DiversityNursing Blog

Beginning in the early 1970s, career-oriented and largely female baby boomers embraced the nursing profession in unprecedented numbers following large increases in health care spending after the introduction of the Medicare and Medicaid programs. By 1990, baby-boomer registered nurses (RNs) numbered nearly one million and comprised about two-thirds of the RN workforce. As these RNs aged over the next two decades, they accumulated substantial knowledge and clinical experience. The number of boomer RNs peaked at 1.26 million in 2008, and, after a brief delay in the early part of the current decade (likely associated with the Great Recession), the baby-boomer RN cohort began retiring in large numbers. Since 2012, roughly 60,000 RNs exited the workforce each year, and by the end of the decade more than 70,000 RNs will be retiring annually. In 2020, baby-boomer RNs will number 660,000, roughly half their 2008 peak.

The retirement of one million RNs from the nursing workforce between now and 2030 will mean that their accumulated years of nursing experience leave with them. We estimate that the number of experience-years lost from the nursing workforce in 2015 was 1.7 million (multiplying the number of retiring RNs by the cumulative years of experience for each RN), double the number from 2005 (see Figure 1). This trend will continue to accelerate as the largest groups of baby-boomer RNs reach their mid to late sixties. The departure of such a large cohort of experienced RNs from the workforce means that patient care settings and other organizations that depend on RNs will face a significant loss of nursing knowledge and expertise that will be felt for many years to come.

The exit and replacement of retiring RNs will not occur uniformly because health care delivery organizations in some regions of the country will confront faster RN retirements and slower replacements of their RN workforce (especially the New England and Pacific regions) compared to other regions of the country (the Southern and Central regions). Consequently, some organizations will experience bursts in RN retirements that may result in temporary nursing shortages and disruptions in care delivery. How can health care delivery organizations overcome the loss of so much nursing knowledge, wisdom, and expertise?

Health care leaders must recognize that the retirement of the RN workforce has only recently begun, that it will intensify over the coming years, and that the loss of RNs with decades of experience creates multiple risks. Foremost, the quality of patient care could decrease as new and less experienced RNs enter the workforce and replace RNs with decades of experience. This is not to suggest that RNs with fewer years of nursing experience are less qualified to provide high-quality nursing care. Rather, it is to acknowledge that the longer an RN is in the workforce, the knowledge accumulated over many years is likely to increase a nurse’s ability to effectively manage all types of clinical and organizational challenges.

Relative to novice RNs, experienced RNs are likely to be more adept at identifying complications and unexpected changes in patient conditions sooner and respond appropriately. They are also more likely to know how to manipulate the organization’s culture to “get things done,” make clinical assignments that better match the knowledge and skills of nurses with the needs of the patient, serve as role models and mentors, and deal effectively with physicians, administrators, and others to assure the well-being of patients and their families. All of these attributes can matter greatly in providing a consistent, predictable, and safe patient environment. It is not difficult to recognize these nurses—often they are the clinical and organizational leaders who are counted on to ensure smooth operations of clinical and administrative systems.

Health care organizations must also recognize that the retirement of so many experienced RNs will occur commensurate with the aging of the country’s nearly 80 million baby boomers. Not only will growing numbers of elders increase the demand for RNs, but because three in four people older than age 65 have multiple chronic diseases, the intensity of nursing care required to manage this medically complicated population will also increase. Aging baby boomers will especially benefit from care provided by the most experienced nurses—the very nurses who are retiring from the workforce.

Four actions should be taken by hospital chief nursing executives, hospital patient care unit managers, and human resource officers to both anticipate and act to prevent the negative consequences that could ensue as RN retirement accelerates.

First, it is important to gather information on an organization’s nursing workforce to ascertain when and how many RNs are expected to retire and identify the nursing units, departments, and patient populations that will be affected. Sharing this information with physicians and other clinicians who will be affected and seeking their involvement will be critical to mitigating potential harmful consequences.

Second, hospital leadership should prioritize working with department and unit leaders to engage soon-to-be retiring RNs to learn what can be done to delay their retirement—for example, decreasing hours and number of workdays, modifying their responsibilities, improving the ergonomic environment to minimize injuries, or revising organizational policies and clinical conditions that hinder and dissatisfy nurses. Similarly, older and more experienced RNs could be offered opportunities to fill new roles in community engagement, patient navigation, or education and prevention.

Third, it is important to encourage the creation of programs that bring older and younger RNs together to identify the knowledge and skills needed by rising RNs that can be imparted by older and more experienced RNs. Fourth, review (and strengthen as needed) succession planning to assure that retiring nursing managers will be replaced by RNs who are well-prepared to assume management of clinical and administrative operations on patient care units. Future RN leaders could be identified and partnered with soon-to-be retiring RNs in management positions and participate in formal programs in management and leadership development, team building, communications, budgeting, program development, and other leadership roles.

It is imperative that health care leaders recognize that as the retirement of RNs ramps up, a different type of nursing shortage will emerge—one of knowledge, skill, experience, and judgment, all attributes that contribute to the successful clinical and administrative operations of complex health care delivery systems. Now is the time to anticipate and prepare for the retirement wave of the nation’s RN workforce.

Figure 1.  Number Of Years Of Experience Lost To The Registered Nurse Workforce, 1979-2030

Nursing departments are known for their willingness to trial new medical technology. From advanced surgery techniques to virtual reality (VR) systems, nurses get to see cutting-edge technologies before most people even hear about them.

Here are three new advancements nurses will see in the near future:

1. Robot surgery

Today's robots may not look like those popularized in science fiction stories, but they have proven to be very useful. In fact, robots have already proliferated within the nursing field.

One of the most exciting robotic advancements in recent years is the da Vinci robot, a multi-limbed piece of equipment that can perform complicated procedures with fewer invasive cuts than traditional surgical methods.

A trained surgeon is still completely in control of the robot, but because the machine has delicate yet strong appendages, it can cut and stitch within highly confined spaces.

2. Advanced prosthetics

Prosthetics have come a long way since the turn of the century. Today, researchers are developing limbs that can be controlled by the patient's own neural system – exactly as they would control a real appendage.

According to MIT Technology review, researchers at Case Western Reserve University have created a prosthetic arm capable of translating thoughts into simple movements. Currently, the movements are simple, but it is a promising step forward.

Meanwhile, at the Massachusetts Institute of Technology, researchers are producing a line of powered prosthetic legs to help amputees walk again.

To see these futuristic biomechanical legs in action, check out the video below:

3. Virtual reality

VR headsets have already made their way into the consumer market, but there's still so much more that researchers can do with the technology. From VR-assisted physical therapy to augmented reality applications, the possibilities of VR medical technology are limitless.

MedicalFuturist explained that VR applications are helping stroke patients recover their motor skills more quickly. By making repetitive exercises more fun, the program increases patient motivation throughout the recovery process.

Nurses in rehabilitation settings are likely to see VR use become more common over the next few years as the technology becomes affordable.

Every day, technological advancements make life a little easier for patients and the professionals who treat them. The above solutions are already in use today and will only become more prevalent as time goes on.

Scientists have created an "artificial womb" in the hopes of someday using the device to save babies born extremely prematurely.

So far the device has only been tested on fetal lambs. A study published Tuesday involving eight animals found the device appears effective at enabling very premature fetuses to develop normally for about a month.

"We've been extremely successful in replacing the conditions in the womb in our lamb model," says Alan Flake, a fetal surgeon at Children's Hospital of Philadelphia who led the study published in the journal Nature Communications.

"They've had normal growth. They've had normal lung maturation. They've had normal brain maturation. They've had normal development in every way that we can measure it," Flake says.

Flake says the group hopes to test the device on very premature human babies within three to five years.

"What we tried to do is develop a system that mimics the environment of the womb as closely as possible," Flake says. "It's basically an artificial womb."

Inside an artificial womb

The device consists of a clear plastic bag filled with synthetic amniotic fluid. A machine outside the bag is attached to the umbilical cord to function like a placenta, providing nutrition and oxygen to the blood and removing carbon dioxide.

"The whole idea is to support normal development; to re-create everything that the mother does in every way that we can to support normal fetal development and maturation," Flake says.

Other researchers praised the advance, saying it could help thousands of babies born very prematurely each year, if tests in humans were to prove successful.

Jay Greenspan, a pediatrician at Thomas Jefferson University, called the device a "technological miracle" that marks "a huge step to try to do something that we've been trying to do for many years."

The device could also help scientists learn more about normal fetal development, says Thomas Shaffer a professor of physiology and pediatrics at Temple University.

"I think this is a major breakthrough," Shaffer says.

The device in the fetal lamb experiment is kept in a dark, warm room where researchers can play the sounds of the mother's heart for the lamb fetus and monitor the fetus with ultrasounds.

Previous research has shown that lamb fetuses are good models for human fetal development.

"If you can just use this device as a bridge for the fetus then you can have a dramatic impact on the outcomes of extremely premature infants," Flake says. "This would be a huge deal."

But others say the device raises ethical issues, including many questions about whether it would ever be acceptable to test it on humans.

"There are all kinds of possibilities for stress and pain with not, at the beginning, a whole lot of likelihood for success," says Dena Davis, a bioethicist at Lehigh University.

Flake says ethical concerns need to be balanced against the risk of death and severe disabilities babies often suffer when they are born very prematurely. A normal pregnancy lasts about 40 weeks. A human device would be designed for those born 23 or 24 weeks into pregnancy.

Only about half of such babies survive and, of those that do, about 90 percent suffer severe complications, such as cerebral palsy, mental retardation, seizures, paralysis, blindness and deafness, Flake says.

About 30,000 babies are born earlier than 26 weeks into pregnancy each year in the United States, according to the researchers.

Potential ethical concerns

Davis worries that the device is not necessarily a good solution for human fetuses.

"If it's a difference between a baby dying rather peacefully and a baby dying under conditions of great stress and discomfort then, no, I don't think it's better," Davis says.

"If it's a question of a baby dying versus a baby being born who then needs to live its entire life in an institution, then I don't think that's better. Some parents might think that's better, but many would not," she says.

And even if it works, Davis also worries about whether this could blur the line between a fetus and a baby.

"Up to now, we've been either born or not born. This would be halfway born, or something like that. Think about that in terms of our abortion politics," she says.

Some worry that others could take this technology further. Other scientists are already keeping embryos alive in their labs longer then ever before, and trying to create human sperm, eggs and even embryo-like entities out of stem cells. One group recently created an artificial version of the female reproductive system in the lab.

"I could imagine a time, you know sort of [a] 'Brave New World,' where we're growing embryos from the beginning to the end outside of our bodies. It would be a very Gattaca-like world," says Davis, referring to the 1997 science-fiction film.

There's also a danger such devices might be used coercively. States could theoretically require women getting abortions to put their fetuses into artificial wombs, says Scott Gelfand, a bioethicist at Oklahoma State University.

Employers could also require female employees to use artificial wombs to avoid maternity leave, he says. Insurers could require use of the device to avoid costly complicated pregnancies and deliveries.

"The ethical implications are just so far-reaching," Gelfand says.

Barbara Katz Rothman, a sociologist at the City University of New York, says more should be done to prevent premature births. She worries about the technological transformation of pregnancy.

"The problem is a baby raised in a machine is denied a human connection," Rothman says. "I think that's a scary, tragic thing."

Flake says his team has no interest in trying to gestate a fetus any earlier than about 23 weeks into pregnancy.

"I want to make this very clear: We have no intention and we've never had any intention with this technology of extending the limits of viability further back," Flake says. "I think when you do that you open a whole new can of worms.

Flake doubts anything like that would ever be possible.

"That's a pipe dream at this point," Flake says.

The problem of nursing burnout has been in a state of evolution for years. For many of these years, the 12-hour shift was the primary focus. However, 12-hour shifts provide nurses time away from the bedside necessary for rest, family time and self-care, allowing for a rested and refreshed start to new shifts.

Several stressors lead to high levels of pressure and nurse burnout. These include:

• High patient acuity (years ago, these patients would have been in the ICU)
• High nurse-to-patient ratios (not acuity-based)
• Multiple discharges and admissions (many nurses will discharge and admit an entire team of patients during their shift)
• Lack of ancillary support and resources
• Leaders who assume that nurses “can take one more patient”
• Physicians who expect nurses to drop everything and attend to their needs
• Interruptions while on their break
• The expectation that nurses are all-giving.

However, the most important stressor includes an old mindset held by organizational and nursing leadership: Nurses who voice concerns related to patient safety and workload are viewed as complainers. As nursing leaders, we must recognize the demands placed on our nurses, validate their concerns, and through best practices and common sense, use our leadership to provide support.

The most important skill of a nursing leader is the ability to listen to nurses. The nursing leader must be engaged in the discussions and have a physical presence in the department. Engaging with nurses allows for an open dialogue and a discussion of ideas, and provides validation.

Validation, in turn, lowers nurses’ stress levels because they know they are being heard. Open dialogue provides the nursing leader a forum to foster best practices, find workable solutions for departmental issues, and teach leadership skills through mentoring sessions.

Nursing leaders must hold nurses accountable who are not carrying their load. Modifications in behavior by the nurse will indicate action and support from the nursing leader. In addition, nursing leaders must know, understand and demonstrate a deep caring for their nurses. This is why having a presence on the unit is so important. Actions always speak louder than words, and we must model healthy, professional and supportive behaviors for our nurses.

Staff meetings can be of great benefit and should include discussions regarding new organizational policies, processes and outcomes from higher leadership meetings. One way to engage nursing input in staff meetings is to post an agenda and ask for additional items the nurses would like to discuss or present. Allowing nurses to create ideas, and to volunteer according to their interests and passions, fosters a sense of belonging that is necessary for engagement.

Imagine nurses researching best practices regarding care of a complex patient diagnosis new to your unit. The nurses present their research and provide the education to the nursing staff. Recognition encourages more nurses to contribute to improving the unit.

As nursing leaders, we must teach and empower our nurses to lead. Self-care has become a buzzword in nursing. Nurses are expected to care for themselves, but are sabotaged by the stress and the demands of the patient care environment. However, nursing leaders must provide supportive environments that foster self-care. For example, a competent team can handle discharge and admissions paperwork and patient education, allowing nurses to attend to their patient loads.

Finally, and most importantly, nurses need to be told that it is OK to take care of their own needs during their work shift. They need to feel confident that the nurses who are covering their team are knowledgeable and competent.

Self-care is included in many of the BSN and master’s-level nursing programs. Nursing programs are teaching leadership skills focusing on professional communication and how to achieve self-care in the work environment. Using best practice and leadership practices learned in nursing programs, nurses should present new ideas and evidence-based models to their nursing leadership.

By communicating in a professional fashion with the leadership, nurses will feel empowered and validated by having a voice. This new refreshing outlook is a far cry from the old, when nurses were expected to give up their chairs for physicians.