NURSING MATTERS
Nursing Matters fact sheets provide quick reference information and
international perspectives from the nursing profession on current health and
social issues.
Nurses and Ageing Workforce
“A society for all ages encompasses the goal of providing older persons with
the opportunity to continue contributing to society. To work towards this goal,
it is necessary to remove whatever excludes or discriminates against them.”1
Background
In 2012 one out of nine persons worldwide was aged 60 years and older. By
2050 one out of five persons will be aged 60 and older, that equates to more
than two billion people. The proportion of the total population that is 60 years
or older is much higher in the more developed regions than in the less
developed regions.2 This demographic includes an ageing workforce and the
management of older workers which has implications for governments and
employers.3 It will affect all segments of society, especially in terms of
financing healthcare and retirement.
Figure 1: Population Pyramid 2010 worldwide
(Population: 6.916.183.000)4
Figure 2: Population Pyramid 2050 worldwide
(Population: 9.550.944.000)5
In relation to effective workforce policies, attention and reference to the
ageing workforce have been increasingly discussed in the last decade and
require a strengthened focus from employers and policy makers. For
example, in the European Union, “[…] concerns about the sustainability of
pensions, economic growth and the future labour supply have stimulated a
range of policy processes and recommendations […]”6:
•
•
“to promote the health and working capacity of workers as they age;
to develop the skills and employability of older workers;
•
to examine raising the pension age; and providing suitable working
conditions as well as employment opportunities for an ageing workforce.”6
ICN • CIE • CII
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Nurses and Ageing workforce
page 2
Within nursing, the situation in many industrialised countries is that the nursing
workforce is ageing. For example: In the United States 850,000 nurses are
between 50-64 years of age, which equates to one third of the nursing
workforce.7
This trend, if left unaddressed, is set to deepen the current shortage of
employed nurses, particularly in countries where there is a shortfall of new
nurses entering the labour market. It will also have a knock-on effect on
developing countries where the age profile may be very different but where
aggressive international recruitment efforts may drain the supply of nurses in
active practice. Failures in dealing with the nursing shortage will directly lead
to failures in maintaining health care.
Causes and consequences
The increased length of life results in part from improved medical treatments.
Former terminal illnesses have become chronic illnesses which require an
increasing complexity of care.
These demographic trends also occur in nursing and implicate a decreasing
flow of young nurses into the workforce and an increasing out flow of the
workforce by reaching the retirement age. Hence there are two crucial
consequences reported: a need to replace retired nurses and a need to retain
nurses beyond the average age of retirement.8
In addition, older nurses may be challenged by normal age-related changes,
such as chronic diseases, visual and hearing impairments, balance issues,
aches and pain associated with musculoskeletal disorders or arthritis.9 In
addition, older people with workplace injuries require longer times for
recovery.10 Therefore, the work environment requires adjustment.
As another consequence of the ageing workforce special and interpersonal
discrimination and stereotypes are reported and constitute an increasing
significant appearance of ageism.11
Prevention and protection
Older nurses are a potential source to augment the workforce. Their
premature or forced exit from the workforce and/or reduction in working hours
means a loss of much needed and experienced nurses to care for patients.
When they retire, their knowledge, wisdom and clinical expertise are lost, as is
their contribution to training and mentoring the next generation of nurses.
Tailoring employment strategies to this group is important to their retention.
Nurses and Ageing workforce
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Government/Legislation:
Governments have to ensure the persistent implementation of the Political
Declaration and Madrid International Plan of Action in Ageing. It was adopted
at the Second World Assembly on Ageing in 2002 for building a society for all
ages. It involves the three main priorities:1
1. “Older persons and development;
2. Advancing health and well-being into old age;
3. And ensuring enabling and supportive environments.”1
Organisation: ICN/ICHRN
Actions of the International Council of Nurses and its International Centre for
Human Resources in Nursing include:
• Advocating/campaigning for positive practice environments for all health
professionals across all age groups, to end age related discrimination and
improve working conditions.
• Publishing scholarly material on managing the multi-generational nursing
workforce and supervising and mentoring this workforce in order to inform
and improve policy and practice in this area.
• Collecting, collating, analysing and disseminating data on the nursing
workforce (e.g. ICN nursing workforce profiles) in order to better assess
the profile of nurses in different countries, regions and sectors.
• Raising awareness through position statements and at meetings and other
forums on the specific issues facing the older nurse, including the
promotion of a “living” pension.
• Developing and promoting nursing human resource management
competencies in order to improve the abilities of managers to develop and
implement HR policies that effectively address the needs of an ageing
nursing workforce.
• Evaluating and disseminating good HR management practice in this area,
to lead to improvements in policy. This is accomplished through
presentations at meetings and other forums and through the ICN-ICHRN
website and published case studies.
• Presenting and discussing research and analysis of age related issues at
international conferences, congresses and regional forums.
• Discussing job redesign, pension benefits and retention strategies of
particular relevance to an ageing nursing workforce during Workforce
Forum meetings.
Employer:
• Knowledge of physical and cognitive challenges in ageing
• Creative solutions for addressing flexible work arrangements (e.g. modified
workloads, flexible scheduling options, reduction in hours of work, etc.)
• An organisational culture that promotes participation in decision-making
and autonomy over practice
Nurses and Ageing workforce
•
•
•
•
page 4
Work recognition, encouragement and positive feedback from
supervisors12
Alteration of work environment: Ergonomic design especially addressing
the needs of older nurses, safe and effective work environments for
reducing workplace injuries
Creating a respectful communication environment without discrimination13
Access to professional development activities that target the needs of
experienced nurses
Individual:
• Sharing knowledge with younger nurses (e.g. in mentoring programmes)
• Sharing information and staying in a socialised connection to co-workers14
• Pursuing access to professional development
Examples
Africa:
Figure 3: Population Pyramid 2010 Africa
15
(Population: 1.031.083.000)
Figure 4: Population Pyramid 2050 Africa
16
(Population: 2.393.174.000)
Added to the usual physical and cognitive changes in ageing, older people in
Africa are disadvantaged because of a lack in social security. In 2003, the
African Union Policy Framework and Plan of Action on Ageing were
established. The aim of the plan is to guide member states in designing,
implementing, monitoring and evaluating national policies for meeting the
needs of the ageing population.17 Among other aspects, there are
recommendations for the elimination of discrimination against ageing persons
in accessing employment and training opportunities.
Nurses and Ageing workforce
page 5
South Africa announced a growth of professional nurses from 2001-2010. As
a result of growing job responsibilities due to a high HIV/AIDS, TB and Malaria
prevalence a shortage of nurses still exists.18
Asia:
Figure 5: Population pyramid 2010 Asia
19
(Population: 4.165.440.000)
Figure 6: Population pyramid 2050 Asia
20
(Population: 5.164.061.000)
For the forecast of the nursing workforce in Japan it needs to be considered
that Japan has the fastest growing ageing population in the world. With 7.4
million people aged 65 and older in 1970, the number grew up to 29.4 million
in 2010. The estimated amount of people aged 65 and older will be one third
of the population in 2025. This challenge asks for innovative reforms in the
healthcare system and a transformation of the nursing profession. Masaki et
al. recommend development of measures following the report “The Future of
Nursing: Leading Change, Advancing Health” by the US Institute of Medicine.
But it is necessary to consider the different national contexts.21
Papua New Guinea is also dealing with an acute ageing nursing workforce
problem. In 2012, 20% of a total of 3,429 nurses surpassed the legal
retirement age of 55, with nearly 40% in the 45-55 age bracket. Midwifery
schools have been reopened, but the number of graduates will not meet the
need. The prime minister declared a need for foreign health workers.22
Nurses and Ageing workforce
page 6
Australia:
Figure 7: Population Pyramid 2010 Australia Figure 8: Population Pyramid 2050 Australia
23
24
(Population: 22.404.000)
(Population: 33.735.000)
From 2007 to 2011 the proportion of nurses and midwives aged 50 or older
increased from 33.0% to 38.6%. The average age of a RN in 2010 was 44.2
years and of an enrolled nurse 45.5 years.25
Europe:
Figure 9:Population Pyramid 2010 Europe
26
(Population: 740.308.000)
Figure 10: Population Pyramid 2050 Europe
27
(Population: 709.067.000)
The RN4CAST study was conducted up until December 2014. This study aims
to forecast the workforce needed and generate effective strategies in the
management of human resources in nursing. There are 12 European
countries included.28
In 2008, more than 65% of nurses registered at the Nursing and Midwifery
Council in the UK were over 40 years. In addition, 31% are over 50 years.
These amounts are still increasing.
Nurses and Ageing workforce
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North America:
Figure 11: Population Pyramid 2010 Northern Figure 12: Population Pyramid 2050 Northern
29
30
America (Population346.500.000)
America (Population: 446.200.000)
In the United States approximately 850,000 nurses are aged 50-64. This
amounts to one third of the nursing workforce who will reach retirement age by
2020.11 Influencing factors for retention in the nursing profession until the age
of retirement include: security, health promotion, relationships, ego protection
and fulfilment. With the knowledge of these aspects, strategies for retaining
the nursing profession should be developed as soon as possible.18
South America:
Figure 13: Population Pyramid 2010 Southern Figure 14: Population Pyramid 2050 Southern
31
32
America (Population: 394.020.000)
America (Population: 505.085.000)
Likewise, Brazilian researchers underline the ageing workforce of nurses.
They reported a decline in work ability due to ageing among Brazilian nurses
in 2011. The mean age of nurses with an inadequate ability to work was about
45 years. In addition, Brazilian nurses showed same work ability index scores
as nurses from Finland. There is a call for the development of strategies to
manage workforce issues associated with ageing.33
Nurses and Ageing workforce
page 8
For further information, please contact: [email protected]
The International Council of Nurses (ICN) is a federation of more than 130
national nurses associations representing the millions of nurses
worldwide. Operated by nurses and leading nursing internationally, ICN works
to ensure quality nursing care for all and sound health policies globally.
LB/04/2015
References
1
United Nations (2002). Political Declaration and Madrid International Plan of Action in Ageing –
Second World Assembly on Ageing, Madrid, Spain. http://undesadspd.org/Portals/0/ageing/
Documents/Fulltext-E.pdf Last access: 14.04.2015.
2
United Nations (2012). Population Ageing and Development 2012. http://social.un.org/ageingworking-group/documents/2012popageing.pdf. Last access: 14.04.2015.
3
Winkelmann-Gleed A (2011). Demographic Change and Implications for Workforce ageing in
Europe – Raising Awareness and Improving Practice. In: Contemporary Readings in Law and
Social Justice Vol. 3(1), 2011. p. 62-81.
4
Population Pyramid (2008a). World 2010. http://populationpyramid.net/world/. Last access:
15.04.2015.
5
Population Pyramid (2008b). World 2050. http://populationpyramid.net/world/2050/. Last
access: 15.04.2015.
6
Cyr J (2010). Bedside implications of an aging nursing workforce. In: Nursing made Incredibly
Easy, January/February 2010. p. 6-10.
7
Burhaus PI, Auerbach DI, Staiger DO, Muench U (2013). Projections of the Long-Term
Growth of the Registered Nurse Workforce: A Regional Analysis. In: Nursing economics,
January-February 2013, Vol. 31, no.1. p. 13-17.
8
Ibid. Cyr J (2010).
9
Stichler JF (2013). Healthy work environment for the ageing nursing workforce. In: Journal of
Nursing Management, 2013, 21. p. 956-963.
10
Centers for Disease Control and Prevention (2012). Older Employees in the Workplace –
Issue Brief No. 1 July 2012.
www.cdc.gov/nationalhealthyworksite/docs/issue_brief_no_1_older_employees_in_the_work
place_7-12-2012_final508.pdf. Last access: 10.12.2014.
11
Kagan SH, Melendez-Torres GJ (2013). Ageism in Nursing. In: Journal of Nursing
Management. 2013, November.
12
Harris R, Bennett J, Davey B, Ross F (2010). Flexible working and the contribution of nurses
in mid-life to the workforce: A qualitative study. In: International Journal of Nursing Studies 47
(2010). p. 418-426.
13
Williamson ML, Cook L,; Salmeron L, Burton D (2010). Retaining Nursing Faculty beyond
Retirement Age. In: Nurse Educator, Vol. 35, no. 4. p. 152-155.
14
Kirgan M Golembeski S. (2010): Retaining an Aging Workforce by Giving Voice to older and
Experienced Nurses. In: Nurse Leader, February 2010. p. 34-36.
15
Population Pyramid (2008c): Africa 2010. http://populationpyramid.net/africa/. Last access:
15.04.2015.
16
Population Pyramid (2008d): Africa 2050. http://populationpyramid.net/africa/2050/. Last
access: 15.04.2015.
17
Gresh A, Maharaj P (2013). Policy and Programme responses. In: International perspectives
on Aging 4 – Aging and Health in Africa. Springer Science and Business Media.
18
Littlejohn L, Campbell J, Collins-McNeil J, Khayile T (2012). Nursing shortage: A Comparative
Analysis. In: International Journal of Nursing I(I). p. 22-27.
19
Population Pyramid (2008e) Asia 2010. http://populationpyramid.net/asia/. Last access:
15.04.2015.
20
Population Pyramid (2008f) Asia 2050. http://populationpyramid.net/asia/2050/. Last access:
15.04.2015.
21
Masaki H, Nagae H, Teshima M, Izumi S (2012). Nursing Leadership in a Rapidly Aging
Society: Implications of “The Future of Nursing” Report in Japan. In: Nursing Research and
Practice, Vol. 2012; 2012: 820345.
22
Humanitarian news and analysis (2013) PNG grapples with ageing health workforce.
www.irinnews.org/report/97643/png-grapples-with-ageing-health-workforce. Last access:
15.04.2015.
23
Population Pyramid (2008g). Australia 2010. http://populationpyramid.net/australia/. Last
access: 15.04.2015.
24
Population Pyramid (2008h). Australia 2050. http://populationpyramid.net/australia/2050/.
Last access: 15.04.2015.
25
Australian Institute of Health and Welfare (2012). Nursing and midwifery workforce 2011.
www.aihw.gov.au/publication-detail/?id=10737422167&tab=3. Last access: 15.04.2015.
26
Population Pyramid (2008i). Europe 2010. http://populationpyramid.net/europe/. Last access:
15.04.2015.
27
Population Pyramid (2008j). Europe 2050. http://populationpyramid.net/europe/2050/. Last
access: 15.04.2015.
28
Sermeus W, Aiken LH, van Den Heede K,; Rafferty AM, Griffiths P, Moreno-Casbas MT,
Busse R, Lindqvist R, Scott AP, Bruyneel L, Brzostek T, Kinnunen J, Schubert M,
Schoonhoven L, Zikos D (2011.: Nurse forecasting in Europe (RN4CAST): Rationale,design
and methodology. In: BioMed Central nursing 2011, 10:6.
29
Population Pyramid (2008k). Northern America 2010. http://populationpyramid.net/northernamerica/. Last access: 15.04.2015.
30
Population Pyramid (2008m). Northern America 2050. http://populationpyramid.net/northernamerica/2050/. Last Access: 15.04.2015.
31
Population Pyramid (2008n). South America 2010. http://populationpyramid.net/southamerica/. Last access: 10.12.2014.
32
Population Pyramid (2008o). South America 2050. http://populationpyramid.net/southamerica/2050/. Last access: 15.04.2015.
33
Monteiro MS, Costa Alexandre NM, Milani D, Fujimura F (2011). Work capacity evaluation
among nursing aides. In: Revista da Escola de Enfermagem da USP 2011, 45(5). p. 11771182.
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