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

“Love is the reason I do what I do, even though at times it’s painful when you have a loss.” — Tommy Covington, hematology-oncology nurse at Children’s Hospital Los Angeles.

Thank you, Tommy, for the last 50 remarkable years you’ve given us.

From Vietnam and all those severely wounded soldiers and Marines you cared for during your four years as an Army nurse. How many beds did you say were filled in your hospital ward in Guam during one stretch of heavy fighting — 92?

You knew it was just a matter of days, even hours, before you’d be sitting by the bedside of many of these men as they were given their last rites. You felt the pain and the loss, but where was the love?

You came home and enrolled in the RN program at Los Angeles Trade Tech College, leaving your friends wondering why you would want to work in a “female profession.”

You didn’t see it that way. You had just left a war full of male nurses. Gender had nothing to do with saving lives. You landed a job in the hematology-oncology unit at Children’s Hospital Los Angeles in 1970 where your patients now were babies and kids fighting another enemy — cancer.

That’s where you say you found it. In pediatrics. The love. 

You cared for these kids and cradled them in your arms for 46 years, giving their emotionally drained parents a chance to catch a few hours of precious sleep. You’d sit at your nurse’s station at 3 a.m. on the night shift and turn on soft music to calm the babies down.

“You cuddle them and make eye contact, and when they smile back at you, well, it’s just a wonderful thing,” you told me. Yeah, I bet it is, Tommy.

But with the love, came the pain. Always. You knew many of these babies and young children would not see another birthday. You had to block that out and just do your job.

“Many of my patients have succumbed to their disease,” you say. “How do you learn to deal with it? It’s part of life. It’s been my way of life for 50 years.”

The people at CHLA tell me you’re a legend at the hospital, one of its most beloved employees. You’re still getting mail and phone calls from parents who can’t shake you from their minds, even years after their babies have died.

If it hadn’t been for you, the heartache they went through would have been so much worse. You helped get them through the lowest point in their lives, and they still feel a need to thank you for that all these years later.

One young mother of a 22-month-old daughter, Jessica, who spent a month in the oncology unit recently, described your gift perfectly.

“It was about 10 o’clock at night and she just kept crying,” Brittany Thornton says. “Tommy came to the door and asked if he could help. He picked Jessica up and it was like magic — she stopped crying immediately and laid on his shoulder.

“He took her for about two hours and let me sleep. He’s the only one who can make Jessica stop what she’s doing and smile.” What a gift you have, Tommy.

And now, it’s time to say goodbye to this hospital you’ve served for almost half a century and go fishing. To throw your line in the water and find that peace you can’t find anywhere else.

Your 71-year-old knees are killing you, and there’s a lot of walking on this job. You don’t want to cheat your patients.

“If I can’t function at 100 percent for them, it’s time for me to go,” you say. I can see that. The smart ones always know when it’s time.

But there’s a hurt in your voice you can’t hide, Tommy. It’s not going to be easy walking away from a job you love, even with all the pain and loss attached to it. You’re going to miss these kids and the rookie nurses you’ve helped train to one day take your place.

They were a large part of why you worked the 7 p.m.- to -7 a.m. shift three nights a week all these years. You joked the hours made the commute from your home in Valencia to L.A. easier with less traffic, but that wasn’t the real reason.

The night shift gave you more independence, a chance to spend extra time looking into the eyes of the crying babies in your arms. Feeling their love.

This morning you’re going into work one last time to clean out your locker and sign some retirement papers before driving home to your wife, Laurie, who also works at CHLA as a staffing coordinator, as does your son, Joe.

Next week, you’ll be on a fishing boat out of Ventura Harbor, throwing your line in the water and just relaxing. It all sounds perfect, but you admit your heart won’t be out there on that boat with you. Not for a while.

It’ll still be at work with all those beautiful babies and children who gave you so much love and pain throughout your remarkable career.

Thank you, Tommy Covington, for the last 50 years. You’re a hell of a man.