By Paul Restuccia
Boston Herald

As a 64-year-old nurse administrator, Ed Coakley is using his own experience at Mass. General as a catalyst to help make the hospital workplace more accommodating for older nurses.When Coakley began rethinking his future after a 30-year-plus career, it led him to examine the problems older nurses face.

The hospital, in turn, came up with a new role for the former nursing director of the operating room, who wanted to get back into clinical medicine. He would work fewer hours and as a supplement to an RN. He would have more limited basic care tasks but much more oversight, mentoring and support responsibility.

As part of his new role, Coakley formed what’s called the Aging Nurse Project at MGH, an initiative he devised to investigate issues of concern to older nurses and to find ways to keep them working longer at the hospital.

As part of the project, he has interviewed older nurses at MGH, and at hospitals in Michigan and in Florida.

“The biggest concern older nurses have is about their physical health,” says Coakley, who is currently MGH’s project director of the RN residency program for geraitric and palliative care. “They are worried about their backs and if they will continue to have the stamina to do their jobs.”

He also found that because of retirement plan changes at many hospitals, older nurses say they will have to work longer than anticipated.

National studies, such as one done by Professor Peter Buerhaus of Vanderbilt University, back up Coakley’s contention that the country’s nursing force is aging. Buerhaus’ 2003 study found that the number of nurses between the ages of 50 and 64 grew by 129,750 in just two years and they represented two-thirds of nurses entering or re-entering the work force.

Why are so many older nurses returning to the work force?

“There are many nurses who were out of the work force raising their children who now want or need to return,” says Dr. Jean Weyman, director of continuing education at the William S. Connell School of Nursing at Boston College, who oversees the RN Refresher Certificate Program. “Some do so because of concerns about their spouse’s job. Others have divorced and need to support themselves.”

Older nurses now make up 28 percent of the national nursing work force.  At Mass. General, the numbers are even higher. MGH nurse recruiting specialist Michele Andrews estimates that a third of some 6,000 nurses at Mass. General are over 50.

“Many nurses express a desire to retire but they are not ready to leave both because they love the work and also because they can’t afford to leave,” says Andrews, adding that the nurse turnover rate at MGH is only 4 percent, one of the lowest among Bay State hospitals.

With growing numbers of older nurses planning to work longer, MGH’s Coakley saw a need for hospitals to find better ways to retain them.

Hospitals offer flexibility in terms of hours and schedules. Many hospitals, such as MGH and North Shore Medical Center, will provide benefits as long as nurses work at least 20 hours per week. Some older nurses work shorter shifts of 4-to-6 hours, some even “retire” and then come back as part of a growing pool of “per diem” nurses. Others change direction into less demanding work.

“We had one nurse who worked for 30 years in a medical surgery unit and retrained to go into day surgery,” says Tim Kerrigan, the nurse recruiter at North Shore Medical Center.

Kerrigan says it isn’t just physical labor that challenges older nurses, but the constantly evolving technology. With new computerized IVs, physician order entry systems and online patient documentation, nurses must be able to keep up with the latest technology.

Mass. General has begun equipping nurses with cell phones as well, and Coakley says that while multitasking with phones is second-nature for younger nurses, it takes some adjustment for older RNs.

“The good news is that in our surveys older nurses say they are not frightened by new technology,” Coakley says. “In fact, contrary to the stereotype, older nurses are able to learn quickly and keep up with changing job demands.”

But it’s the physical part of the job that is a more difficult challenge to solve.

Faith Kramer, a 74-year-old nurse who retired but works as a per diem nurse at the North Shore Medical Center’s Union Hospital in Lynn, agrees. “Nursing is a rewarding career, but it’s hard - people just get tired,” Kramer says. “There’s a lot of physical strain from lifting and moving patients.”

Working with the MGH, Coakley began a pilot program in the medical ICU unit where mechanical lifts were installed in the ceilings to help lift and move patients.

With the graying of the work force, what’s called Safe Patient Handling has become a huge issue. U.S. Bureau of Labor statistics show an increasing number of nurses with injuries blamed on lifting patients. Nurses have even higher injury rates than construction workers, with 12 nurses out of every 100 in hospitals and 17 out of 100 in nursing homes reporting muscular-skeletal injuries, including back injuries - nearly double the rate for all other industries combined.

A bill now in committee at the State House would establish policies and standards for patient lifting just as OSHA now has for workers who routinely lift heavy objects.

“OSHA has standards for the average warehouse worker lifting 40-pound boxes, but nurses are expected to lift 300-pound patients by themselves with no help,” says David Schildmeier, communications director for the Mass. Nursing Association, which is backing the Safe Patient Handling bill.

But there is more to the Aging Nurse Project than trying to ease nurses’ physical work.

Coakley applied for and has received a grant from the Department of Health & Human Services that will provide funds to pair older and younger nurses for nine months, an extension of the hospital’s usual 6-to-8 week preceptor programs.

One nurse who is planning to participate at MGH is clinical nurse specialist Lillian Ananian, who has been a nurse for 29 years, including 19 at Mass. General.

“Older nurses can help younger nurses in a lot of ways,” say Ananian. “How to comfort patients during infusions, show them ways to cope with end-of-life issues, and to learn to deal with seeing so much death.”

Coakley sees it as a way to establish deeper connections between older and younger nurses and create a better functioning multigenerational staff.

“Older nurses are a rich repository of wisdom that they can pass on to younger RNs,” Coakley says. “Valuing that wisdom is one of the most important things a hospital can do.”