Retaining experienced nurses is a problem that may get worse before it gets better. The average nurse is between 44 and 47 years old, and many are 55 and older. With today's nursing shortage, replacing years of contributions, knowledge and experience is no easy matter.

Root causes of dissent
Many older nurses don't need to work, so even if you have the budget to throw more money at the problem, you need to give a nurse who has "had it up to here" with working conditions a reason to stay. To do so, you must first understand why older nurses may be dissatisfied.

Three Things You Can Do - Take action on their concerns, especially shceduling and pacing. - Recognize their special needs. - Make them feel like they still have a future in your organization.

• Changing times. Older nurses can have a hard time adapting to the ultra-fast pace of an ASC. There is also the issue of technology: computers and high-tech equipment can intimidate.
• Generation gap. Older nurses, many of whom went to a three-year nursing school and then straight into the clinical setting, often view their younger counterparts with great disdain. Many older nurses have no desire to get into management and they have a problem with "business" nurses who want to use the clinical setting as a stepping-stone for their own careers.
• Scheduling. Don't assume that older nurses can cover odd shifts because they don't have family responsibilities. Watch out for less experienced staffers who leave because "it's time to go," regardless of whether relief staff is on hand.

Practical retention suggestions
Here are strategies to consider:

• Let them develop a niche. An older nurse may no longer be able to move quickly or stand for extended lengths of time. She may also feel uncomfortable with some of the more complicated equipment being introduced into the OR. So why not let her conduct pre-operative interviews? Most of the work is done sitting down, and her experience in patient care can help get the interviews done effectively.
• Make advancement continual. If the older nurse is interested in management, offer her training. For those who prefer patient care, provide added opportunities to excel in the clinical setting. For example, appoint a resource nurse for each specialty you house at your facility.
• Provide resources for elder care. We often consider the special needs of working mothers and overlook the problems of those who have to assume caretaking responsibilities for their elderly parents. Especially if the parents are in poor health, this can be a tremendous burden. Older nurses need just as much flexibility in their schedules to care for elderly parents as younger nurses do to tend to growing children.
• Offer creative scheduling. One is self-scheduling. Once you provide guidelines for your core staffing requirements (the minimum number of people required throughout the day), let nurses sign up for their shifts, with the requirement that each nurse will have to rotate to fill the uncovered shifts. This arrangement allows for optimal individual flexibility.

Another possibility is assigning shifts for a set period of time. For example, every nurse is expected to cover an early shift (6:30 a.m. to 3 p.m.) for a week or a month and a later shift (9:30 a.m. to 6 p.m.) for a week or a month. The advantage to this arrangement is that it is an equitable sharing of shift burdens among the staffers.

• Create a reward and recognition program. You may be able to get your facility owners to sign off on monetary bonuses to recognize outstanding work from your nurses. Even if they won't put up extra money, there are things you can do to let your nurses know you appreciate their hard work. This can be as simple as mentioning specific nurses by name at staff meetings, taking a nurse out to lunch or creating an employee-of-the-month program. If you do so, recognition can't be given on a "who's-turn-is-it-now?" basis or you've defeated the purpose. Older nurses in particular are more likely to take these gestures of gratitude seriously if they are awarded on merit.
• Show respect in your salary and benefits program. In my first column ("Wanted: Nurses Who Understand the ASC Mentality"), I discussed how the preference in modern health care is to get a recent graduate and train her to work at your facility. There is intense competition for new graduates, and they can virtually write their own ticket to generous salaries and benefits packages. However, you should not fall into the trap of hiring younger nurses at all costs. People do talk about and compare salaries. Older nurses resent hearing that some brand new graduate is starting at virtually the same salary she has worked 35 years to attain.

Contact Ann Geier at [email protected].