1. McNeal, Linda J. PhD, RN, CCRN

Article Content

Many institutions now have large cohorts of "older" nurses-nurses who became registered in the 1950s to 1970s-and many of them are leaving the profession. In an effort to increase retention, institutions may be considering incentives for these nurses such as reduced or select patient loads and/or assignment to permanent day shift if they remain employed. In my opinion, a nurse's age or longevity in the profession should not be used to determine staffing or shift assignments. Rather, the nurse's expertise as a clinician and her or his ability to provide safe and competent care for patients should be the primary considerations in making assignments.


Optimally, shift assignments for nurses should be based on the nurse's own personal preferences. Staffing systems that permit more personal control over work hours should help to create flexibility and more satisfaction with work schedules. Researchers have demonstrated that overall job satisfaction and coping skills of workers satisfied with their work schedules are improved when compared with workers who are dissatisfied with their schedules (Axelsson, Akerstedt, Kecklund, & Lowden, 2004). Some older nurses may prefer evening or night work; perhaps these shifts are the ones they have always worked, and their bodies have adapted to working while others sleep. Others may feel these shifts provide opportunities for interactions with patients and their families that are superior to those afforded during the busier daytime shifts.


Instead of initiating policies that favor one group over another, policies should be established that increase job satisfaction among all nurses, regardless of their age or longevity within the institution.


Despite their desire to work specific shifts, balancing work, sleep requirements, and other personal needs are challenges for all staff nurses, regardless of age or longevity in the profession. To ensure patient safety and the promotion of health of the nurses working in the institution, hospitals would be wise to institute policies for shift work that are not based on the age of the nurse but are based on empirical evidence. Researchers have demonstrated that preventing frequent shift changes (i.e., nurses assigned to permanent evenings or nights) improves productivity and decreases health risks to the employee (Pilcher, Lambert, & Huffcutt, 2000). Improvements in patient care can result from the nurse's improved mental alertness, decreased fatigue, and improved work performance. Furthermore, it is well-documented that more errors occur when nurses are sleep deprived and when mental acuity is not at its peak. Prevention of these conditions in nurses should decrease the risk of errors that may occur in caring for patients.


Likewise, patient assignments should be dictated not by the nurse's age or longevity in a position, but by the proficiency of the clinician to provide high-quality nursing care. Most of us may have had experiences with "older" nurses who were experts at providing care to patients-so much so, perhaps, that it seemed they could do the work of two. Their advanced age certainly was not a deterrent to their ability to carry out their patient care. Age or longevity in the profession does not determine performance when it comes to providing care. The environment in which a nurse works should be flexible and should help to promote professionalism in the workplace. Nurses should participate in decision making at all levels, including decisions regarding patient assignments.


Instead of institutions initiating policies that favor one group over another or that may cause conflict between groups, policies should be established that increase job satisfaction among all nurses, regardless of their age or longevity within the institution. Improved working conditions, manageable workloads, and adequate wages for all nurses would be a good place to start. Nurses, too, would be wise to examine their governance structures and amend them so that nurses have key roles in decision making at all levels.




1.Axelsson, J., Akerstedt, T., Kecklund, G., & Lowden, A. (2004). Tolerance to shift work-how does it relate to sleep and wakefulness?International Archives of Occupational & Environmental Health, 77 (2), 121-129. [Context Link]


2.Pilcher, J. J., Lambert, B. J., & Huffcutt, A. I. (2000). Differential effects of permanent and rotating shifts on self-report sleep length: A meta-analytic review. Sleep, 23 (2), 155-163. [Context Link]