs willing to hit the books.

Rosalee Yeaworth, 71, taught a class last fall at the University of Nebraska Medical Center, College of Nursing. Yeaworth, Ph.D., MSN, served as dean of the college from 1979 to 1994, and officially retired from part-time teaching in 1998. Still, when a faculty member was unable to teach an Internet course in nursing theory, Yeaworth stepped up to the plate.

"I went back into teaching last fall not because I needed money, but because the college needed help," she said. "It was stimulating to go back."

Having a stimulating, active life is important to aging people, said Jeanie Kayser-Jones, Ph.D., RN, FAAN, project director of the newly funded Center for Geriatric Nursing Excellence at UCSF. At the same time, the growing numbers of older and elderly Americans will require more nurses.

Kayser-Jones said one solution for nurses and the health care system could be older RNs working into their retirement years with elderly patients.

Nurses in their 60s may not be able to handle the physically rigorous work of moving patients in their beds. Kayser-Jones said that as an alternative, older nurses could take on administrative roles and offer referrals to elderly people and their families, such as phone numbers for local Meals on Wheels or elder care programs.

"A nurse who’s been in the field for quite a while is helpful in providing families with information about the kinds of resources that are available," she said.

Already, Kayser-Jones points out, older Americans do plenty of caring for one another. She gives the example of her mother-in-law, who recently died at age 99 but regularly assisted a neighbor who was 20 years younger.

Another way older nurses stay active in the profession is by working part time. Susan Grant, MS, RN, chief nursing officer at the University of Washington Medical Center, estimates that 50 percent of her staff works part time, with shifts ranging in duration from eight to 12 hours. The part-time arrangement helps older nurses handle the rigors of the job and secures a sound workforce for the hospital, Grant said.

"That allows us to regain seasoned nurses who can mentor younger nurses," she said, "and also maintain the expertise that they bring to the patients."

The part-time approach, though, may not be enough to keep older nurses throughout the profession working, Grant said. She said hospitals are experimenting with nursing shifts just five to six hours long, as well as considering more flexible schedules.

Opportunities for advancement
Another method, one nurses have used for many years, involves a professional ladder that doesn’t require nurses to move exclusively into management. Many nurses derive much of their job satisfaction from working with patients, so taking a management job that involves less direct patient care to earn more money is unattractive. At the same time, hospitals desperate for nurses can little afford to promote skilled, accomplished nurses out of direct care.

"What has always been a problem in nursing is to be able to have some type of advancement without leaving the bedside," Seago said.

Possibly for this reason, many middle-aged nurses have left the profession. The University Medical Center in Tucson, however, is trying to persuade them to return. The medical center along with the University of Arizona offers refresher courses for nurses who may want to return to the hospital but fear that their knowledge of the latest medical techniques is not up to date.

Brown is hopeful the program not only will bolster the nursing staff, but amplify the cry for shorter shifts and other reforms to help older RNs. Wiggin wonders how to attract younger nurses.

"Who’s going to take care of me when I’m 80 years old?" she said.

Brown believes re-entry will help. "As we get more nurses back, we’ll see other accommodations," she said.

Recruitment and retention of younger nurses would largely solve the nursing shortage, but Cronk said relatively low pay has failed to attract them in droves so far.

"Better pay would be good. And it would help to glorify nursing [in recruitment efforts]. I don’t know how to say what I want to say, but if we could have younger people look at nursing as a privilege, it would help," Cronk said.

"Maybe then they’d be attracted to it as a way to benefit mankind."

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