The juxtaposition of ageing and nursing: the challenges and enablers of continuing to work in the latter stages of a nursing career

Ageism directed at older nurses in their workplace: A systematic review

AIMS

To identify and synthesise evidence related to ageism in older regulated nurses' practice settings.

DESIGN

A systematic review following Joanna Briggs Institute methodology.

METHODS

The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta-analysis reporting (SWiM) guideline was employed in the review.

DATA SOURCES

Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered.

RESULTS

Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well-being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age-inclusive.

CONCLUSION

To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational-led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age-inclusive work environment that supports an age-diverse nursing workforce.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti-ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role-playing and simulation during in-service training may also be effective interventions. Additionally, incorporating anti-ageism initiatives into staff meetings and mandating anti-ageism training could support the continuation of practice for older nurses while fostering a more age-diverse nursing workforce.

IMPACT

We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well-being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age-inclusive policies that support older nurses' continuation of practice.

REPORTING METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis checklists were used to report the screening process.

TRIAL AND PROTOCOL REGISTRATION

The PROSPERO registration number for the review was CRD42022320214 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320214). No Patient or Public Contribution.

Older nurses and work-related factors that impact their mental health and wellbeing: a qualitative systematic review

BACKGROUND

The COVID-19 pandemic has placed a significant pressure on the nursing workforce, leading to an increased risk of infection and work-related issues impacting nurses' mental health. This review aims to explore the workplace challenges faced by older nurses and their impact on mental health.

METHOD

This qualitative systematic review followed the Joanna Briggs Institute methodology.

RESULTS

The review included 32 studies and identified three interconnected themes: heavy workload and nature of nursing, lack of recognition and feeling undervalued, and challenges in balancing personal life and work. These themes illustrated the complexity of the workplace challenges faced by older nurses.

DISCUSSION AND CONCLUSION

Workplace demands and shift work were common negative contributors to mental health and wellbeing. The physical and cognitive capacity of older nurses may diminish due to age-related changes, making the workload more challenging. Recognition and support from the organisation, especially from management and leadership, played a crucial role in nurses' resilience.

Supporting older nurses and midwives in the Australian healthcare workplace-A qualitative descriptive study

AIM

To explore support strategies for older nurses and midwives in Australian healthcare workplaces.

DESIGN

A qualitative descriptive study.

METHOD

Participants were 50 older nurses and midwives and 20 healthcare managers recruited from a broad range of Australian healthcare settings. Data were collected using semi-structured interviews from November 2018 to April 2021. The interviews were recorded, transcribed and thematically analysed.

RESULTS

The limited number of identified sedentary roles and inequitable distribution of workload responsibilities were identified as constraints that impact the provision of workplace support for older nurses and midwives in healthcare settings. Three major themes were identified: Workplace support, Personal support and Doing more. A small number of participants reported support was available at work, but most said there was not. Of the reported strategies some were offered exclusively to a cohort that met an age criterion, while others were open to all staff regardless of age. Personal support strategies were employed outside of the workplace while others used strategies during working hours. Doing more related to suggestions about how organizations could do more to support older nurses and midwives at work.

CONCLUSION

Support mechanisms like adjustments in workload, employment fraction, practice location, upskilling and wellness programs in workplaces are limited. To facilitate retention and support older nurses and midwives in the workforce, health workplaces should consider implementing support mechanisms that can be tailored to the individual needs of the nurse or midwife over the life course of their career.

IMPACT

The findings of this study highlight the lack of support for many older nurses and midwives in Australian healthcare workplaces, emphasizing the need for further research into innovative practices on how to better support healthcare staff as they age.

REPORTING METHOD

This study adhered to the COREQ reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

What interventions and programmes are available to support older nurses in the workplace? A literature review of available evidence

BACKGROUND

High exit rates, stalling entry rates, population ageing, and, most recently, the COVID-19 pandemic have placed significant strain on the world's nursing workforce. Both developed and developing countries face similar predicaments. Evidence-based programmes to support older nurses in the workplace are urgently needed to ensure the sustainability of a career in nursing for this group of healthcare professionals.

OBJECTIVES

To scope and synthesise available evidence on evaluated programmes and interventions implemented to support the ageing nursing workforce's health, wellbeing, and retention.

DESIGN

A literature review of available evidence using a systematic approach.

METHOD

Medline, Scopus, PsycINFO and CINAHL were searched for relevant peer-reviewed evidence. Data from the peer-reviewed literature were extracted separately into purpose designed-extraction spreadsheets. Information relevant to study design, intervention design, outcome constructs, intervention outcomes, and barriers and enablers to intervention success were collected. The protocol for this review was registered in PROSPERO [CRD42021274491].

RESULTS

Eighteen published studies were included in this review. We identified a range of interventions and programmes that have been implemented to support older nurses, which included flexible and reduced work arrangements, mentoring programmes, exercise and lifestyle interventions, continued professional development and purpose-designed remote retreats. We found limited evidence of evaluated outcomes from workplace support interventions that addresses the actual challenges faced by ageing nurses as reported in previous literature reviews. Interventions that were designed to promote a sense of purpose at work resulted in positive outcomes and appeared to more directly address the stated needs of older nurses. Holistic programmes and interventions that could potentially promote both physical well-being and psychological well-being required a broader, whole-of-organisation approach rather than more piecemeal interventions addressing individual physical and mental health concerns. Interventions which acknowledged older nurses' clinical expertise and experience (e.g., mentoring programmes) were linked to positive outcomes.

CONCLUSION

Future intervention efforts should acknowledge and balance intervention participation opportunities against existing everyday workload constraints faced by older nurses. Our review suggests the need for further intervention studies assessing specific outcomes such as psychological and emotional health, as well as interventions that more directly address the most pressing concerns that ageing nurses report at personal and organisational levels. A paradigm shift in productivity measurement in clinical nursing work is required in order to increase the value placed on the unique contribution of older nurses working clinically, particularly in sharing their acquired knowledge, skill, and expertise.

Managers' perception of older nurses and midwives and their contribution to the workplace-A qualitative descriptive study

AIMS AND OBJECTIVES

The aim of this study was to explore healthcare managers' perceptions about older nurses' and midwives' and their contribution to the workplace.

DESIGN

A qualitative descriptive methodology.

METHOD

Twenty healthcare managers working in Australia participated in semi-structured interviews. Data were collected between April 2019 and April 2021. Interviews were recorded, transcribed and then analysed using thematic analysis.

RESULTS

All healthcare managers said older nurses and midwives contributed to the workplace through their experience and knowledge. Managers viewed them as a different type of worker and while there were some positive aspects to this, it was mostly negative. Although managers identified a broad age range for the older nurses or midwives, there was a common perception that if they were no longer able to perform their duties, they should leave the workforce.

CONCLUSION

Healthcare managers' perceptions towards older nurses and midwives are mostly negative, and their understanding of older workers' contribution is contradictory and poor. These negative views co-exist with the lack of agreement on who is the older worker, which explain the reluctance of healthcare organizations to invest in their older workforce. Future research is needed to better understand the unique contribution of older nurses and midwives in healthcare and how they can be supported at work.

IMPACT

The global ageing population will result in a rise in complex age-related health issues and will require an experienced and knowledgeable workforce. Given the greater experience of older nurses and midwives they are an important part of the health workforce. Yet managers' perception of the contribution by older nurses and midwives were often negative. The findings of this study highlight the need for organizational change so that the contribution of older nurses and midwives is recognized and supported by managers.

Career resilience of the tourism and hospitality workforce in the COVID-19: The protection motivation theory perspective

By applying the protection motivation theory, the study aims to investigate factors influencing tourism and hospitality (T&H) workers' career resilience when faced with health-related risks at work during a pandemic. Data were collected from 495 part-time and full-time employees in the Vietnamese tourism and hospitality sector. The study found that workers' perceived vulnerability and perceived severity of the pandemic were positively associated with career resilience. Perceived severity was positively related to self-efficacy and response efficacy, while perceived vulnerability was positively associated with self-efficacy only. Both self-efficacy and response efficacy positively influenced career resilience through the mediating role of health risk preventative behavior. Theoretically, the study advances the stream of research in resilience in general and career resilience in particular among T&H workers when faced with a health-related crisis. Practical implications are provided with recommendations on how to facilitate career resilience among T&H employees working in the current high-risk environment.

Sustainable Working Life in Intensive Care: A Qualitative Study of Older Nurses

To counteract the shortage of nurses in the workforce, healthcare organizations must encourage experienced nurses to extend their working lives. Intensive care (IC) has higher nurse-to-patient ratios than other settings, which includes a particular susceptibility to staff shortage. This qualitative study investigated how older IC nurses experienced their working life and their reflections on the late-career and retirement. Semi-structured interviews with 12 IC nurses in Sweden (aged 55-65 years) were analyzed using an interpretative phenomenological analysis approach. The results showed that nurses planned to continue working until the age of 65 and beyond. When reflecting on their late-career decisions, nurses considered nine areas covering individual, work, and organizational factors as being central to their ability and willingness to stay. Overall, the nurses had good health and were very satisfied and committed to their job and to the organization. They mentioned having both the job and personal resources required to cope with the physical and mental job demands, which were perceived as motivational challenges, rather than hinders. They also reflected on various human resource management practices that may promote aging-in-workplace. These findings may inform organizations aiming at providing adequate conditions for enabling healthy and sustainable working lives for IC nurses.

Worker-related ageism: a systematic review of empirical research

With the demographic and workforce ageing, ageism has been reflected in the work context. Ageism can be defined as stereotypes, prejudice and/or age-based discrimination. It is a form of devaluation and non-inclusion of workers, which materialises in a decent work deficit. It affects workers and organisations. The present literature review aims to provide a comprehensive and accurate picture of empirical research on worker-related ageism. We searched the word ageism in the title or abstract of articles indexed in the EBSCOhost and Web of Science. Fifty-eight peer-reviewed articles were retrieved (March 2020). Some of these articles report more than one empirical study. Thirty-two articles include quantitative design studies, 20 qualitative design, three mixed methods, two experimental and three instrument development and/or validation. The focus of the studies is mostly about negative ageism on older workers. The main findings present several facets of ageism and show different experiences, whether implicit or explicit. Ageism acts in a plurality of aspects, such as obstacles in the hiring process, employability and performance evaluation of older workers. We found research gaps such as determinants and interventions aiming at ageism prevention and proposed corresponding future research.

Being an older nurse or midwife in the healthcare workplace- A qualitative descriptive study

AIM

To explore the experiences of being an older nurse or midwife employed in the healthcare workplace.

DESIGN

A qualitative descriptive study.

METHOD

Semi-structured interviews were conducted with nurses and midwives who self-identified as older workers. All Australian states were represented and given recruitment was undertaken nationally, most interviews were conducted via telephone. Data were collected between November 2018 and October 2019. Audio recordings were transcribed verbatim and then thematically analysed.

RESULTS

A total of 50 nurses and midwives were recruited, aged between 46 and 74 years. Three themes were identified. Ageing body: Being an older worker meant increased fatigue and physical changes affecting their ability to function at full capacity. Youth focus: For many, being an older worker was about being viewed as a poor-quality worker, with limited access to education and promotional opportunities because of their age. Wise worker: For a small number of older nurses and midwives, it was about being valued and respected for their knowledge, experience and skills.

CONCLUSION

Participants self-identifying as older nurses or midwives represented a wide age range. Spanning across the age spectrum, many experienced fatigue, physical changes or loss of value to the workplace which often impacted on their working lives. The findings contributed to an understanding about what it is to be an older nurse or midwife in terms of how their contribution is regarded and valued by others in the workplace.

IMPACT

This study highlighted there is a need for support of older nurses and midwives in managing age-related fatigue and physical changes. It also suggests consideration of a wise-worker model as a means to recognize the important contribution that older workers can offer.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.

Evaluation of a nursing and midwifery exchange between rural and metropolitan hospitals: A mixed methods study

Introduction

This paper reports on the findings of the Nursing and Midwifery Exchange Program, initiated to promote rural and remote nursing and midwifery, and to facilitate clinical skills development and clinical collaboration between health services in Queensland, Australia. The project was undertaken over an 18-month period in one state of Australia, offering structured, temporary exchange of personnel between metropolitan and rural health services.

Background

Globally, there is an increasing awareness of nursing shortages, and with it, the need to ensure that nurses and midwives are prepared for specialist roles and practice. This is particularly important in rural and remote areas, where there are pre-existing barriers to access to services, and difficulties in attracting suitably qualified, permanent staff.

Methods

A mixed methods approach to the evaluation was undertaken with two cohorts. One cohort was the nurses and midwives who participated in the exchange (n = 24) and the other cohort were managers of the participating health services (n = 10). The nurses and midwives who participated in the exchange were asked to complete a questionnaire that included questions related to embeddedness and job satisfaction. The managers participated in a Delphi series of interviews.

Results

Those who participated in exchange reporting a higher score on the reported degree of understanding of rural client, which was accompanied with a moderate-to-large effect size estimate (d = 0.61). Nurses/midwives in the exchange group reported higher scores on their perceptions of aspects of their home community that would be lost if they had to leave, which was accompanied with a large effect size (d = 0.83). Overall, NMEP was reported by the participants to be a positive way to improve professional development opportunities for nurses and midwives. The findings also show the program supported practical collaboration and raised the profile of nursing and midwifery in rural areas.

Conclusion

Exchange programs support clinical and professional development, raising the awareness of different contexts of practice and related skills requirements, and thereby supporting a greater understanding of different nursing roles. In the light of increasingly complex care required by patients with chronic conditions being managed in community-based services, programs such as NMEP provide the opportunity to build collaborative networks between referring and referral centres as well as contribute to the ongoing skills development.

The impact of age norms on career transition intentions

Purpose

The purpose of this paper is to examine how age norms influence the relationship between individual differences, job attitudes, and intentions to pursue career transitions for midlife adults (aged 35 and above). The authors hypothesized that the effects of individual difference variables (i.e. resilience and reframing abilities) on career change intentions in addition to the effects of job attitude (i.e. commitment) on such intentions are moderated by career youth norms (CYN) which the authors defined as perceptions that the typical worker in a career field is younger than midlife.

Design/methodology/approach

In all, 206 people comprised the sample which was derived from an online survey. Moderated regression analysis was used to assess the extent to which age norms operated as a moderator of proposed relationships. Control variables were included based on prior research findings.

Findings

Findings demonstrated that age norms operate as a significant moderator for midlife adults. Specifically, the relationships between resilience, reframing, and commitment on intentions to pursue alternative careers are moderated by CYNs.

Research limitations/implications

Data were collected from a single source and assessed behavioral intentions in place of actual career change choice. Future research should derive data from multiple sources and assess behavior beyond intentions.

Practical implications

Industry leaders’ stereotypes about the appropriate ages for specific occupations or professions may impact the psychological mobility of midlife workers. Managers may wish to highlight midlife workers with particular skills (e.g. technological savvy), examine recruitment advertising for language that emphasizes youth, and invest in resilience training for aging workers.

Originality/value

Research examining careers at midlife and beyond has extensively discussed age discrimination and stereotypes as potential barriers to professional or occupational change. However, few studies have investigated how age norms and the comparisons people make between themselves and those they believe are occupying the jobs they desire may also pose barriers to career transition.

Career Resilience: An Integrated Review of the Empirical Literature

In this article, we review and synthesize the empirical literature on career resilience (CR) to develop a nomological network that describes the major components of the construct, and its relationships with other constructs. Specifically, we outline the antecedents and consequences of CR and describe their theoretical basis. We discuss the implications of the nomological network for future research on CR. Finally, we describe the practical implications of our model for individuals, managers, and organizations.