A touch of gray: Hiring, retaining older workers is cost-effective
'Best' employers woo older nurses with benefits
Faced with an aging work force of nurses, hospitals are beginning to remake the work environment to keep nurses at the bedside. When the AARP released its list of the nation's 50 "Best Employers of People over 50" earlier this year, half of them were hospitals or other health care employers.
These hospitals have a strategy to retain and even recruit health care workers over 50 through flexible hours, shorter shifts, and tailored benefits. They also are implementing "minimal lift" policies with ergonomic equipment and lift teams to reduce the physical burden of the job.
They recognize the reality: About 40% of registered nurses are 50 years of age or older. Only 8% are under 30. And the percentage of workers over 50 will continue to grow.1
"[Hospitals] are very much ahead of the curve in contemplating these issues because [aging] has such a profound impact, not just on their work force but who their clientele will be in the future," says Deborah Russell, director of Workforce Issues for AARP, a nonprofit membership organization for people 50 and older.
"We're starting to see evidence of certain accommodations that employers are willing to make for workers as they age," she reports. "Technology will also help to support that as well."
Hiring and retaining older workers is cost-effective, according to a study by Towers Perrin, a Stamford, CT-based management consulting firm, commissioned by AARP. For example, the researchers found that doubling the retention of 55-year-old nurses from 20% to 40% would cost only about 2% more than hiring new, younger nurses, mostly due to greater compensation and health care costs. Yet the hospital would spend the equivalent of 29% of a nurses' annual salary to recruit and train that new worker. (The age of 55 was chosen for the purposes of the study.)
The cost difference between hiring a new nurse who is 40 and one who is 55 would be only 1%, according to the analysis.2
Meanwhile, hospitals would benefit from the experience and knowledge of the older nurses and will need them due to the growing nursing shortage.
Hospitals can make their own cost-benefit analysis with an assessment tool from AARP, which evaluates the demographics of departments and the impact on staffing costs. (The tool is available free of charge from www.aarpworkforceassessment.org/template/index.cfm?CFID=5715922&CFTOKEN=97219325.)
Bon Secours Richmond (VA) Health System has made the AARP "best employers" list for five years in a row. When the hospital first applied, it discovered that 25% of its employees were 50 years old or older. Today, 32% of employees are 50 or older.
In fact, Bon Secours has a nurse who is 85 a former operating room nurse who now helps administer TB tests. The hospital hired a nurse who was 74. And working at Bon Secours past the traditional retirement age of 65 is not unusual, says Dawn Wynn Malone, administrative director of work and family services at the hospital.
Nurses work into their 70s
In the Catholic health system, nuns often work well into old age, so having older workers seems natural, she says. "We don't look at age at all as a reason someone's not able to perform for us," Malone adds.
With the growing nursing shortage, Bon Secours has even more reason to retain its older nurses, and it constantly strives to create programs to address their needs. "We've tried to put [programs and policies] in place to address the main reasons why people leave," says Malone.
Some want to slow down, take more vacations, or need to help care for aging relatives. Bon Secours offers benefits to employees who work as few as 16 hours a week. "We have a lot of people who said, 'The first thing I wanted to do was retire and go to Florida, but I realized I wanted to come back,'" says Malone.
Some want to explore something new in their work or personal lives. "Don't retire, rewire," Bon Secours urges them. "We try to get managers to find new roles and ways to utilize our most seasoned workers," she says.
For example, employees may have an opportunity to job-share or may move into a mentoring position. Meanwhile, the hospital has offered classes ranging from watercolor and photography to financial planning.
The hospital even sponsors a retiree fair and recruits retirees to stay connected. Often, retired nurses will return for "on-call" duty, a part-time position, or a short-term project.
Retaining older workers doesn't cost more, says Malone. Fewer of them have covered dependents on their health insurance plans. When a group of the oldest employees recently met with the CEO all of them in their 70s and 80s they were a physically fit group, Malone recalls.
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Creating a workplace that attracts older HCWs If hospitals want to keep aging nurses in patient care, they will need to alter the workplace physically, to reduce the burden of nursing, and through new benefits to entice nurses to remain on the job. That was the conclusion of Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace, a 2006 report by the Robert Wood Johnson Foundation. "Unless hospitals begin to address the conditions that would help older nurses extend their work life past usual retirement age, many of these nurses will retire at the very time hospitals are faced with the growing [health] demands of an aging population," the report states. Based on a literature review and nurse survey, the authors suggested the following issues are important to older nurses:
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Still, aging presents physical limitations and nursing is a physically demanding job. Older nurses may have decreased strength in their knee and hip joints, and may have back or neck pain or cumulative trauma disorder. They may feel the long-term impact not just of patient lifting and repositioning, but from being on their feet for long hours, or working at awkward postures.3
Personal health problems, such as diabetes or obesity, contribute to musculoskeletal disorders. One-third of workers with arthritis reported that their condition was severe enough to limit their work, according to an analysis of survey data by the Centers for Disease Control and Prevention in Atlanta.4
Workers' compensation claims at Bon Secours health system showed that repositioning posed the greatest risk of injury to all nurses, regardless of age. The health system responded by investing $800,000 in lift teams and patient handling equipment. But putting that into perspective, the cost is significantly less than the cost of workers' compensation claims, notes Cindy Stutts, MS, RN, administrative director of employee wellness services and EAP.
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Health care rates high as AARP 'Best Employers' These are the health care employers that made the AARP 'Best Employers of People Over 50' list of 2007, along with their ranking: 2. Mercy Health System, Janesville, WI; 4. Scripps Health, San Diego; 6. Lee Memorial Health System, Fort Myers, FL; 7. Leesburg (FL) Regional Medical Center/The Villages Regional Hospital; 10. Massachusetts General Hospital, Boston; 11. MidMichigan Health, Midland, MI; 12. Bon Secours Richmond (VA) Health System; 15. Atlantic Health System, Florham Park, NJ; 18. Saint Vincent Health System, Erie, PA; 19. Trinitas Hospital, Elizabeth, NJ; 22. Pinnacle Health System, Harrisburg, PA; 26. Jennings Center for Older Adults, Garfield Heights, OH; 28. Bon Secours St. Francis Health System, Greenville, SC; 29. Centegra Health System, Woodstock, IL; 31. Durham (NC) Regional Hospital; 32. Rush-Copley Medical Center, Aurora, IL; 33. Monongalia General Hospital, Morgantown, WV; 34. Saint Barnabas Health Care Organization, West Orange, NJ; 36. Ochsner Clinic Foundation, New Orleans; 38. Hospice of Marion County and Affiliated Companies, Ocala, FL; 39. West Virginia University Hospitals, Morgantown; 40. The University of Texas M.D. Anderson Cancer Center, Houston; 41. Scottsdale (AZ) Healthcare; 43. Fairfield Medical Center, Lancaster, OH; 45. St. John Health, Warren, MI. |
"Even [just] since 2000, we've probably spent several million dollars in workers' comp claims," she reports.
Beyond the financial aspect, there is a human toll for both the nurse and hospital, she notes. "What's happening to the livelihood of those nurses?" Stutts asks. "We're losing these highly skilled bedside nurses to care management, and we need to keep them at the bedside."
Bon Secours has contracted with an outside vendor to provide lift teams. From 7 a.m. to 11 p.m., they rotate throughout the units every two hours to help with turning, repositioning, and other patient handling tasks. If a patient falls, they are paged to come immediately. Meanwhile, patient transport assists with other patient handling.
Nurses are being trained to assess the mobility needs of patients. Nurses also receive training to use the equipment and 'superusers' support their co-workers in the minimal lift program.
"It's a matter of changing the culture of how they handle the patient," says Stutts. "We've seen decreases in injuries in every month since we started, but we've still got a long way to go."
The impact of a minimal lift program goes beyond the retention of older nurses. It helps with recruitment even of younger nurses. "We've had some nurses who made the decision to come to Bon Secours vs. one of our competitors because of the lift equipment," she says.
References
1. Steiger DM, Bausch S, Johnson B, et al. The Registered Nurse Population: Findings from the 2004 National Sample Survey of Registered Nurses. Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services; 2006. Available at bhpr.hrsa.gov/healthworkforce/rnsurvey04/default.htm. Accessed on June 21, 2008.
2. Towers Perrin. The Business Case for Workers 50+. Wash-ington DC: AARP; 2005. Available at http://assets.aarp.org/rgcenter/econ/workers_fifty_plus.pdf. Accessed on June 21, 2008.
3. Hatcher BJ, Bleich MR, Connolly C, et al. (2006) Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace. Princeton, NJ: Robert Wood Johnson Foundation; 2006. Available at http://www.rwjf.org/files/publications/other/wisdomatwork.pdf. Accessed on June 21, 2008.
4. Centers for Disease Control and Prevention. State-specific prevalence of arthritis attributable work limitation United States, 2003. MMWR 2007; 56:1,045-1,049.
Faced with an aging work force of nurses, hospitals are beginning to remake the work environment to keep nurses at the bedside. When the AARP released its list of the nation's 50 "Best Employers of People over 50" earlier this year, half of them were hospitals or other health care employers.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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