Nurses’ intention to work after retirement, work ability and perceptions after retirement: a scoping review

Nurses’ intention to work after retirement, work ability and perceptions after retirement: a scoping review

Wonpen Kaewpan¹, Karl Peltzer^2,&

 

¹Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Salaya, Phutthamonthon, NakhonPathom 73170, Thailand, ²Department of Research and Innovation, University of Limpopo, Turfloop 0527, South Africa

 

 

^&Corresponding author
Karl Peltzer, Department of Research and Innovation, University of Limpopo, Turfloop 0527, South Africa

 

 

 

 

Globally, there appears to be a growing shortage of nurses [1-3]. In addition, the average age of the nursing workforce has been increasing [4, 5]. The retirement age for nurses differs by country, with e.g. no statutory retirement age in Australia [4]. Various statements have indicated the need of nurses to work as nurses in post-retirement, e.g., "flexible working after retirement can help older workers adjust" [6]. "Reactivation of retired nurses: a part time employment and understanding attitude of the work environment" [7]. "Reject retirement age of 65" [8]. "Bring nurses out of retirement to help ailing hospitals" [9]. For example in Thailand, the crisis of the nursing shortage is not only the failure to retain qualified and experienced nurses but also inadequate production. The research on policy on demand and supply projection of nurses for the period of 2017 to 2021 found that the shortage of skilled and experienced nurses in Thailand will become more severe in next 10 years due to early leaving of young nurses and retirement of senior nurses [10]. The results also revealed that improving policies in recruiting and retaining qualified nurses, creating positive practice environment and engagement, strengthening collaboration and resource sharing among all stakeholders are needed [10]. Moreover, maximizing the efficient use of nurses, particularly among the seniors, was also suggested to reduce the degree of severity of this problem, in line with Thailand's Twelfth National Economic and Social Development Plan (2017-2021) [11]. Yet, there is a scarcity of research on how retired professional nurses can help in filling some of the gaps of the nursing shortage [12]. There is also little professional literature on the intention and ability of nurses to work as nurses post-retirement [12]. Some research seem to suggest that retired nurses are entering the workforce again because of financial reasons, which could have positive impact on the nursing shortage [12]. Previous reviews of research studies focused on the intention and work ability of nurses to retain them into employment until retirement [13-19], but we are not aware of a review of studies focusing on the intention, recruitment strategies, work ability and perception of nurses post-retirement, which prompted this scoping review.

 

 

Search strategies: according to CRD guidelines on EQUATOR, a comprehensive search strategy was used to identify relevant studies. PubMed, CINAHL, Web of Science, Nursing and Health Database and in addition Google scholar were searched for combinations of keywords, such as retired nurses, retired RNs, work intention, work ability, work perceptions, and older nurses (Table 1). Specific inclusion and exclusion criteria were used to select relevant studies and an independent reviewer cross validated all the identified studies.

 

Inclusion criteria: this scoping review included studies conducted between 2000 and 2018 that: (a) were published or electronically available in the English or Thai language; (b) were based on empirical quantitative and qualitative studies; (c) measured the intention and recruitment strategies to work as nurse post-retirement or beyond 65 years; and (d) focused on nurses working post-retirement or beyond 65 years in various settings and capacity.

 

Exclusion criteria: this scoping review excluded papers that: (a) involved insufficient details on either intention or working as a nurse post-retirement (not early but regular retirement); (b) included samples consisting of other health professionals (doctors, social workers); (c) described retirement experiences of nurses in general but not in the nursing profession; (d) retired nurses describing past nursing issues; (e) merely gave descriptive accounts of projects and/or programmes on the role of retired nurses without evaluation. The selected studies included in this scoping review were analysed based on their findings and reported in terms of the description of the intention of working as nurses post-retirement and work ability and perceptions of retired nurses.

 

 

Using the described search strategy, a total of 37 studies that met the inclusion criteria were electronically identified from PubMed, CINAHL, Web of Science, Nursing and Health Database and in addition Google scholar and hand search. However, following application of the exclusion criteria, 26 of the 37 studies were excluded leaving 11 relevant studies. Four studies (3 quantitative and 1 qualitative) dealt with nurses' intention to work post-retirement, two qualitative studies on strategies and attitudes to attract nurses working post-retirement, and five studies (2 mixed method and 3 qualitative) on work ability and perceptions of working as a nurse post-retirement. This is illustrated below (Figure 1). Of these 11 identified studies, majority (n=9) were from high-income countries (5 from USA, 3 Australia and 1 Singapore) and 2 from middle-income countries (South Africa and Thailand).

 

Nurses' intention to work post-retirement: the review identified four studies on nurses' intention to work post-retirement [20-23]. One study in Australia reported a high intention to work as nurses post-retirement (73.2%) [20], while in Singapore only 18.3% wanted to work post-retirement (>65 years) [21]. Facilitators of the intention to work as nurses post-retirement included no shift work, reduced workload, job sharing or job rotation, short-term placements, financial incentives, supportive work environment, having a degree, disagreeing with attitudes not to work post-retirement [20-22]. Barriers to the intention to work as nurses post-retirement included work place incivility, remoteness of nurse practice settings, only informal system of post-retirement working arrangements [22] (Table 2).

 

Strategies and attitudes to attract nurses working post-retirement: the review identified two qualitative studies on strategies and attitudes to attract nurses to work post-retirement [24, 25]. Nurse managers in South Africa had mixed attitudes regarding nurses working post-retirement. Some argued that they could still have a useful role to play while others were against bringing retired nurses back [24]. Nurses in the US recorded different strategies to attract retired healthcare workers back into the work force, including attractive rehiring policies (financial, status, flexible work schedules) [25] (Table 2).

 

Work ability and perceptions of working as a nurse post-retirement: the review identified three studies on work ability and perceptions of working as a nurse post-retirement [26-28]. In all studies nurses in older homes, nurse mentors and nursing lecturers expressed benefits of working post-retirement (positive view, ability to contribute to nursing, satisfaction such as positive intrinsic factors, and enjoyed capacity for engagement with new people, etc.). Various challenges were also expressed in the form of overworking, handling technology, feeling disconnected from nursing community post-retirement, and their own physical decline due to ageing (Table 2).

 

Work ability and perceptions of retired nurses working as volunteers: the review identified two studies work ability and perceptions of retired nurses working as volunteers [29-30]. Retired nurse volunteers expressed several benefits of their work (enhanced self-worth, intellectual stimulation, opportunity to help others, and reduction of social isolation) and several challenges or barriers (such as physical problems, increased paperwork, new technology, lack of respect and licensing problems) (Table 2 suite).

 

This review identified 11 studies on nurses' intention to work after retirement and work ability and perceptions after retirement. The intentions to work after retirement ranged from 18.3% in Singapore [12] to 73.2% in Australia [11]. Facilitators of both intentions to work as a nurse post-retirement and strategies to attract nurses post-retirement were similar, including lighter and flexible work conditions, supportive environment and financial incentives [11-13]. Likewise, barriers of both intentions to work as a nurse post-retirement and strategies to attract nurses post-retirement were similar, including lack of attractive rehiring policies, lack of formal system of post-retirement working arrangements, un supportive environment and inflexible work schedules [4, 12-16] on the retention of older nurses (up to retirement)found similar facilitating and challenging factors, ranging from supportive environment, reduced and flexible workload, to improved education and training. Nurses working as nurse or nurse volunteer in post-retirement reported both beneficial and challenging aspects of their work. Benefits included intrinsic factors (self-worth, overcoming social isolation) and barriers included job demands and reduced physical work ability [26, 28-30]. Current retirement policies in the various countries may need to refocus by introducing more flexible opportunities for post-retirement employment of nurses [13]. Other programmes seem to successfully employ nurses post-retirement in the academic sector, such as in the study from Thailand [17] and Baldwin et al. [31] describe the integration of retired nurses into a new graduate orientation programme in the US.

 

Limitations: most studies (9 of 11) included in this scoping review had been conducted in high-income countries, lacking generalize ability to low- and middle- income countries. Due to the scarcity and descriptive nature of the data, no quality assessment of the specific studies was conducted.

 

Funding: the research was carried out within the framework of research project "development of intermediate and long term care model for dependent elderly by enhancing competency and employment of retired nurses as community nurse managers", supported by Mahidol University.

 

 

The scoping review found low and high intentions to work as nurses after retirement, and identified factors influencing both intentions and recruitment strategies to work as a nurse post-retirement and benefits and barriers of working as nurses post-retirement that can inform strategies to retain nurses post-retirement. Too few studies have been conducted on the topic emphasizing the need for more quantitative and qualitative research, especially in low- and middle-income countries.

 

 

The authors declare no competing interests.

 

 

Wonpen Kaewpan and Karl Peltzer conceptualized, conducted the formal analysis and wrote the paper.

 

 

Table 1: detailed search strategy

Table 2: method, sample and findings of identified studies

Table 2 suite: method, sample and findings of identified studies

Figure 1: PRISMA 2009 flow diagramme showing study selection and data extraction process at every stage of the review

 

 

1. Nardi DA, Gyurko CC. The global nursing faculty shortage: status and solutions for change. J NursScholarsh. 2013;45(3):317-26. PubMed | Google Scholar


2. Yun H, Jie S, Anli J. Nursing shortage in China: State, causes and strategy. Nurs Outlook. 2010;58(3):122-8. PubMed | Google Scholar


3. Wakaba M, Mbindyo P, Ochieng J, Kiriinya R, Todd J, Waudo A et al. The public sector nursing workforce in Kenya: a county-level analysis. Hum Resour Health. 2014;12:6. PubMed | Google Scholar


4. Graham E, Donoghue J, Duffield C, Griffiths R, Bichel-Findlay J, Dimitrelis S. Why do older RNs keep working? J Nurs Adm. 2014;44(11):591-7. PubMed | Google Scholar


5. Sherman RO, Chiang-Hanisko L, Koszalinski R. The ageing nursing workforce: a global challenge. J NursManag. 2013;21(7):899-902. PubMed | Google Scholar


6. Carlowe J. Flexible working after retirement can help older workers adjust. Nurs Times. 2009;105(20):suppl 12-3. PubMed | Google Scholar


7. Endo K. Reactivation of retired nurses: a part time employment and understanding attitude of the work environment. KangogakuZasshi. 1974;38(1):55-6. PubMed | Google Scholar


8. Wiltshire KT. Reject retirement age of 65. Nurs Older People. 2005;17(3):35. PubMed


9. Keogh K. Bring nurses out of retirement to help ailing hospitals, says academic. Nurs Stand. 2014;28(32):8. PubMed | Google Scholar


10. Sawaengdee K. Crisis of nursing shortage in health service facilities under office of permanent secretary, Ministry of Public Health: Policy Recommendations. J Health Sci. 2017;26(2):456-468. Google Scholar


11. Office of the National Economic and Social Development Board Office of the Prime Minister Bangkok, Thailand. The twelfth national economic and social development plan (2017-2021). 2016. Accessed 5 October 2018.


12. Neal-Boylan L,Cocca K, Carnoali B.The benefits to working for retired RNs. GeriatrNurs. 2009; 30(6): 378-383. PubMed


13. Uthaman T, Chua TL,Ang SY. Older nurses: a literature review on challenges, factors in early retirement and workforce retention. Proceedings of Singapore Healthcare. 2016; 26(1): 50-55. Google Scholar


14. Fitzgerald DC. Aging, experienced nurses: their value andneeds. Contemp Nurse. 2007; 24(2):237-242. PubMed | Google Scholar


15. Stichler JF. Healthy work environments for the ageing nursingworkforce. J Nurs Manag. 2013; 21(7):956-963. PubMed | Google Scholar


16. Cohen JD. The aging nursing workforce: How to retain experiencednurses. J Healthc Manag. 2006; 51(4):233-245. PubMed | Google Scholar


17. Moseley A, Jeffers L, Paterson J. The retention of the oldernursing workforce: a literature review exploring factors whichinfluence the retention and turnover of older nurses. Contemp.Nurse 2008; 30(1):46-56. PubMed | Google Scholar


18. Storey C, Cheater F, Ford J, Leese B. Retention of nurses in the primary and communitycare workforce after the age of 50 years: databaseanalysis and literature review. J AdvNurs. 2009; 65(8):1596-1605. PubMed | Google Scholar


19. Lartey S, Cummings G, Profetto-McGrath, J. Interventions that promote retention of experienced registered nurses in health care settings: a systematic review. J NursManag. 2014; 22(8): 1027-41. doi: 10.1111/jonm.12105. PubMed | Google Scholar


20. Voit K, Carson DB. Post-retirement intentions of nurses and midwives living and working in the Northern Territory of Australia. Rural Remote Health. 2014; 14(3): 2399. PubMed | Google Scholar


21. Ang SY, Ayoob SBM, Hussain NBS,Uthaman T, Adenan H, Chiang P, Ong LT, Fong MK, Ostbye T. Older nurses in Singapore: Factors associated with attitudes towards extending working life. Proceedings of Singapore Healthcare. 2016; 25(4):222-229. Google Scholar


22. Voit K, Carson DB. Retaining older experienced nurses in the Northern Territory of Australia: a qualitative study exploring opportunities for post-retirement contributions. Rural Remote Health. 2012; 12(2): 1881. PubMed | Google Scholar


23. Peng Y. Electronic Thesis or Dissertation Center. Accessed 10 August 2018.


24. Mokoka E, Oosthuizen MJ, Ehlers VJ. Retaining professional nurses in South Africa: Nurse managers' perspectives. Health SA Gesondheid. 2010; 15(1): Art. #484, 9 pages. Google Scholar


25. US Department of Labor and Maryland Department of Labor, Licensing and Regulation. Assessment of Strategies to Retain Experienced Technical and Professional Healthcare Personnel After Retirement Age: Mature Healthcare Workers Focus Group Research. January 22, 2008. Accessed 10 August 2018.


26. Aroonsang P, Sritanyarat W, Nansupawat R, Kaewpan W, Lertrat P, Isaramalai S. Work and health connditions of retired nursing lecturers still in nursing schools' employment. Thai J. Nursing Council 2012; 27(2):63-80.


27. Rossman TL. Older home health registered nurses: Work perceptions and satisfaction. Dissertation Submitted to the School of Graduate Studies and Research in Partial Fulfilment of the Requirements for the Degree Doctor of Philosophy, Indiana University of Pennsylvania. August 2011. Google Scholar


28. McDonald G, Mohan S, Jackson D, Vickers MH, Wilkes L. Continuing connections: the experiences of retired and senior working nurse mentors. J ClinNurs. 2010; 19(23-24): 3547-54. PubMed | Google Scholar


29. Wilson LB, Lester L, Simson SP. Assessing the involvement of retired health professionals in meeting the needs of underserved populations. Nurs Outlook. 2000; 48(1): 34-9. PubMed | Google Scholar


30. Cocca-Bates KC, Neal-Boylan L. Retired RNs: perceptions of volunteering.GeriatrNurs. 2011; 32(2): 96-105. PubMed | Google Scholar


31. Baldwin KM, Black DL, Normand LK, Bonds P, Townley M. Integrating retired registered nurses into a new graduate orientation program. Clin Nurse Spec. 2016;30(5): 277-83. PubMed | Google Scholar