The Exec: How to Keep Seasoned Nurses From Leaving

Flexibility and innovative practice models can enhance retention of nurses reaching retirement age.

Most nurses aged 55 and older have such passion for their work that providing schedule flexibility and different practice models to focus on their strengths could go a long way in keeping them in the workforce, a new study says.

Worsening patient acuity, competing roles, and the centrality of computers are workplace stressors, according to nurses aged 55+, who participated in A Focus Group Study of Retirement-Age Nurses: Balancing Tension and a Love of Nursing in a Changing Healthcare Environment.

“Understanding what predicts, mitigates, and prevents the retirement of expert senior nurses is paramount given the current environment of the nursing workforce,” writes the study’s lead author, Kim Slusser, MSN, RN, vice president of Patient Care Services, Smilow Cancer Hospital, part of Yale New Haven Health.

Slusser spoke with HealthLeaders about her study’s findings that could help healthcare organizations retain their seasoned nurses.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: What, generally, is the perception of the current nursing profession by nurses over 55?

Kim Slusser: They're very concerned about the nursing shortage and that it puts a stress on them and their ability to perform the things that they know make a difference for patients, just like we all are. But for this group of nurses, as we found in the study, the whole joy of their work as a nurse is what keeps them in the workforce, so all of these stressors that we're feeling right now from a nursing shortage can put that at risk.

In our study, they talked a lot about rising patient acuity and how that continues to be a challenge for healthcare systems. They, over the years, have seen that acuity increase yet, because of their experience and their expertise, we rely heavily on these nurses to do so much for us beyond patient care.

These are the people we're asking to precept new nurses, who are the charge nurses on units who manage the patient flow and how assignments are made, the troubleshooter for everyone. In academic hospitals, they are the resource to residents and interns who rotate onto their unit. These are things they enjoy doing, but with the rise in patient acuity, staffing challenges, and having all of these competing roles, it adds a lot of stress to the work every day.

HL: What are some challenges unique to them in today's workplace?

Slusser: Wearing a lot of hats in addition to taking care of patients. They also talked about the physical demands as you get older and how they used to be able to work long shifts but how that gets harder over time.

Many of them would like to continue to work because it's such a part of their identity—it’s what brings them so much value—so they're looking for ways to be able to do that in ways where physical demands would not take such a toll on them.

They brought up a lot of things such as more flexible hours. Some of the nurses we interviewed said they’ve stayed in nursing because they’ve been able to have flexible work assignments. Other recommendations are a lesser- or no-patient assignment. We need to see how they contribute to the next generation of nurses in a different way than the way we are asking them to do today.

HL: So many nurses over 55 opted to retire or quit during the pandemic, but others chose to stay on. Why?

Slusser: Their absolute love of what they do, that they feel they are making a difference, which brings them a lot of joy, and commitment to their career.

They did say that flexible scheduling was helpful in the decision to stay, so when you can put things like that in place, you have a better chance of retaining these nurses that are so valuable for our care delivery and the training of our future nurses.

HL: What are the benefits of retaining retirement-age nurses?

Slusser: They bring such a richness of experience to the organization. They are the people who we rely on to train more novice nurses. So many of the nurses, at least in this study, have worked for the same organization for a long time, so they have a commitment to the organization and they can foster that hospital’s culture.

Even beyond clinical experience, these nurses know how to develop relationships with patients, how to develop relationships with other clinical team members like physicians, social workers, and pharmacists. It takes a long time to be confident in your practice as a nurse, and these nurses have developed that confidence in their practice and they're able to help instill that in newer nurses coming onboard.

HL: What are specific accommodations that nurse leaders can make to encourage seasoned nurses to stay?

Slusser: We have to think differently about how our entire nursing workforce works. In this study, we focused on the nurses near or at retirement age, but we've learned with the younger generations of nurses that they want similar things. They want flexibility in their schedules. They want non-traditional shifts, as well, so it’s a win-win for the entire nursing workforce that many of the things that our nurses from this study wanted are similar things that we found in younger nurses.

We can become more creative and offer our scheduling, shifts, and even our roles part time. During peak times of clinical care activity, does everyone have to come into work at the same time? Right now, we’re traditional in how most of our hospitals schedule their nurses, so it’s going to require nursing leaders to take a step back and look very creatively.

Nurses can help inform how to do that well; hospitals that have strong nursing shared governance groups can lean on the nurses to help accomplish that so that the nurse leaders don't have to come up with these ideas all on their own.

Another recommendation of nurses in the study was to find a way to coach, precept, and educate more novice nurses in a way where they don't have to continue their other responsibilities such as maintaining a full patient assignment or being the charge nurse on the unit. There are ways we can relieve them of some or all of those duties so they can focus on coaching.

It is more expensive to take nurses and reduce their responsibilities to give them more time to coach novice nurses, so as nurse executives, we have to figure out a way to measure the return on investment for doing that. How can we measure that from a patient-outcomes perspective, retention of nurses, job satisfaction of nurses, and their confidence, which makes them a stronger clinician?

I do think there's cost avoidance if we stand up programs like this, especially around reducing turnover. Back in 2020, the nursing turnover rate was as high as 18% in some places, and turnover for new graduates was anywhere from 17% within their first year up to 30% within two years. If we can keep nurses in their profession by having nurses near retirement focus on coaching them, there could be a huge return on investment.