Nursing understaffing is a prevalent issue in the U.S. healthcare system impacting the quality of care, the safety of patients, and the professional wellbeing of medical professionals. Nurses face increased workloads, long hours, and highly irregular work patterns which lead to chronic fatigue, stress, and sleep deprivation. To prevent further deterioration of the status quo, a potential evidence-based solution is to prolong nursing careers and bring back retirees into the workforce, temporarily reducing the workload and turnover rates. The PICOT statement for this study is in nursing practitioners (P), encouraging retirees to continue their services (I), compared to traditional turnover rates (C), will provide additional nurse aids to minimize the current nursing shortage (O), over a one-year period (T).
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The literature for the topic addressed a variety of impactful research questions on the issue focusing on influencing factors for turnover to extending careers and how the aging workforce affects the industry. To investigate the impacts of turnover and early retirement, a study by Hewko, Reay, Estabrooks, and Cummings (2019) provides a quantitative analysis of the influence of such factors on the workforce.
Ang et al. (2016) focused on demographic factors including economic, work demands, and organizational aspects which extend the working career of nurses as well as attitudes towards older workers. Similarly, Perry et al. (2016) seek to analyze how the nurses’ health may impact the intention to remain in the workforce.
Building on that Armstrong-Stassen, Freeman, Cameron, and Rajacic (2015) sought to determine how organizational parameters, including human resources practices, contribute to nurses continuing working. Ryan, Bergin, White, & Wells (2019) investigate the effect of aging among nurses and the potential use of older and migrant nurses to remedy the situation.
Finally, investigating the topic of older nurses, Kaewpan and Peltzer’s (2019) research on the desire of older nurses to continue working as well as the recruitment strategies and work abilities of nurses post-retirement. Sirisub, Suwannapong, Tipayamongkholgul, Howteerakul, and Noree (2019) seek to determine the number of nursing that are willing to extend their working life. Meanwhile, Uthaman, Chua, and Ang (2016) investigate the different challenges that older nurses face in their work and how to retain them in the workplace.
The sample population for most of the studies is similar, including registered nurses from various countries or regions. The number of nurses ranged from 483 to close to 6,000 depending on the study. Certain studies such as Ang et al. (2016), Armstrong-Stassen et al. (2015), and Hewko et al. (2019) included both registered nurses as well as retired or older (aged 45 and higher) nursing staff. Perry et al. (2016) also included midwives in the sample, but it is unclear the proportion of the total. Studies by Uthaman et al. (2016) and Kaewpan et al. (2019) were literature synthesis reviews, analyzing 20 and 37 studies respectively within the last two decades. The synthesized literature also focused primarily on nurses as the primary sample population.
Limitations of the Study
A significant number of the studies including Perry et al. (2016), Sirisub et al. (2016), and Hewko et al. (2019) indicated potential limitations with data collection. This includes methods such as electronic surveys and influence on results due to the self-reporting aspect of the surveys. A single-source, single method collection method raises concerns about method variance as well as issues with determining multifactor causality (Armstrong-Strassen et al., 2015). Ang et al. (2016) indicated a lack of follow-up study or longitudinal study as a potential limitation.
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Ryan et al. (2018) does not provide a limitation, but it can be argued that its focus on policy context rather than practical solutions is a weakness of the study. The literature reviews cited their limitations as either not examining articles in non-English languages or focusing on studies from high-income countries, lack global generalizability (Kaewpan et al., 2019; Uthaman et al., 2016). However, since this PICOT question focuses on the United States, it is not an issue.
The concept of reintroducing retirees and prolonging careers of nurses to resolve to understaff is unique and potentially counterintuitive. However, evidence demonstrates that this is a viable approach. Nevertheless, the analyzed literature agrees that further research and policy changes are necessary. Ang et al. (2016), Uthaman et al. (2016), and Hewko et al. (2019) suggest further research on how management and hospital administration implement retirement and the factors that help to retain nurses in the workplace. Meanwhile, Armstrong-Strassen et al. (2015) and Kaewpan, & Peltzer (2019) discuss the need for research on successful strategies of recruitment and retainment for older nurses, including recognizing their needs.
Perry et al. (2016) and Sirisub et al. (2019) suggest further research on nurses’ health and factors influencing the ability to work for older nurses, considering reasonable income and benefits. Ryan et al. (2019) suggest an analysis on dynamic changes that occur when the retainment of older nurses increases. Therefore, there are a variety of approaches to continuing research on the topic in order to determine the influential factors on nurses and how to balance the needs of the individual nurses and the medical facilities.
Ang, S. Y., Ayoob, S. B. M., Hussain, N. B. S., Uthaman, T., Adenan, H., Chiang, P., … Ostbye, T. (2016). Older nurses in Singapore: Factors associated with attitudes towards extending working life. Proceedings of Singapore Healthcare, 25(4), 222-229.
Armstrong-Stassen, M., Freeman, M., Cameron, S., & Rajacic, D. (2015). Nurse managers’ role in older nurses’ intention to stay. Journal of Health Organization and Management, 29(1), 55-74.
Hewko, S., Reay, T., Estabrooks, C. A., & Cummings, G. G. (2019). The early retiree divests the health workforce: A quantitative analysis of early retirement among Canadian Registered Nurses and allied health professionals. Human Resources for Health, 17(1), 1-10.
Kaewpan, W., & Peltzer, K. (2019). Nurses’ intention to work after retirement, work ability and perceptions after retirement: A scoping review. The Pan African Medical Journal, 33(217), 1-8.
Perry, L., Gallagher, R., Duffield, C., Sibbritt, D., Bichel-Findlay, J., & Nicholls, R. (2016). Does nurses’ health affect their intention to remain in their current position? Journal of Nursing Management, 24(8), 1088-1097.
Ryan, C., Bergin, M., White, M., & Wells, J. S. G. (2019). Ageing in the nursing workforce – a global challenge in an Irish context. International Nursing Review, 66(2), 157-164.
Sirisub, P., Suwannapong, N., Tipayamongkholgul, M., Howteerakul, N., & Noree, T. (2019). Intention to extend working life among Thai registered nurses in Ministry of Public Health: A national survey. Nursing Research and Practice, 2019, 1-11.
Uthaman, T., Chua, T. L., & Ang, S. Y. (2016). Older nurses: A literature review on challenges, factors in early retirement and workforce retention. Proceedings of Singapore Healthcare, 25(1), 50-55.