Nursing past midlife: does it have to mean ‘tired out’?
With many nurses staying on the register past retirement age, we look at the pros and cons of nursing beyond your 40s, including through menopause
- Around a sixth of nurses in England are working beyond retirement age, bringing valuable experience and knowledge to the workforce
- The challenges of being an older nurse, and why employers should be doing their best to retain these experienced staff
- Two recent recruits to the nursing workforce on the benefits of training in their late 40s, plus tips on working during perimenopause
The nursing workforce is getting older – the latest data from the Nursing and Midwifery Council (NMC) register shows that one in three
With many nurses staying on the register past retirement age, we look at the pros and cons of nursing beyond your 40s, including through menopause
- Around a sixth of nurses in England are working beyond retirement age, bringing valuable experience and knowledge to the workforce
- The challenges of being an older nurse, and why employers should be doing their best to retain these experienced staff
- Two recent recruits to the nursing workforce on the benefits of training in their late 40s, plus tips on working during perimenopause
The nursing workforce is getting older – the latest data from the Nursing and Midwifery Council (NMC) register shows that one in three nurses on the permanent register is aged 51 or older.
The register, which includes nurses and midwives eligible to practise in the UK and nursing associates in England, shows that as of September 2022 one fifth (21.3%, or 164,383) are aged over 56 – a year above the pensionable age of 55. That represents a rise of 3,328 (2.1%) compared with the previous year.
Working way beyond retirement age
In part this is a reflection of an ageing population as a whole. But the COVID-19 pandemic is a likely contributing factor, with some older nurses either delaying retirement or returning to the profession to boost the workforce during this time.
Some of those who joined the temporary COVID register have since moved to the permanent register, the NMC says. And the number of professionals who have been on the register for between ten and 30 years grew by 6,091 (1.9%) in the year to September 2022, with 641 nurses on the register who are aged over 75 and 3,048 aged 71-75.
‘Arguably, it’s unfortunate that it requires a global crisis for policy to look at how to encourage returners and retain older nurses… but I think it’s clear that their contribution is better recognised now’
James Buchan, visiting professor, University of Edinburgh nursing studies department
Visiting professor at the University of Edinburgh nursing studies department James Buchan suggests it is a positive step that the importance of the contribution of older nurses is now more widely recognised – especially during a staffing crisis.
‘Arguably, it’s unfortunate that it requires a global crisis for policy to look at how to encourage returners and retain older nurses, and emergency measures cannot be sustained in the long term, but I think it’s clear that their contribution is better recognised now,’ says Professor Buchan, who has researched labour market issues with the Health Foundation and the International Council of Nurses.
The ‘healthy worker’ effect: how older nurses can continue to work
This year’s RCN congress discussed the welfare and occupational safety of healthcare workers aged over 50 years.
The discussion paper submitted by the RCN Liverpool and Knowsley branch says that with NHS pensions linked to the state pension, and the often poor occupational pensions on offer in the independent sector, it is likely that more of the nursing workforce will continue to work into their late sixties.
It adds that this is set against a backdrop of diminishing pension benefits and decreased tax allowances, creating an environment where workers may be forced to work longer for less.
The Nuffield Trust’s analysis of the age profile of nurses working in the NHS in England also reveals a large cohort fast approaching pensionable age. Data show 27% are aged between 45 and 54. The percentage of NHS nurses working past age 65 is up from 0.5% in 2009 to 1.5% in 2022.
University of Southampton lecturer in nursing Chiara Dall’Ora, who studies nursing shift patterns, says that those who continue working night shifts and long shifts later in life are the ‘survivors’.
‘We see the “healthy worker effect” – the ones who can manage it, who feel healthy and fit enough to still do shifts, so haven’t dropped out earlier,’ she says. ‘They are more likely to have disturbed sleep than younger colleagues, but they can sustain it, so they continue working.’
The challenges of nursing through midlife and menopause
Nurses responding to a post from Nursing Standard on social media about the challenges of nursing into your 40s and beyond cite challenges such as caring for children at home and for ageing parents, loss of confidence, shift work, long-term health conditions or disabilities that become more difficult to manage with age, and negative workplace cultures.
Some say these factors leave them exhausted and demoralised, and they are planning to retire earlier. Several mention the perimenopause and menopause as a significant problem.
In its 2022 report, Understanding Older Workers, the Chartered Institute for Personnel and Development highlights that more than 50% of workers have a long-term health condition by the time they reach 60, and a third are affected by some form of disability.
While only a quarter of workers over 60 say that their health limits the type or amount of work they can do, too many workers leave employment by this age because of poor health, the report says. The institute calls for investment in timely, preventive occupational health services that are accessible to all workers throughout their working lives.
The NMC Leavers’ Survey 2022 reveals the top reason for leaving the register is retirement (43%) and one of the main reasons for this is respondents feeling that they have no other option due to pressures, stress and unrealistic workloads.
‘Why I stopped working during the perimenopause’
Lincolnshire nurse Helen Hutchings believes older nurses are often not valued until they leave or retire, and a huge gap in experience and knowledge becomes evident.
‘I think they are often taken for granted,’ she says. ‘We have focused so much on recruiting and retaining our youngest, newly qualified nurses that we have forgotten about our much-needed workforce at the other end.
‘Nurses starting to go through perimenopause or menopause now are also in the sandwich generation, caring for ageing parents and younger children. I know some who have tried to reduce their hours, but this has not been granted.’
Experiencing debilitating symptoms
‘I started to notice some changes in how I dealt with my workload and situations when I was 47, but put this down to working through the pandemic. I had many different symptoms, but the ones that affected me at work the most were relating to cognitive and emotional well-being. I struggled to retain information and my brain fog was horrendous. I now know what I was experiencing were perimenopausal symptoms.
‘We have focused so much on recruiting and retaining our youngest, newly qualified nurses that we have forgotten about our much-needed workforce at the other end’
Helen Hutchings, nurse who left her post
‘I was working as assistant director of nursing for non-medical education. I knew I needed some time off but I never envisaged I wouldn’t go back to the job I loved, but it took a long time and many tweaks in HRT doses to start to feel myself again.
‘Sadly, some of my symptoms became debilitating even with medication. I was well supported by my occupational health department and they took the time to listen.
Felt I had no choice but to give notice
‘After several months off sick, I gave in my notice at the age of 48 with no job to go to. I remember being told how brave I was to make this decision, but I didn’t feel I had any other choice. I also have a 12-year-old daughter and elderly parents.
‘I now work for the flexible staffing services at the same hospital but I am careful what hours and stress levels I commit to and much of my work is done at home.’
Positive aspects of being an older member of the nursing workforce
Two women who opted to train as nurses when they were in their late forties say they feel positive about working in the profession later in life.
Dorset-based Catherine Haines, now 51, applied for a registered nursing degree apprenticeship two years ago when her business selling children’s party packs was affected by the pandemic. ‘I needed to rethink and wanted a change of direction where I could help in the COVID crisis,’ she says. ‘I thought that at the age of 49, I would still have time to contribute and have a career.’
She is working regularly in an acute ward for older people during her course. Her placements have included orthopaedic trauma, cardiac care and a renal unit. She also attends university once a week.
‘Because I’m in my fifties, my children are aged between 16 and 21. They are much more independent, so it is easier for me to work the long days’
Catherine Haines, registered nursing degree apprentice who applied for the course in her late forties
‘The first year was scary but I gradually found my feet and I am now halfway through my second year,’ she says. ‘I love opportunities for learning, meeting amazing staff and patients, as well as contributing to the care of those who need the support of the NHS.
‘The course is tiring at times, but I think I cope well, considering. I absolutely made the right decision for me.’
She says her age is in part why this is a good time for her to work in nursing. ‘Because I’m in my fifties, my children are aged between 16 and 21. They are much more independent, so it is easier for me to work the long days.
‘I have a good work ethic after running my own business and I am grateful for the opportunity to get more education without student debt. I do get tired, but younger students seem to need more sleep.’
Benefits of starting later outweigh the challenges
Another late starter, Trafford-based Lindsey Foots, also 51, says the benefits of qualifying in mental health nursing when she was 48 far outweigh the challenges.
‘My dad is developing dementia, my kids are now teenagers and my training and few years of experience are helping me deal with the needs of both generations,’ says Ms Foots, who works for Greater Manchester Mental Health NHS Trust in primary care.
After 15 years working in ‘the more glamorous’ world of public relations, she found herself badly affected by premature menopause and left the workforce for seven years.
When she did return to work, she took on a role as a healthcare assistant. This helped her she realise that she wanted to work in mental health nursing, specifically in the NHS, so she studied at the University of Manchester.
‘I was in a women’s acute inpatient setting, which many believe is the most challenging area, and I thought the experience and camaraderie were fantastic,’ she says.
Tips for working while going through perimenopause
For those experiencing the symptoms of perimenopause and menopause, Lincolnshire nurse Helen Hutchings advises addressing the things that you can control.
Healthy sleep routines, good diet and hydration, regular breaks in fresh air, and booking regular annual leave can all help, as well as reducing night shifts and even hours if required on a temporary basis.
‘It’s important to have honest conversations with line managers,’ she says. ‘Be open with colleagues and help break the stigma of the menopause.
‘You should seek occupational health support if you need to. Set boundaries – say no when you need to.’
The NHS has its own menopause guidance, which stresses the need for employers and managers to be supportive and foster an open environment where staff feel empowered to ask for help.
Life experience is an advantage
‘I think my age and related confidence and tolerance protected me from the burnout and stress that affected some younger colleagues; my life experience meant I was less shockable,’ Ms Foots says.
‘Being a parent and older person kept me calm and I know other older nurses commonly feel this way. I don’t think age has increased my tiredness on shifts.'
Her main challenge is that colleagues think she knows more than she does. ‘I tell everyone that I only have three years of post-registration experience, not the 20 they assume because of my age.’
With the ageing of the general population set to continue, and financial pressures remaining high, it is likely the number of nurses working past retirement age will continue to grow. It is important, therefore, that employers recognise their value in the workforce, and are ready and able to support them through the challenges they may face. If they do, then nurses, employers and patients will all benefit.
Further information
- International Centre on Nurse Migration: (2020) Ageing well? Policies to Support Older Nurses at Work
- RCN congress 2023: Older healthcare workers (matter for discussion) reading list
- NHS (2022) Supporting our NHS people through menopause: guidance for line managers and colleagues