The experience of being an older perioperative nurse

AORN Journal,  Oct, 2003  by Susan Letvak

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Aging of the nursing workforce has compounded an already acute nursing shortage. The average age of RNs in the United States has increased substantially from 37.4 years in 1983 to 41.9 years in 1996 and 44.5 years in 2000. The total US workforce has aged only two years during the same 17-year period. (1,2) Although the average age of RNs is increasing, specialty areas, such as perioperative nursing, are experiencing an even more significantly aging workforce. One author reported that the average age of the 86,000 perioperative nurses in the United States is at least one to two years older than that of the average practicing nurse. (3) Another author cites the average perioperative nurse as being 47 years of age. (4) More specifically, a 2000 AORN member survey found the average perioperative nurse to be 47.3 years of age. (5)

The largest cohort of nurses in the United States currently is aged 40 to 49, and there is a significant decline in the number of nurses who continue to work after age 50. (2) With nurse labor market analyses indicating poor prospects for recruiting adequate numbers of nurses to meet US health care needs, retention of older nurses is imperative. (6)

Despite the recent media attention to the aging nurse workforce, little is known about older nurses, specifically older perioperative nurses. In the midst of a critical nursing shortage, it is crucial to understand what it is like to be an older nurse.

REVIEW OF THE LITERATURE

Aside from demographic and anecdotal reports, little research has been conducted on older nurses, and almost no research has been conducted on older perioperative nurses. One researcher surveyed 105 RNs aged 24 to 69 and found that contrary to the expected stereotype, older nurses (ie, older than age 40) were more apt to stay up to date with changing job demands. (7) Another researcher interviewed eight female RNs older than age 50 who were employed full time in a hospital. Although these RNs desired more continuing education, the researcher determined that they felt good about themselves and their clinical skills. (8) More than 60 working and retired nurses in Canada, aged between their late 40s and mid-50s, were interviewed informally by one researcher. (9) Using a verbal history approach, the researcher found that nurses stop working in their 50s because nursing is too difficult and labor intensive. Additionally, older nurses felt too distanced from younger nurses. This distancing made the older nurses feel that they could not join forces to bring about change. Another researcher used the constant comparative method to analyze in-depth interviews of 50 nurses older than age 50. (10) These older nurses discussed placing obligations to family members before their careers yet believed they had a moral obligation to continue providing patient care.

In-depth interviews of 11 staff nurses older than age 55 were conducted by one researcher. Results of the interviews demonstrated that these older nurses were working because they continued to care about patients, despite

* the stressors of intergenerational conflict with younger nurses,

* less respect from patients and their family members, and

* inequity in pay. (11)

They were confident in their abilities and felt capable of continuing to meet the demands of hospital nursing.

In another study, one important finding was that administrators desire to retain older nurses. In this survey of 571 hospital and nursing home administrators, nurses older than age 55 made up 14.1% of respondents' RN staff members. Almost all administrators were aware of the aging RN workforce and strongly desired to retain older nurses; however, 94% had no policies in place to address the needs of older workers, and 87% admitted to having no immediate plans to address this issue. (12)

In summary, although demographic information is available, little is known about the aging RN workforce, and even less is known about the work experiences of older perioperative nurses. The purpose of this qualitative study, therefore, was to describe the work experiences of older perioperative nurses. An additional purpose of this study was to encourage nurse empowerment, specifically of older perioperative nurses, by contributing to research. The research question asked was: What is the experience of being an older perioperative nurse?

THEORETICAL FRAMEWORK

Feminist, relational ontology provided the theoretical framework for this study. Nursing is a female-dominated profession; however, much of the research on the profession has lacked a gender perspective. (13) During the past 25 years, numerous feminist theorists have challenged the prevailing adult growth and development models (ie, separation, individuation, independence) in favor of an alternative model of women's growth. (14-16) By listening to the voices of women, researchers discovered that a woman's self develops, not as the result of movement away from infant symbiosis and embeddedness toward adult autonomy and individuation, but rather as an inextricable part of relationships, interpersonal connections, and interactions. When women speak, therefore, they speak of themselves as living in connection with others. (17) One theorist described this inner sense of connection to others as the central organizing feature of women's development. (18) This connection provides a sense of value and effectiveness in life activities. Healthy relationships are mutual and growth enhancing. Historically, women have been deprived by a male-dominated society that has overlooked relational needs.