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The Aging Nurse Project

August 15, 2007 -- Today The Boston Herald ran a generally good piece by Paul Restuccia about issues presented by the aging Massachusetts nursing workforce. "Nursing comes of age: Project helps older practitioners" focuses on efforts like the Aging Nurse Project at Massachusetts General Hospital. That project looks for ways to help older nurses work longer and more effectively. The piece explores some of the challenges older nurses may face, given the extraordinary physical demands of nursing. It also discusses innovations that may help nurses to cope with those demands while passing on the benefit of their expertise to younger colleagues. It focuses particularly on the ideas and innovations of senior MGH nurse Ed Coakley, who founded the Project, and also includes some good quotes from nursing scholars and advocates. We thank Mr. Restuccia and the Herald for this helpful article.

The piece explains that the Aging Nurse Project was formed by "64-year-old nurse administrator" and "former nursing director of the operating room" Ed Coakley, who wanted to "get back into clinical medicine." The piece says Mass. General "came up with a new role" for Coakley. He would have more limited "basic care tasks" but "much more oversight, mentoring and support responsibility." (We might quibble with the assumptions about nursing managers and the profession arguably embedded in language like "administrator" and "basic care tasks.") The piece later says Coakley serves as "project director of the RN residency program for geriatric and palliative care."

Coakley formed the Project "to investigate issues of concern to older nurses and to find ways to keep them working longer at the hospital." He interviewed older nurses at MGH and elsewhere. He concluded that they were most concerned about their physical health, particularly their backs, especially since many older nurses will be working longer than they expected, reportedly because of changes in their retirement plans. The piece says Coakley saw that MGH needed to find ways to retain these nurses. He began a pilot program in the medical ICU to install mechanical lifts to help lift and move patients. Although there is concern about older nurses keeping up with constantly evolving technology, Coakley's surveys found that older nurses were not frightened by new technologies. He did suggest that the new cell phones MGH has begun to issue to nurses require "some adjustment for older RNs."

The piece also notes that Coakley has obtained a grant from the Department of Health & Human Services to extend MGH's existing 6-8 week "preceptor programs" to "pair older and younger nurses for nine months." Coakley believes that will "create a better functioning multigenerational staff," noting that "[o]lder nurses are a rich repository of wisdom that they can pass on to younger RNs." MGH clinical nurse specialist Lillian Ananian cites examples, including teaching how to handle end-of-life issues and "to deal with seeing so much death."

Is all this working? MGH nurse recruiter Michele Andrews says that about a third of the hospital's nurses are over 50, and that the "nurse turnover rate at MGH is only 4 percent, one of the lowest among Bay State hospitals."

The article also provides larger context for the shift in the nursing workforce. It cites a 2003 study by Vanderbilt's Peter Buerhaus showing the strong growth of nurses between the ages of 50 and 64, and that at that time they represented two thirds of nurses entering or re-entering the work force. To explain this, the piece relies on "Dr. Jean Weyman" of the Boston College School of Nursing, who notes that some nurses want to return after raising families, others may be concerned about a spouse's job, and still others "have divorced and need to support themselves." Of course, Buerhaus has a doctorate as well, so it's not clear why he doesn't get the title.

The piece focuses on the physical challenge of moving patients. It reports that "Safe Patient Handling has become a huge issue," with federal statistics showing an increasing number of related injuries. The piece notes that nurses have higher injury rates than construction workers, with "12 nurses out of every 100 in hospitals and 17 out of 100 in nursing homes reporting muscular-skeletal injuries, including back injuries - nearly double the rate for all other industries combined." The piece does not discuss the extent to which the obesity epidemic, nurse short-staffing, or other issues may contribute to this staggering injury rate. It does note that a Massachusetts bill would establish standards for patient lifting, and quotes Center advisory panel member David Schildmeier, of the Massachusetts Nurses Association, which backs the bill.

OSHA has standards for the average warehouse worker lifting 40-pound boxes, but nurses are expected to lift 300-pound patients by themselves with no help.

The piece explores other measures some hospitals use to retain older nurses. These include scheduling flexibility, both in terms of hours per week and hours per shift, including shifts as short as 4-6 hours. Some nurses may retrain and move into a different field they may find less demanding, such as from medical surgery to day surgery.

We thank Mr. Restuccia and the Herald for covering this important issue, which seems likely to become even more pressing as more of the Baby Boomer nurses the piece is discussing do ultimately retire. Of course nursing is physically much harder than most other skilled professions. But with the kind of innovations discussed in this piece, nursing could benefit from its "repository of wisdom" for some time.

See the article "Nursing comes of age: Project helps older practitioners" in the August 15, 2007 edition of the Boston Herald.

Nursing comes of age: Project helps older practitioners

By Paul Restuccia

Wednesday, August 15, 2007

As a 64-year-old nurse administrator, Ed Coakley is using his own experience at Mass. General as a catalyst to help make the hospital workplace more accommodating for older nurses.When Coakley began rethinking his future after a 30-year-plus career, it led him to examine the problems older nurses face.

The hospital, in turn, came up with a new role for the former nursing director of the operating room, who wanted to get back into clinical medicine. He would work fewer hours and as a supplement to an RN. He would have more limited basic care tasks but much more oversight, mentoring and support responsibility.

As part of his new role, Coakley formed what's called the Aging Nurse Project at MGH, an initiative he devised to investigate issues of concern to older nurses and to find ways to keep them working longer at the hospital.

As part of the project, he has interviewed older nurses at MGH, and at hospitals in Michigan and in Florida.

"The biggest concern older nurses have is about their physical health," says Coakley, who is currently MGH's project director of the RN residency program for geriatric and palliative care. "They are worried about their backs and if they will continue to have the stamina to do their jobs."

He also found that because of retirement plan changes at many hospitals, older nurses say they will have to work longer than anticipated.

National studies, such as one done by Professor Peter Buerhaus of Vanderbilt University, back up Coakley's contention that the country's nursing force is aging. Buerhaus' 2003 study found that the number of nurses between the ages of 50 and 64 grew by 129,750 in just two years and they represented two-thirds of nurses entering or re-entering the work force.

Why are so many older nurses returning to the work force?

"There are many nurses who were out of the work force raising their children who now want or need to return," says Dr. Jean Weyman, director of continuing education at the William S. Connell School of Nursing at Boston College, who oversees the RN Refresher Certificate Program. "Some do so because of concerns about their spouse's job. Others have divorced and need to support themselves."

Older nurses now make up 28 percent of the national nursing work force.

At Mass. General, the numbers are even higher. MGH nurse recruiting specialist Michele Andrews estimates that a third of some 6,000 nurses at Mass. General are over 50.

"Many nurses express a desire to retire but they are not ready to leave both because they love the work and also because they can't afford to leave," says Andrews, adding that the nurse turnover rate at MGH is only 4 percent, one of the lowest among Bay State hospitals.

With growing numbers of older nurses planning to work longer, MGH's Coakley saw a need for hospitals to find better ways to retain them.

Hospitals offer flexibility in terms of hours and schedules. Many hospitals, such as MGH and North Shore Medical Center, will provide benefits as long as nurses work at least 20 hours per week. Some older nurses work shorter shifts of 4-to-6 hours, some even "retire" and then come back as part of a growing pool of "per diem" nurses. Others change direction into less demanding work.

"We had one nurse who worked for 30 years in a medical surgery unit and retrained to go into day surgery," says Tim Kerrigan, the nurse recruiter at North Shore Medical Center.

Kerrigan says it isn't just physical labor that challenges older nurses, but the constantly evolving technology. With new computerized IVs, physician order entry systems and online patient documentation, nurses must be able to keep up with the latest technology.

Mass. General has begun equipping nurses with cell phones as well, and Coakley says that while multitasking with phones is second-nature for younger nurses, it takes some adjustment for older RNs.

"The good news is that in our surveys older nurses say they are not frightened by new technology," Coakley says. "In fact, contrary to the stereotype, older nurses are able to learn quickly and keep up with changing job demands."

But it's the physical part of the job that is a more difficult challenge to solve.

Faith Kramer, a 74-year-old nurse who retired but works as a per diem nurse at the North Shore Medical Center's Union Hospital in Lynn, agrees. "Nursing is a rewarding career, but it's hard - people just get tired," Kramer says. "There's a lot of physical strain from lifting and moving patients."

Working with the MGH, Coakley began a pilot program in the medical ICU unit where mechanical lifts were installed in the ceilings to help lift and move patients.

With the graying of the work force, what's called Safe Patient Handling has become a huge issue. U.S. Bureau of Labor statistics show an increasing number of nurses with injuries blamed on lifting patients. Nurses have even higher injury rates than construction workers, with 12 nurses out of every 100 in hospitals and 17 out of 100 in nursing homes reporting muscular-skeletal injuries, including back injuries - nearly double the rate for all other industries combined.

A bill now in committee at the State House would establish policies and standards for patient lifting just as OSHA now has for workers who routinely lift heavy objects.

"OSHA has standards for the average warehouse worker lifting 40-pound boxes, but nurses are expected to lift 300-pound patients by themselves with no help," says David Schildmeier, communications director for the Mass. Nursing Association, which is backing the Safe Patient Handling bill.

But there is more to the Aging Nurse Project than trying to ease nurses' physical work.

Coakley applied for and has received a grant from the Department of Health & Human Services that will provide funds to pair older and younger nurses for nine months, an extension of the hospital's usual 6-to-8 week preceptor programs.

One nurse who is planning to participate at MGH is clinical nurse specialist Lillian Ananian, who has been a nurse for 29 years, including 19 at Mass. General.

"Older nurses can help younger nurses in a lot of ways," say Ananian. "How to comfort patients during infusions, show them ways to cope with end-of-life issues, and to learn to deal with seeing so much death."

Coakley sees it as a way to establish deeper connections between older and younger nurses and create a better functioning multigenerational staff.

"Older nurses are a rich repository of wisdom that they can pass on to younger RNs," Coakley says. "Valuing that wisdom is one of the most important things a hospital can do."

 

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