ArticlePDF AvailableLiterature Review

Abstract

Aims To identify and synthesise evidence related to ageism in older regulated nurses' practice settings. Design A systematic review following Joanna Briggs Institute methodology. Methods The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta‐analysis reporting (SWiM) guideline was employed in the review. Data Sources Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered. Results Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well‐being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age‐inclusive. Conclusion To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational‐led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age‐inclusive work environment that supports an age‐diverse nursing workforce. Implications for the profession and/or patient care The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti‐ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role‐playing and simulation during in‐service training may also be effective interventions. Additionally, incorporating anti‐ageism initiatives into staff meetings and mandating anti‐ageism training could support the continuation of practice for older nurses while fostering a more age‐diverse nursing workforce. Impact We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well‐being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age‐inclusive policies that support older nurses' continuation of practice. Reporting method The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and Synthesis Without Meta‐analysis checklists were used to report the screening process. Trial and Protocol Registration The PROSPERO registration number for the review was CRD42022320214 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320214 ). No Patient or Public Contribution.
J Clin Nurs. 2024;00:1–24.
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1wileyonlinelibrary.com/journal/jocn
Received: 10 September 2023 
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Revised: 23 November 2023 
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Accepted: 19 February 2024
DOI : 10.1111/jocn .170 88
SYSTEMATIC REVIEW
Ageism directed at older nurses in their workplace:
A systematic review
Chunxu Chen RN, BHSc(Hons), PhD student, Teaching Assistant1|
Kay Shannon RN, PhD, Senior Lecturer1| Sara Napier RN, PhD, Senior Lecturer1|
Stephen Neville RN, PhD, Professor2| Jed Montayre RN, PhD, Associate Professor3
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
1AUT Centre for Active Ageing, School of
Clinical Sciences, Auckland University of
Technology, Auckland, New Zealand
2National Head of Nursing, Te Pūkenga,
New Zealand
3School of Nursing, The Hong Kong
Polytechnic University, Hong Kong,
Hong Kong SAR
Correspondence
Chunxu Chen, AUT Centre for Active
Ageing, School of Clinical Sciences,
Faculty of Health and Environmental
Sciences, Auckland University of
Technology, 90 Akoranga Drive,
Northcote, Auckland 0627, New Zealand.
Email: chunxu.chen@autuni.ac.nz
Abstract
Aims: To identify and synthesise evidence related to ageism in older regulated nurses'
practice settings.
Design: A systematic review following Joanna Briggs Institute methodology.
Methods: The review included empirical studies that involved older nurses as the
primar y study population and studies that focused on ageism in older nurse s' work en-
vironments, including strategies or interventions to address ageism within the work-
place. Following the initial screening, all relevant studies were critically appraised by
two reviewers to ensure they were appropriate to include in the review. A synthesis
without meta- analysis reporting (SWiM) guideline was employed in the review.
Data Sources: Medical Literature Analysis and Retrieval Systems Online, Scopus,
Psychological Information Database and Cumulative Index to Nursing and Allied
Health Literature and Google Scholar were searched to identify empirical studies and
a range of academic institutional websites were accessed for master's and doctoral
dissertations and theses. The search covered the period from January 2022 to May
2022, and only publications in English from 2000 onwards were considered.
Results: Nineteen studies were included, ten qualitative studies, seven quantitative
studies and two mixed methods secondary analyses. Our results revealed that nega-
tive perceptions and beliefs about older nurses' competencies and skills prevail in
their practice settings, which influences older nurses' health and well- being as well as
their continuation of practice. Further, older nurses' continuation of practice can be
facilitated by having a positive personal outlook on ageing, meaningful relationships in
their practice settings and working in an environment that is age- inclusive.
Conclusion: To combat ageism in older nurses' practice settings and support their
continuation of practice, effective interventions should be organisational- led. The in-
terventions should focus on fostering meaningful relationships between older nurses
and their colleagues and managers. Further, healthcare institutions should implement
initiatives to promote an age- inclusive work environment that supports an age- diverse
nursing workforce.
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    CHEN e t al.
1 | INTRODUC TION
Global population ageing has led to significant demographic shifts in
various workforces, including nursing. In many countries, there has
been a steady increase in the average age of nurses (World Health
Organisation [WHO], 2016). For instance, in New Zealand, the me-
dian age of nurses rose from 42.6 in 1998 to 46 years in 2019 (Nursing
Council of New Zealand [NCNZ], 2019). Similar trends can be observed
in the nursing workforces of Australia, the United States of America,
Cana da and the United Kingd om, where the per centage of nurses aged
50 years and older has gradually risen (Uthaman et al., 2016; Walker
et al., 2018; Wargo- Sugleris et al., 2018; WHO, 2016).
There have been an increasing number of studies addressing older
nurses' practice (Montayre et al., 2023; Ryan et al., 2 017; Uthaman
et al., 2016). Nonetheless, the age threshold that defines an older
nurse is not clearly established in the literature. Some studies define
older nurses as those over the age of 50 years (Vickerstaff, 2010;
Wargo- Sugleris et al., 2018), whereas others may use thresholds of
55 (Centers for Disease Control and Prevention, 2012) or 60 years
(Denton et al., 2023; Walker et al., 2018). The definition of older
nurses may vary across different cultural or national contexts, and
the reasons for this variation are not always clear.
1.1  | Background
The ageing nursing workforce brings about both challenges and op-
portunities for the healthcare system. One of the key challenges is
the potential for a nursing shortage, as many nurses may choose to
retire or reduce their work hours as they age (Montayre et al., 2023).
Such trends could lead to increased workload and stress for the re-
maining nurses, potentially compromising patient care. However,
the ageing nursing workforce also presents opportunities, as older
nurses bring valuable experience and knowledge that can positively
Implications for the profession and/or patient care: The review findings offer in-
sights for healthcare managers, policymakers and researchers, emphasising the need
for anti- ageism policies in healthcare organisations. According to WHO (2021), edu-
cational activities such as role- playing and simulation during in- service training may
also be effective interventions. Additionally, incorporating anti- ageism initiatives into
staff meetings and mandating anti- ageism training could support the continuation of
practice for older nurses while fostering a more age- diverse nursing workforce.
Impact: We found evidence on the presence of ageism in older nurses' workplace
and the detrimental effects of ageism on older nurses' well- being and continuation
of practice. Importantly, we identified a lack of organisational initiatives to address
ageism and support older nurses. These findings should encourage healthcare or-
ganisations to address ageism in older nurses' practice settings and prompt policy-
makers to develop age- inclusive policies that support older nurses' continuation of
practice.
Reporting method: The Preferred Reporting Items for Systematic Reviews and Meta-
Analyses and Synthesis Without Meta- analysis checklists were used to report the
screening process.
Trial and Protocol Registration: The PROSPERO registration number for the review
was CRD42022320214 (h t t p s : / / w w w . c r d . y o r k . a c . u k / p r o s p e r o / d i s p l a y _ r e c o r d . p h p ?
ID= CRD42 02232 0214).
No Patient or Public Contribution.
KEY WORDS
age- diverse, ageism, nursing, nursing workforce, nursing workforceage discrimination, older
nurses, systematic review, workplaces
What does this paper contribute to the wider
global community?
This review could serve as a foundation for further re-
search on ageism in nurses' practice settings.
Researchers and policymakers could build upon the
findings to develop more targeted interventions and
policies for supporting nurses of all ages.
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CHEN et al.
impact patient outcomes and provide mentorship for younger nurses
(Ryan et al., 2017 ).
Nevertheless, older nurses encounter various obstacles that hin-
der their continuation of practice. For instance, a study by Uthaman
et al. (2016) found that nurses in their 40s experienced physical
limitations such as musculoskeletal disorders and chronic pain that
made moving and handling and shift work challenging. Although
early retirement is common in the nursing profession, many older
nurses choose to work beyond retirement or pensionable age due to
financial instability (Nurmeksela et al., 2022). Therefore, addressing
challenges related to older nurses' continuation of practice is crucial
for retaining their valuable expertise and suppor ting those who can-
not afford to retire due to financial constraints.
Flexible work arrangements, meaningful relationships with col-
leagues and recognition within the organisation have been identi-
fied as factors for older nurses wishing to extend their work lives
(Nurmeksela et al., 2022). However, evidence suggests that ageism
could hinder older workers from accessing the support needed to
remain in the workforce (van Solinge & Henkens, 2014). Ageism was
originally described by Butler (1969) as ‘prejudice by one age group
toward other age groups’ (p. 243). Butler later refined the definition
to encompass ‘a process of systematic stereotyping or discrimination
against people because they are old, just as racism and sexism accom-
plish with skin and gender’ (Butler, 1975, p. 12). While Butler's defi-
nition faced criticism for oversimplification, an alternative definition
proposed by Iversen et al. (2009) has gained prominence in the liter-
ature. This definition characterises ageism as the negative or positive
stereotypes, prejudice and/or discrimination directed at older individu-
als based on their chronologic al age or perception as ‘old’. Further, age-
ism can manifest implicitly or explicitly on micro, meso or macro levels
(Iversen et al., 2009). By acknowledging the cognitive, affective and
behavioural components of ageism, this definition allows for a nuanced
understanding, recognising that ageism can involve positive or nega-
tive aspects and operate consciously or unconsciously at various so-
cietal levels (Iversen et al., 2009; WHO, 2021). Extensive research has
identified that ageism negatively impacts older workers' mental well-
being, job satisfaction and overall performance (Nilsson et al., 2016;
Thorsen et al., 2016; Weber et al., 2019). In this paper, our focus is on
ageism dire cte d at olde r nur ses , and the review will inc lud e stu dies that
refer to research participants as older nurses, regardless of whether
they use an age th re shold to define this group. This st udy is the fir st re-
view to investigate ageism in older nurses' practice settings. The study
aimed to provide synthesised evidence on the impact of ageism and in-
terventions to ameliorate ageism in older nurses' employment context.
2 | THE REVIEW
2.1  | Aims
The overarching aim of this review was to identify and synthesise
evidence related to ageism in older regulated nurses' practice set-
tings and sought to address the following questions:
a. How is ageism portrayed in older nurses' practice settings?
(places where nurses carry out their professional duties).
b. How does ageism impact older nurses' continuation of practice? and
c. How can older nurses be supported to continue to practice?
3 | METHODS/METHODOLOGY
3.1  | Design
This systematic review followed the Joanna Briggs Institute (JBI)
protocol for systematic review. The PROSPERO registration number
for the review was CRD42022320214 (h t t p s : / / w w w . c r d . y o r k . a c . u k /
p r o s p e r o / d i s p l a y _ r e c o r d . p h p ? I D = CRD42 02232 0214).
3.2  | Search methods
An initial search was conducted on CINAHL, using terms related to age-
ism and older nurses. In consultation with the university librarian, rele-
vant results, keywords and subject headings were analysed to formulate
the final search terms. The final searches were conducted on MEDLINE,
Scopus, PsycINFO, CINAHL, Google Scholar and a range of academic
institutional websites such as Proquest to identify relevant doctoral and
master's theses. The database search process ran from January 2022 to
May 2022. The search terms used included (old* or experienced* or ‘late
career’ or ‘late- career’ or seasoned or senior) proximity search (nurse or
nurses or nursing), and (ageism OR agism OR ageist OR ‘age discrimina*’
OR ‘age prejudice*’ OR age identit*’ OR ‘age stereotyp*’ OR ‘age atti-
tude*’ OR age dynamic*’ OR ageist stereotyp*’ OR ‘agist stereotyp*’)
OR (intergenerational OR generational OR workplace) proximity search
(conflict* OR tension* OR diversit* OR relation*) OR (age) proximity
search (discrimina* OR stereoty* OR bias* OR attitude* OR favourit-
ism OR favouritism OR conflict). The searches ran across databases and
their corresponding results can be found in Appendix. All studies identi-
fied were transfer red to Endnote to remove dup licates, which were then
uploaded onto Covidence Systematic Review Software for screening.
3.3  | Inclusion and exclusion criteria
The inclusion criteria for the review were empirical or primary peer-
reviewed studies that have been published in English after the year
2000; including older nurses as the primary study population, fo-
cused on ageism towards older nurses at their workplace, and pro-
vided a description of strategies or interventions that could be used
to combat ageism in older nurses' work. Dissertations and theses
were also included in the review.
We excluded review studies, book chapters, reports, white
papers, internal evaluations, commissioned evaluations, policy
documents, grey literature, and other non- academic or non- peer-
reviewed sources. Moreover, studies that described older nurses'
ageism towards older patients, studies that focused on unregulated
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nursing staff, and studies with an inadequate description of ageism,
age discrimination or age stereotypes were excluded.
3.4  | Search outcome
All relevant citations were uploaded into Covidence for screening.
Duplicates were deleted using Covidence's automatic deduplication
feature. However, during the manual screening process, additional
duplicates were identified and these were also removed. For each
entry, the initial screening of the title and abstract was conducted
by the primary author and one other author. Titles and abstracts
were screened against inclusion and exclusion criteria to determine
their eligibility. Conflicts were discussed and resolved with all au-
thors involved. Full- text screening was completed by two independ-
ent reviewers to ensure consistency in the application of inclusion
and exclusion criteria. The Preferred Reporting Items for Systematic
Reviews and Meta- Analyses checklist (PRISMA) and The Synthesis
without meta- analysis reporting (SWiM) guideline were used to re-
port the screening process, see Figure 1 (Moher et al., 2009) and
Table 1 (Campbell et al., 2020).
3.5  | Quality appraisal
All studies were critically appraised by two authors using the Joanna
Briggs Institute (JBI) Critical Appraisal Tools (Porritt et al., 2014).
The JBI checklists for qualitative studies and cross- sectional surveys
were used. All studies were assessed as moderate to high quality and
were therefore included in the review. The quality appraisal results
of the included studies can be found in File S1.
3.6  | Data abstraction
Data were extracted into an Excel spreadsheet. The data extracted
included population, sample size, aim(s), methodology, study out-
comes, recommendations and detailed information about the por-
trayal of ageism in older nurses' practice settings, the impact of
ageism in older nurses and the interventions for ageism in older
nurses' practice settings.
3.7  | Synthesis
The quantitative data and numeric values pertaining to ageism in older
nurses' practice settings were converted into textual descriptions to
facilitate data synthesis and integration. Data synthesis of qualitative
and quantitative data relevant to the review questions occurred con-
vergently using thematic synthesis to identify meaningful patterns and
themes across the included studies (Hong et al., 2017). The finalisation
of themes was achieved through a consensus process among review-
ers. Subsequently, the findings of the review were reported using the
synthesis without meta- analysis guideline.
FIGURE 1 PRISMA flow diagram for
the process of study identification and
selection.
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CHEN et al.
4 | RESULTS/FINDINGS
A total of 1833 studies were screened; 87 full texts were retrieved
for further evaluation. A total of 19 studies were included in this sys-
tematic review. The review included 10 qualitative studies (Denton
et al., 2021; Fragar & Depczynski, 2011; Gabrielle et al., 2008a, 2008b;
Helaß et al., 2022; Letvak, 2003; Li et al., 2020; Mion et al., 2006;
Price & Reichert, 2017; Sinoski et al., 2020), seven quantitative stud-
ies (Balko, 2013; Bilinska et al., 2016; Cadiz, 2010; Kovner et al., 2007;
Powell, 2010; Walker & Clendon, 2013; Wray et al., 2009) and two
secondary analyses (Clendon & Walker, 2016; White et al., 2021). The
summary of the studies is presented in Table 2.
4.1  | Characteristics of the included studies
The review included 15 journal articles (Bilinska et al., 2016; Clendon
& Walker, 2016; Denton et al., 2021; Fragar & Depczynski, 2011;
Gabrielle et al., 2008a, 2008b; Helaß et al., 2022; Kovner
et al., 2007; Letvak, 2003; Li et al., 2020; Mion et al., 2006; Price
& Reichert, 2017; Walker & Clendon, 2013; White et al., 2021;
Wray et al., 2009), three doctoral theses (Balko, 2013; Cadiz, 2010;
Sinoski et al., 2020) and one master's thesis (Powell, 2010). Three
of the included papers explicitly addressed ageism (Balko, 2013;
Cadiz, 2010; Helaß et al., 2022), whereas others focused on con-
tinuation of practice (Bilinska et al., 2016; Clendon & Walker, 2016;
TAB LE 1  Synthesis without meta- analysis reporting (SWiM) guideline.
SWiM reporting items Item description
Pages in the manuscript where the
item is reported
Methods
1. Grouping studies for synthesis (1a) Provide a description of, and rationale for, the groups
used in the synthesis (e.g. groupings of populations,
interventions, outcomes, study design). (1b) Detail and
provide rationale for any changes made subsequent to the
protocol in the groups used in the synthesis
Pages 3–4 ‘Defining an older nurse’
2. Describe the standardised metric
and transformation methods
used
Describe the standardised metric for each outcome. Explain
why the metric(s) was chosen and describe any methods
used to transform the intervention effects, as reported
in the study, to the standardised metric, citing any
methodological guidance consulted
Pages 5–6 ‘Synthesis’
3. Describe the synthesis methods Describe and justify the methods used to synthesise the effects
for each outcome when it was not possible to undertake a
meta- analysis of effect estimates
Pages 5–6 ‘Synthesis’
4. Criteria used to prioritise results
for summary and synthesis
Where applicable, provide the criteria used, with supporting
justification, to select the particular studies, or a particular
study, for the main synthesis or to draw conclusions from
the synthesis (e.g. based on study design, risk of bias
assessments, directness in relation to the review question)
Page 5 ‘Quality appraisal’
5. Investigation of heterogeneity in
reported effects
State the method(s) used to examine heterogeneity in reported
effects when it was not possible to undertake a meta-
analysis of effect estimates and its extensions to investigate
heterogeneity
Table 3 Quality appraisal results using
JBI checklists
6. Certainty of evidence Describe the methods used to assess the cer tainty of the
synthesis findings
Table 3 Quality appraisal results using
JBI checklists
7. Data presentation methods Describe the graphical and tabular methods used to present the
effects (e.g. tables, forest plots, harvest plots). Specify key
study characteristics (e.g. study design, risk of bias) used
to order the studies, in the text and any tables or graphs,
clearly referencing the studies included
Table 4 Data extraction summary
Results
8 Reporting results For each comparison and outcome, provide a description of
the synthesised findings and the certainty of the findings.
Describe the result in language that is consistent with the
question the synthesis addresses and indicate which studies
contribute to the synthesis
Pages 6–8 ‘Findings of the review’
Discussion
9. Limitations of the synthesis Report the limitations of the synthesis methods used and/or
the groupings used in the synthesis and how these affect
the conclusions that can be drawn in relation to the original
review question
Page 10 ‘Strengths and limitations’
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TAB LE 2  Data extraction summary.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Balko (20 13)/USA/44 out
of 76 RNs worked i n
hospit als (58%), 13 in
nursin g homes (17%),
one doc tor's office (1%),
four in ho me care (5%),
one in sch ool setting
(1%), and 13 in oth er
setti ngs (17%)/RNs who
are enro lled in the onlin e
RN to BS pro gramme,
43% were n urse
manage rs, and 57% were
not. Inclusion criter ia:
have an RN li cense,
betwe en the ages of 18–
65, enrol led in the online
RN to BS in nu rsing
progra m (part- time or
full- time), cur rently
employed/n= 76/Mean
age 43
To examine wo rkplace
incivi lity and ageism
exper ienced by RNs
who were enrolled
in an onli ne RN to BS
nursin g programme
and compare
the resu lts by
generational cohorts
Quantitative
correl ational surve y
design , the study
used the Workplace
Incivi lity Scale,
the Age ism Survey
and the Turn over
Intention Scale
and demographic
quest ionnaire to
collect data
RNs who are compl eting
their RN t o BS training
experience incivility,
ageism an d turnover
in their w orkplaces,
regard less of their gen der,
age or gene rational
cohort
Nursin g curricula ne ed to
incorporate content related
to inciv ility, ageism and t he
multigenerational workforce
so nurs e educators cou ld
bette r prepare the st udents.
Organ isations and ma nagers
also have t he responsibi lity
to teach t heir employees
about in civility, and ag eism
in the wor kplace and prov ide
generational education and
defuse t he issues when it
arises
Perceiv ed level of ageism is
related to part icipants'
intent to q uit
Bilinska et al. (2 016)/
Germany/Participants
were sel ected across 45
small an d medium- sized
nursin g homes and
mobile n ursing home
service companies/
Nurse s, 70% trained ,
30% unt rained, no
apprentices/n= 397/
Participan ts were
divide d into two groups
younger t han 40 years
old and o lder. Thei r
average a ge was 40.86
To introduc e the concept
of organ isational age
climate (OAC) and
investigate wh ether
strong OAC enhan ces
geriatric nur ses'
retention
Quanti tative, part of a
larger longitudinal
study w ithin the
geriatric nur sing
secto r in Germany.
Quest ionnaires were
used to me asure
PAC, orga nisational
identification,
age ster eotypes,
turnover intentions
and job satisfactio n
Younger emp loyees held mor e
negati ve age stereoty pes
in compa nies with lower
Organ isational Age
Climate (OAC), whereas
nurse s in companies
with mor e positive OAC
repor ted the lowest
rating s of negative age
stereotype s. The findings
sugges t that OAC and
individual- level age
stereotype s are related
and that s trong OAC
may redu ce younger
employees' negative
belief s about older
colleagues
Employe rs in geriatric n ursing
should v alue their old er
nurse s. Future research
to test if t he results app ly
to other p rofessions. A
longit udinal design would
allow th e drawing of caus al
inferences on OAC and
variab les of interest
In compa nies with lower
OAC, old er nurses were
found to h ave increased
turnover intent ions and
lower job s atisfacti ons
A strong organisatio nal
age clima te may
reduce n egative
belief s held by
young nurses
agains t older nurses
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CHEN et al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Cadiz (2010)/USA/Most
participants worke d in
hospit al or acute care
setting/RNs/n= 773/
Average age 45.86 ,
SD = 11.3. Sa mples
were div ided into three
groups , under 40, 40
and old er and com bined
sampl e. The age range
was 22–70. 11% of the
participants are un der
30, 20% a re between
30 and 39, 24% are
betwe en 40 and 49, 37%
are bet ween 50 and 59,
and 9% are 6 0 and older
To examine ho w nurse
retention is aff ected
by workp lace climate,
using a new ageism
climate measurement
tool
Quanti tative. A new
ageism cl imate
measur e was
develo ped and
validated in thi s
study. Pa rticipant s'
job withdrawal
intentions,
organisational
commit ment and
work engagement
were also measur ed
using qu antitative
tools. A dditionally,
the stu dy
investigated w hether
Core Self- Ev aluation
(CSE) w as related to
ageism climate
The stu dy showed evide nce
of younge r worker ageism
climate a nd older worker
ageism cl imate and
identi fied the varia bles
that affect ageism climate
work dif ferently in th e
three age groups. In the
under 4 0 sample, CSE
buffe red the negati ve
effec ts of negative
younger and older
workers ageism cl imates
and enha nced the positive
effec ts of positive
genera l age climate on
turnover intentions
and organisational
commit ment. In 40 and
older s ample and the
combin ed sample, a les s
ageist yo unger and older
workers climate s were
found to b e associated
with decrease d turnover
intenti ons and increas ed
affective commitment
It is impo rtant for HR to as sess
whether the or ganisation
has a positive or ne gative
ageism cl imate. Furthe r,
age diver sity traini ng is
impor tant for build ing a
positi ve ageism climate , and
can be in corporated as p art
of the ori entation proc ess.
Future studies should e xamine
the variable of ageism
climate i n different nursing
setti ngs, since the ag e
cohor t of the patients
may inter fere with nurses'
percep tions of ageing.
Regard ing the ageism
climate m easuring tool , it
can be st rengthene d by
adding m ore items speci fic
to the you nger wor ker
climate . Further, additional
items ca n be added in the
future r egarding older
workers and the ge neral
age clima te. A parallel
positi vely worded sca le
could be c reated to measur e
positi ve age climate whic h
will als o enhance the val idity
of the exi sting age climat e
measur ement tool. Futu re
research shou ld develop
an understa nding of age-
suppor tive climate an d
under stand whether it is a
diffe rent construc t from age
climate o r the opposite po les
of the sam e construct
Older n urses being viewed
as less va luable, poor
invest ments, not bei ng
given mu ch access to
career development
resour ces, and older
nurse s not being given
much sup port.
Ageism c limates affec t
turnover intentions,
affec tive organis ational
commit ment and work
engagement
TAB LE 2  (Continued)
(Continues)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
8 
|
    CHEN e t al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Clendon and Walke r (2016)/
New Zealand/A range
of settings/Stu dy 1:
RN (85%), EN (8%), NP
(0.6%)
Study 2: R N (96%), EN(2 %),
NP(2%)/St udy 1:
n= 3273
Study 2: n= 4 6/Study 1:
50–60 (67%) , 61–70
(28%), 71+ (1.7% )
Study 2: 5 0–60 (61%), 61–70
(39%), 71+ (0)
To identif y the factors
that contribute
to some nu rses
successfully
practicing into older
age as well a s the
challe nges faced by
others
Secondary analysis
of data fr om
two existing
studies. Stud y 1 is
quantitative, online
survey with fre e text
answer s, Study 2
is qualitative f ocus
group, h owever,
only qua litative data
were ana lysed in this
paper
Older n urses are less
physic ally strong which
negatively impacts their
practice.
Mainta ining their own h ealth
and fit ness enables
continuation of p ractice
however self- care
strategies we re only used
by a small gr oup of older
nurse s. The study als o
identi fied guilt among
older nu rses, it stems
from not b eing able to
perfo rm as much, and
having to l eave some
of the tas ks to their
younger c olleagues which
all cont ribute t o moral
distre ss. The positi ve
generational stereotypes
also pre ssure older nur ses
and cont ribute to moral
distress
Managers and organisations
are key to sup porting
older nu rses' pract ice.
Organ isations may wan t to
self- assess the ir approach
to older workers i n order
to addre ss the implicit
ageism. To better facilit ate
older nu rses' pract ice, the
organisatio n should provid e
flexib ility and car ved- ou t
roles to t hem
Manage rs suggest
older nu rses
had a ‘shor t
shelf li fe’. The
workpl ace did
not unde rstand
the dif ferent
learning needs
of older n urses.
The work place
prioritised
younger n urses'
needs ove r older
nurses'
Participan ts worked
hard to ma intain
their ow n health
and fit ness.
‘Doing m y part in
keeping f it, eating
healt hy and doi ng
furt her study to
keep my br ain
and comp etency
up to date’. Work
in a famil iar area
with a sen se of
belonging, bu ild a
rapport and learn
to trus t colleagues.
Flexib le working
hours , changing
job role s, adjusting
environment and
reduci ng hours are
potential solu tions
to challenges ol der
nurse s face
Denton e t al. (2021)/
Austr alia/’A wide range
of clinic al settings a cross
many dif ferent health
workpl aces located in
metropolitan, regional
and remote areas o f
all Aust ralian state s’.
Four nur ses from aged
car e/re hab/p all iati ve/
Nurse s and midwives,
74% RN/n= 50/Age
range 45–74, 44% in th e
60–64 r ange
To explore the firs thand
experiences of older
nurse s or midwives
workin g in healthcar e
settings
Qualit ative descript ive
methodology/
semi- structured
interviews
The stu dy identifie d three
theme s, (1) ageing
bodies, (2) yout h focus
and (3) wis e- worker s.
For the va st majority,
their ex periences at t he
healthcare wo rkplaces
were neg atively affec ted
by their a geing bodies,
the work places had a
youth- focuse d culture,
leaving the old er nurses
and midw ives feeling
ignored, criticised, limited,
disadvantaged, isolated,
exclud ed and tr eated
diffe rently becau se of
their ag e. For a small
group of t he participa nts,
being an o lder healthc are
worker me ant more value
and resp ect from the
collea gues and manage rs
The stu dy highlighted t he need
to provid e more suppor t to
older nu rses in relati on to
age- related ch allenges and
change s. Employers should
conside r the wise- worker
model w hich values and
recognises old er nurses.
Further rese arch is needed
on stra tegies to enable older
workers in healt h care to
contin ue to cont ribute t o the
workplace
Emotional dist ress, older
nurse s felt the y were
invisib le to younger
management with the
youth foc us culture at
their workplaces. Older
nurse s were over looked,
and exclu ded from
responsibilities and
(educational, promotional)
opportunities.
Management treated
older an d younge r nurs es
differently. Experiences
as an older nu rse are
being ign ored, critici sed,
limited, disadvantaged,
isolated, excluded,
and treated diff erently
limited access to tr aining
and promotional
opportunities. Implication
older nu rses should ste p
aside for yo unger workers
and olde r nurses were
seen as pas sed their
use- by date
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   
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 9
CHEN et al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Fragar a nd
Depcz ynski (2011)/
Austr alia/A range of
settings including
aged care/’Re gistered
nurse s and enrolled
nurse s from communit y
health, aged care,
genera l hospital war ds,
operating theatres,
sterilising departments,
midwifery, emergency
depar tments and he alth
serv ice management .
A small nu mber were
from oth er professiona l
groupi ngs (less than
10%), enco mpassing
‘other professio nal,
para- profes sional and
clinic al support st aff’
(Abor iginal health),
‘corpor ate services
(cleric al administr ation)
and ‘hote l services’
(catering)’./n= 80/
Aged 50 a nd over.
demagr aphic data on ag e
was not col lected
To pinpoint t he work-
related challe nges
that old er rural healt h
workers face and
under stand how age-
related change s and
other factor s worsen
these difficulties
Qualitative/Focus group Due to old er age, certain task s
become m ore difficult in
hospital settings.
Older n urses consta ntly need
to adjus t to changes and
new tech , whereas their
exper iences were not
valued a nd consulted
during t hese process es
Older h ealth workers s hould be
involve d in the dev elopment
of a resou rce booklet on
ageing and other f actors
that imp act upon work wi th
practical sugges tions for
addressing th ese at persona l
and loc al level—The Health
Serv ice should est ablish a
health serv ice ‘Task Force’,
compri sing managers , older
rural h ealth workers a nd an
occupational t herapist, to
examin e the study fin dings
and implement area- wide
polic y and practice s olutions
as well as re commendatio ns
for sta te- wide po licy
development
Training op portuniti es are
being gi ven to younger
colleagues
(Continues)
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
10 
|
    CHEN e t al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Gabrielle et al . (2008b)/
Australia/Acute hospital
and community/Female
RNs/n= 12/aged
40–60 years
To gain a deep er
under standing of th e
health, ageing- related
issues a s well as
self- care str ategies
employed by older
female R Ns who
practice in direct
caregiving ro les in
acute pu blic hospitals
and community
facilities.
Qualitative/Semi-
structured,
convers ational sty le
inter views using a
feminist perspective
Participan ts were
experiencing many
health issues a ssociated
with age ing, which
negati vely affecte d their
QoL and deci sion to
continue nursing. The
impac t of back problem s
was ext ravagated by
heavy worklo ads and
unsupp ortive work
environment . Although
participants were aw are
of the nee d for self- c are,
they often prio ritised
the nee ds of patients
over thei r own and
cared for other s at the
expens e of self- neg lect.
For some p articipant s,
self- care str ategies
such as exe rcising and
eating h ealthy were used
to maint ain a balance
betwe en working and
ageing
Tailored exe rcise program mes
during w orking hours could
help mai ntain endura nce
and fit ness levels. Th e
issues r aised by parti cipants
point to a need for furth er
research inves tigating the
health concer ns of the
ageing nursing w orkforce.
Such res earch could lead
to the imp lementation of
protec tive work prac tices
that imp rove service
delive ry and help add ress
the retention problem
Feeling exploited, un cared
for, by managers (after
injuri es, managers never
asked, di sheartened),
ageist b eliefs from
manage ment (want to
retain y ounger staff,
older nu rses' injurie s,
sickne ss nobody cares,
their lo yalty to the
organisatio n, the time
they ser ved, was not
valued)
Gabrielle et al . (2008a)/
Australia/Acute hospital
and community/Female
RNs/n= 12/aged
40–60 years
To investig ate the
perspectives and
exper iences of
female R Ns aged
40–60 years, working
in acute h ospital
and community
healthcare s ettings
Qualitative/Narrative-
based study
inform ed by feminist
principles, in- depth
semi- structured
interviews
Self- neglect a nd self- ca re,
ignori ng the pain and
fatigu e, older nurse s
just wor k around it, are
also una ble to commit to
regula r exercise due to
family responsibilities.
other pe ople perfor m
self- care, exercise, e at
healt hily and g et their
nails do ne, self- care
makes th em appreciate
ageing more
Future re search needs to explore
the nee d for protectiv e
work practices and pr omote
healthy lifestyle s for ageing
nurse s. Management n eeds
to recogn ise the changin g
needs of t heir older nur ses
and offer flexibilit y in
their wo rk arrangeme nts
and tai lored exercise
progra mmes to promote
their health
Future re search to focus o n
the supp ort needs of ol der
RNs, an d a national stud y
investigatin g the clinical
exper iences and heal th
needs of t he ageing nursi ng
workf orce is needed
Feeling unappreciate d
at their workpl aces,
admini strators allocate
heavie r workload to old er
nurse s because they w ish
to retai n younger nurse s.
Employe rs did not care
about t heir wor k- r elated
injur y, it was up to t he
part icipan t to keep
turnin g up to work
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   
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11
CHEN et al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Helaß et a l. (2022)/
Germa ny/A German
university hospital/
Nurse s with and
without management
positions/n= 50/average
age 47.39 (SD = 10.89;
range 22–63 years;
Md = 51)
To identif y and compare
the age st ereotypes
of RNs in inpatien t
settings
Qualit ative/19 Face- to-
face interviews and 5
focus gr oups
Reflec ting on the agein g
proces s and cooperation
in mixed- ag e teams,
nursin g staff and
super visors defin ed
similar age ster eotypes
towards o lder and
younger n urses
reminiscent of co mmon
genera tional labels
‘Baby Bo omers’ and
Gener ations X. Thei r
evaluation created
an incon sistent and
contradictor y pattern
diffe ring to the respe ctive
work cont ext and goals.
Age ste reotypes wer e
described as both
potentially be neficial
and detriment al for
the indi vidual and the
cooper ation in the
team. If a s uccessfully
implemented diversity
manage ment focuses on
age ster eotypes, ne gative
assumptions c an be
reduced and cooperation
in mixed- ag e teams can be
considered beneficial
Divers ity manageme nt should
be impl emente d to reduce
stereotype s among
intergenerational healthcare
teams
Older n urses have
intuit ion, core
competencies
in patie nt
observations,
de- escalat ion and
a good over view
of the wor k
area. T hey were
also consulted
by super visors
for advi ce on
management
decisions. Older
nurse s were less
vulner able to
stress- related
phenomena due
to profes sional
and per sonal
exper iences and
wisdom. Older
nurse s are seen
as less ad aptive
and less willing to
change
Older workers should
be integrated into
change a nd all
activ ities at work
(Continues)
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
12 
|
    CHEN e t al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Kovner et a l. (2007)/USA/
RNs work ing nursing,
outsi de nursing and
not work ing in US/
RNs/n= 1906/older RN s
are thos e aged 50 years
and older younge r RNs
are thos e under the age
of 50
To assess the attri butes
and profession al
attit udes of RNs
aged 50 an d above in
compar ison to those
below 50 d uring
two dis tinct time
periods. Addi tionally,
to make compariso ns
within t he older age
group, disting uish the
characteristics a nd
attit udes between
those actively
workin g in nursing,
those employed in
non- nursing roles, and
those not curre ntly
employed
Qunantitative/Survey Older R Ns were less likel y
to have an inj ury, more
older than youn ger RNs
had reti red or report ed
that the y could not work,
older RNs repor ted that
the primary reason fo r
not work ing as an RN
was reti rement, follo wed
by poor he alth or ‘other
reason s’. On the ot her
hand, yo unger RNs were
more like ly to indicate
that the y could afford no t
to work or we re caring for
a family membe r as their
reason s for not working .
Older R Ns reported
more dis tributive jus tice
(fairn ess of rewards),
workg roup cohesion
and supe rvisory su pport
and less organisatio nal
constr aint, and
quantitative workload
than you nger RNs.
Overall older R Ns were
more sat isfied, had
greater organisatio nal
commit ment and had
less desire to qui t than
younger R Ns. There
were no sig nificant
differences between
older and younge r RNs
for autonomy, mento r
suppor t or variety
Workpla ces should deve lop
polici es targeting older
nurse s. carve out roles
and prov ide flexibility
and ergonomic work
environment s that take
older nu rses' ageing bo dies
and nee ds into consider ation
Older n urses perceiv ed
they had f ewer chances
of findi ng other jobs
compar ed with younger
nurse s, and they had
fewer promotio nal
opportunities
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   
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13
CHEN et al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Letva k (2003)/USA/
participants were
recruited fro m three
US hospi tals/Staff
nurse/n= 11/age rage
55–62, mean age 58.3
To describ e the
exper ience of being
an older staf f nurse
Qualitative/In- depth
interviews, analysed
using feminist
perspective
Older n urses are working
becau se they continu e to
care, d espite the stre ssors
of intergenerational
conflic t with younger
nurse s, less respec t from
patients and f amilies and
inequi ty in pay. Older
nurse s are confident in
their ab ilities and are
capab le of meeting the
demands of hospi tal
nursing
Older n urses are from a
genera tion with a can- d o
attit ude and usually n ot
stand u p for themselve s.
Resear ch should repre sent
and advo cate for older
nurse s more, they are
the present and f uture of
nursing
Older n urses took
pride in t heir own
skills , younger
nurse s looked up
to older n urses.
Older n urses
were pre ssured
by their f amilies,
peer an d
organisations
to move into
non- clinical
positi ons. Some
of the younger
nurse s did not
think older
nurse s had the
abilit y to carry
out basi c nursing
tasks . Managers
frequently as ked
older nu rses
when th ey would
retire . Feeling
dispirited that
their salarie s
were not m uch
diffe rent from
new graduates
(Continues)
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
14 
|
    CHEN e t al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Li et al. (2020)/China/
Two Chinese h ospital/
Nurses/n= 2 7/5 6
60 year s old
To explore older nur ses'
percep tions of
contin uing to wor k in
a nursin g career after
retirement
Qualitative/Semi-
structured
interviews
Based on the definitio n of the
three e ssential condi tions
of the framewor k for
under standing beh aviour,
14 subthem es that
emerge d from the data
were categoris ed under
this framewor k. The
three main them es were
as follow s: the nurses'
percep tions of their
capab ility, motivati on,
and opp ortunity re lated
to engag ing in a nursing
caree r after retirem ent.
A number of older
nurse s with rich clinical
exper ience have the
abilit y and motivati on
to engage in nursi ng a
caree r after retirem ent.
However, discrimination
agains t nurses, bur nout,
and the ef fects on you ng
peopl e's employment are
barriers to old er nurses
conside ring working in
a nursin g career after
retirement. Regarding
re- employment after
retirement, older
nurse s also expresse d
concer ns about their
physic al health, fam ily
responsibilities, and
salar y as well as lack of
manage rial and polic y
support
Recomm end the use of
innovat ive programs to
retain o lder RNs and make
use of the ir knowledge.
Have car ved- ou t roles for
them.
Future re search should inter view
post- retirement age nurses
as well as those wor king and
those not worki ng to explore
their percept ions of ongoing
work and t heir reasons
for and fe elings about n ot
continuing.
A quanti tative study w ith a larger
sampl e size is needed to
determine whether there
are dif ferences in fin dings
based on d ifferent hos pital
levels an d demographi c
characteristics o f the
participants
Some older nur ses
felt goo d about
their ph ysical and
mental capacities,
some thought
they dec lined as
they age d with
less phy sical
power an d less
able to t ake in
new knowledge.
The hea lthca re
system lacks
polici es to
suppor t
older nu rses'
continuation of
practice after
retirement.
Administrators
did not va lue
older nu rses, and
would ra ther hire
younger n urses
to reduce cost.
Older n urses
were forced
out of clin ical
setti ngs to do
cleani ng jobs.
Hospit als did not
have positions
that would suit
older nurses
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   
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15
CHEN et al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Mion et al . (2006)/USA/A t
MetroH ealth Medical
Center (MHMC), a
730- bed ter tiary care ,
teachi ng county hospi tal
in nort heast Ohio,
focus gr oup consisted
of membe rs from acute
care, rehab, lo ng- term
care, a nd outpatient o r
satellite clini cs/RNs and
nurse managers/n= 33/
three fo cus groups
consist of nurse s aged
46–73 years, one
consisted of nur ses aged
22–2 9
To describ e one medical
centre's multif aceted
approach and
subsequent
strategies to create
a work env ironme nt
conducive to retaining
mature , experienced
nurses
Qualit ative exploratory
study/Fo cus groups
with sem i- stru ctured
open- ended
questions
Organ isational str ategies to
retain o lder nurses and
to accomm odate their
ageing needs include
carv ing out roles for t hem
and adju sting the work
environments. Discussed
some examples of what
the car ved- ou t roles
might be
The rete ntion strateg ies are
showing some suc cess,
some nur ses approaching
retire ment are inquir ing
about c arved- out roles an d
educa tion opportunitie s to
enable t hem to return to
practice or continue practice
within t heir capabilities.
Impor tant to rememb er
that retaining older
nurse s and addressin g the
challe nges for them req uire
multif aceted approa ch, not
one sing le strategy
Older n urses know
the rul es and
follow the rule s,
they are m ore
adaptable to
organisational
change a nd
have a bank of
life and c linical
exper iences for
dealing with
new situ ations.
Older n urses are
less phy sically
strong and fas t as
when th ey were
younger, so me
younger n urses
percei ved this
as older n urses
‘not pull ing their
weight’
Expan ded or carved out
roles to s uit older
nurse s' needs, such
as admis sion nurses
and disc harge
nurses
Powell (2 010)/New Zealan d/
Two distric t health
boards/Clinical/Charge
Nurse Managers/n= 76/
approx imately 46%
aged 40 –49, 43% aged
50 years a nd over
To explore t he
under standing of
the issu es facing the
older nu rse in a New
Zealan d context
Descr iptive survey/
Questionnaire
Clinic al Nurse Managers
(CNMs) are very awa re of
the chal lenges that old er
nurse s face and they are
using their own innovative
strategies to retain older
nurse s in the workplac e.
The fin dings are similar to
international literature
Organ isation needs t o support
CNMs to do t heir jobs
properly so th ey can suppor t
older nu rses. Recruiting th e
right pe rson for the job of
CNM and get them to at tend
train ing and ed ucation to
continuously g row with the
role. Or ganisations should
invest in genera tional
divers ity education and age
discrimination education.
Attent ion to the alloc ation
of heavy patien ts and
ensuri ng that there is th e
appropriate equipment
for manu al handling. Th e
organisatio n AND CNM
must fi nd ways to make
older nu rses feel valu ed
Inequi table access to t raining
as train ing opportu nities
are allo cated to younger
nurse s by managers.
In order to implement
strategies tha t could
retain o lder nurses ,
nurse manager s
need sup port from
organisatio ns, in
terms of innovative
roster ing, reducing
the number of
night shi fts and
ensuri ng equitable
access to t raining.
CNMs wor k very
hard to re tain ol der
nurse s, making sure
they fee l valued,
being li stened to
and supp orted
despit e limited
suppor t from the
organisational
levels. CNMs are
workin g on their
own to supp ort
older nurses
(Continues)
TAB LE 2  (Continued)
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16 
|
    CHEN e t al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Price an d Reichert (20 17)/
Canad a/Various set tings
across e ight provinces
in Cana da/Students,
early- career, mid- to
late- caree r nurses
(self- selected), 100/185
were mid- to late ca reer
nurses/n= 185/Mid- to
late- caree r nurses
ranged i n age from 25
to 70+ wit h more than
half of partici pants (62%)
being ab ove 50 years
of age.
To explore t he
exper iences of nurse s
across a ll career
stage s as they relate
to their p rofessional
development and
work environment
Qualitative descriptive/
focus gr oup
Despit e the importance
the late- career nur ses
attri buted to ongoing
educa tion and traini ng,
this was n ot considered a
prior ity by ma nageme nt.
There was litt le support
for maintainin g the
training requirements
necess ary to under take
their wo rk. There was a
percep tion of a lack of
respect for late- career
nurses
Discus sed about olde r nurses'
retention prog rammes in
Canada.
Employe r's recognition of
older nu rses' continu ous
professional d evelopment
needs is a v ital part of a
healt hy work env ironment
that wil l support their
practice
Inequi table treatm ent,
not receiving as m any
training opportunities
compar ed with the
beginn ing of the career.
their co ntributions d o
not get tr ansferred
into pro motion . Their
exper iences are bein g
used in trainin g new
nurse s, but do not
contri bute towards the ir
own career advancement
Sinosk i et al. (2020)/USA/
Hospital settings/RNs
with at le ast 20 years of
experience/n= 16/45– 49
12.5% 50 54 31.25%
55–59 25% 60–64
31.25%
To explore t he lived
exper iences of
experienced nurses
workin g in hospitals in
Virginia to dete rmine
factors influencing
the nurse's deci sion to
retire ment before the
retirement eligibility
age
Descriptive,
phenomenological
qualit ative study/
semi- structured
interviews
Experienced nurses identified
a passion for nursing,
self- effica cy, rewards,
recognition, generational
divers ity, physical de cline,
techno logy fatigue
and inte ntion to leave
as fact ors influenci ng
their de cisions to retir e
early. Th ese themes are
suppor ted by current
litera ture. Further, the
study i dentified moral
distress contributes
to early r etirement
intenti ons among
experienced nurses, this is
a new theme unexplored
in other l iterature
Further inves tigating into
workpl ace factors creatin g
or incre asing moral dis tress
in relat ion to loss of
autono my for experien ced
nurse s and leading to
patient safet y concerns.
A study w ith a wider base
of eligib le participants
from mul tiple states would
contri bute to additio nal data
for anal ysis. To increase
the dat a collection p eriod
from 4 wee ks to 6 months
to allow mo re participants
to share t heir experiences.
Sharin g results with n ursing
manage ment and HR
should r aise awarenes s of
the fac tors contributing
to early r etirement amo ng
exper ienced nurses a nd help
develop retention str ategies
for this cohort of nurse s
Not valu ed by
leadership,
treate d no
diffe rently from
new nurs es.
Feeling exclud ed
at the wor kplace
becau se co-
workers are all
younger. Feeling
isolate d by others
becau se of older
age. Not being
able to get a
part- tim e job
despit e extensive
experience,
employers prefer
to hire nov ice
nurse s with lower
pay rates
TAB LE 2  (Continued)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
   
|
17
CHEN et al.
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Walker & Cle ndon (2013)/
New Zealand/Acros s
a range of settin gs in
NZ, main ly in DHBs and
primary health/RNs,
ENs, mid wives an NPs.
(RNs n= 2781 (8 4.97%),
ENs n= 263 (8. 04%)
midwives n= 28, NPs
n= 19/n= 3273/50 years
and older)
To report t he retirement
intenti ons of
regulated nurses aged
over 50 in th e New
Zealand workforce
Quantitative/online
survey with fre e text
response
New Zealand nur sing age
demogr aphics have be en
confir med and reflec ted
in the respondents to t he
survey. In concord ance
with th e intern ational
litera ture, good heal th,
access to f lexible work ing
option s, safe staff ing
levels an d choice of shift s
were all ve ry import ant
to older n urses. Eviden ce
of ageism a nd a bullying
cultur e towards older
nurse s was reported .
Bette r pay levels were
particularly important
to younge r late- ca reer
nurse s (age 50–55).
Specific to New Zealand ,
lack of ret irement fund s
may delay r etirement, and
migrat ion to Australia may
exacer bate shorta ges and
skill/experience deficits
Bette r choice of shift s,
continued acce ss to flexible
hours a nd roles that are
approp riate to older nu rses'
capab ilities and sti ll utilise
their knowled ge, skills and
exper iences will supp ort
their co ntinued prac tice,
despit e on a part- tim e basis.
Further rese arch is urgently
neede d to explore the is sues
identi fied from this su rvey in
more depth
Subtle p ut downs
ageist co mments
about t heir
abilit ies from
colleagues
and mana gers,
nil access to
promotions/
caree r
development
are disc ussed.
Retirement
decisions are
influe nced by
experiences
of ageism .
workplace
bullying
identi fied by
older nurses
White et a l. (2021)/Australia/
Victo rian public hea lth
setti ng/RNs, ENs and
midwives divided
into four g enerational
cohor ts baby
boomers, generation
X, Gen eration
Y, Generat ion
Z/n= 18,963/3781
Baby Boo mers (BB),
9022 fro m Generation
X (Gen X), 4971 from
Gener ation Y (Gen
Y), and 1189 f rom
Gener ation Z (Gen Z)
To explore t he
exper iences of change
manage ment, career
intenti ons, learnin g
and development
and well- b eing across
different generations
of Victorian pu blic
health nurse s
Second ary analysis of the
2018 People Matter
Survey
In total , 3781 Baby
Boome rs, 9022 from
Gener ation X, 4971
from Ge neration Y and
1189 from Generation
Z responded to th e
survey. The expe rience
of workp lace change had
the mos t adverse impact
and incr eased with age
(Gen Z; 34.3%; Ge n Y:
49.3%; Gen X: 53 .6%
and BB; 56 .3%) and most
participants felt t hey had
limited control over issu es
that caused st ress
Supporting nurse s through
organisatio nal change is
essent ial. Further, promotin g
professional d evelopment
and car eer progress,
particular ly in older nurs es,
may prom ote retention in
an era of gl obal nursing
shortages
Older n urses
encounter limited
opportunities
for career
growt h and
percei ve a lack
of suppo rt from
management
for enga ging
in professiona l
development
initiatives.
Therefore,
they often face
uncer tainty ab out
their pr ospects
for career
advancement if
they con tinue
workin g within
their cu rrent
organisation
(Continues)
TAB LE 2  (Continued)
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18 
|
    CHEN e t al.
Gabrielle et al., 2008b; Li et al., 2020; Mion et al., 2006), experiences
of being an older nurse (Denton et al., 2021; Gabrielle et al., 2008a;
Letvak, 2003; Price & Reichert, 2017; Sinoski et al., 2020; White
et al., 2021; Wray et al., 2009), age- related challenges (Fragar &
Depczynski, 2011; Gabrielle et al., 20 08b; Powell, 2010) and retire-
ment of older nurses (Sinoski et al., 2020; Walker & Clendon, 2013).
Kovner et al. (2007) examined the characteristics and work attitudes
of older nurses and compared these with younger nurses and nurses
who exited the nursing workforce.
The studies were conducted in hospitals (Balko, 2013; Cadiz, 2010;
Gabrielle et al., 2008a, 2008b; Helaß et al., 2022; Letvak, 2003; Li
et al., 2020; Mion et al., 2006; Powell, 2010; Sinoski et al., 2020; White
et al., 2021), nursing homes (Bilinska et al., 2016) and other healthcare
settings and involved nurses with (Helaß et al., 2022; Mion et al., 2006;
Powell, 2010) and without managerial positions, including RNs, en-
rolled nurses and nurse practitioners (Clendon & Walker, 2016; Denton
et al., 2021; White et al., 2021). The age range of older nurses varied
acr o ss th e s tu d ie s , wi t h so m e in c lu d ing nu r se s age d 40 an d ol d er (Bi l in s ka
et al., 2016; Cadiz, 2010; Gabrielle et al., 2008a, 20 08b; Powell, 2010),
whereas others recruited nurses aged 50 and above (Clendon &
Wal ke r, 2016; Fragar & Depczyaski, 20 11; Kovner et al., 2007; Sinoski
et al., 2020; Walker & Clendon, 2013; Wray et al., 2009). Some studies
recruited nurses based on their work experience (Sinoski et al., 2020) or
generational cohort (White et al., 2021).
4.2  | Findings of the review
Based on our review of the literature, three themes in relation to
ageism in older regulated nurses' practice settings were identified: (i)
manifestation of ageism in older nurses' practice settings; (ii) impacts
of ageism on older nurses; (iii) support for older nurses' continuation
of practice.
4.2.1  |  Theme 1. Manifestation of ageism in older
nurses' practice settings
A recurring theme among the included studies was the presence
of ageist beliefs held by younger nurses about the abilities of their
older colleagues. While certain studies highlighted younger nurses'
admiration for the exceptional performance of older nurses during
emergencies (Letvak, 2003; Hel et al., 2022), others revealed a
perception that older nurses operated at a slower pace and con-
tributed less to the team (Denton et al., 2021; Mion et al., 2006).
Although two studies shed light on the older nurses' confidence in
their capacities to build rapport with patients, taking pride in their
clinical skills over less- seasoned colleagues (Helaß et al., 2022;
Letvak, 2003), a less optimistic reality was also unveiled where their
capabilities were doubted in practice settings (Sinoski et al., 2020).
Across various studies, older nurse participants reported that their
younger colleagues presumed their lack of essential skills were
due to hospital- based training and that they should be reassigned
Author(s)/year/country/
setting/population/sample
size/age mea n (SD) unless
otherwise state d Aims Methodology/methods Study outcomes Recommendations
How is agei sm
portrayed in older
nurses' work
environments?
How does a geism impact
older nurses' continuation of
prac tic e?
How can older nurses
be supp orted to
continue to practice?
Wray et al. ( 2009)/UK/
Nation al health ser vice
trust s (NHS Trusts) and
primar y care trust s in
UK/Qualified nurses and
midwives/n= 510/62.1%
of the par ticipants
were aged 5 0 or over,
some partici pants were
aged und er 50 years
to compa re with ol der
nurses/midwives
To report o n the
employment
exper iences of nurse s
and midw ives with a
particular f ocus on
issues r elating to age,
ethnic ity, ill- he alth
and disa bility
Quantitative/Postal
survey
Nurse s over the age of 50 had
signif icant less acce ss to
professional d evelopment
oppor tunities tha n their
younger colleagues
Altho ugh continuati on of
professional d evelopment
is a key str ategy to retain
nurse s of all ages, older
nurse s are not accessin g it.
Espec ially, the older nu rses
with ill ness/disabilit y can be
severel y disadvanta ged to
gain access to professio nal
development opportunities
Older n urses have
significantly
less access to
professional
development
opportunities
than their
younger
colleagues
TAB LE 2  (Continued)
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|
19
CHEN et al.
to non- clinical roles (Denton et al., 2021; Letvak, 2003; Mion
et al., 2006). In contrast to their Western counterparts, older nurses
in China often undervalued their skills and believed that they should
retire to relieve the employment pressure on the younger generation
(Li et al., 2020). Several studies uncovered age stereotypes perpetu-
ated by nurse managers (Fragar & Depczynski, 2 011; Letvak, 2003;
Li et al., 2020; Price & Reichert, 2017). Some managers deemed it
unwise to invest in ongoing education for older nurses, citing their
nearing retirement and perceived lack of long- term career prospects
(Fragar & Depczynski, 2011; Price & Reichert, 2017). Participants
in studies by Li et al. (2020) and Letvak (2003) sensed managerial
intentions to replace them with entry- level nurses receiving lower
salaries. In Denton et al.'s (2021) study, older nurses recounted in-
stances where managers advised them to adjust their employment
expectations and be thankful for retaining their jobs.
4.2.2  |  Theme 2. Impacts of ageism on older nurses
Ageism hindered older nurses from accessing training and promo-
tions. Older nurses valued the opportunities for continued learn-
ing and believed that ongoing training was beneficial to supporting
practice development (Gabrielle et al., 2008b). However, several
studies reported that older nurses received negative responses
from their managers when requesting training that would enhance
the provision of nursing care (Fragar & Depczynski, 2011; Price &
Reichert, 2017). Hence, older nurses were found to have signifi-
cantly less access to training compared to their younger colleagues
(Helaß et al., 2022; Powell, 2010). Consequently, older nurses re-
ported being ineligible for promotion because they lacked evidence
of professional development (Kovner et al., 20 07; White et al., 2021;
Wray et al., 2009). The impact of ageism also extended to older
nurses' emotional well- being, retention and performance.
Fragar and Depczynski (2011) highlighted that older nurses' per-
spectives on potential organisational changes or restructuring were
frequently disregarded. The older nurse participants, who were sup-
portive of the organisation and willing to be consulted, found that
changes, including role modifications and increased performance
expectations, were implemented without prior consultation (Fragar
& Depczynski, 2011). Excluded from discussions about organisa-
tional changes, older nurses expressed a sense of powerlessness,
especially considering that their opinions had been valued earlier in
their careers (Fragar & Depczynski, 2011). In Walker and Clendon's
study (2013), older nurses reported their managers treated them
differently from their younger colleagues and attributed the ineq-
uitable managerial practices to their age. This left the older nurses
feeling emotionally distressed and led to a perception that their sub-
stantial contributions to the nursing profession over numerous de-
cades were not recognised (Walker & Clendon, 2013).
Additionally, ageism was identified as associated with older
nurses' continuation of practice (Bilinska et al., 2016). Bilinska and
others (2016) compared organisational age climate (OAC) across nurs-
ing companies, which is a concept that examines employees' shared
perception of the value of older nurses in their organisation. Further,
OAC measures the positive attributes associated with older nurses
among their colleagues. The authors have identified that in companies
with lower OAC, older nurses were found to have increased turnover
intentions and lower job satisfaction. Similarly, in organisations with
an ageist workplace climate, there were higher turnover intentions,
lower organisational commitment and work engagement among
older nurses (Balko, 2013; Cadiz, 2010). Overall, ageism negatively
impacted older nurses' career development opportunities and well-
being, hampering their continuation of the practice.
4.2.3  |  Theme 3. Support for older nurses'
continuation of practice
The review identified three factors that could support older nurses'
continuation of practice. First, maintaining a positive perspective
on ageing was identified as a key strategy (Clendon & Walker, 2016;
Gabrielle et al., 2008b; Letvak, 2003). This was characterised as self-
acceptance of older age and engaging in self- care practices, such as
exercise and healthy eating to maintain fitness to continue to prac-
tice (Clendon & Walker, 2016; Gabrielle et al., 2008b; Letvak, 2003).
Second, fostering positive relationships with supervisors and
peers was evidenced as a driving force for older nurses' continuation
of practice (Clendon & Walker, 2016; Denton et al., 2021; Sinoski
et al., 2020). The inclusion of older nurses in social activities reinforces
their sense of belonging and significance (Clendon & Walker, 2016).
Denton et al. (2021) and Sinoski et al. (2020) also found that older
nurses desired to find camaraderie in their workplaces and wished
to be included in social activities. Helaß et al. (2022) highlighted the
role of nurse managers in supporting older nurses' practice by in-
volving them in decision- making processes and ensuring equitable
access to training and promotional opportunities.
Finally, a workplace environment that values all age groups has
been identified as pivotal for older nurses' continuation of practice
(Gabrielle et al., 2008a). A strong organisational age climate may
reduce negative beliefs held by young nurses against older nurses
(Bilinska et al., 2016). Further, an age- inclusive workplace with
adaptable work schedules, innovative rostering, redefined job re-
sponsibilities and the optimisation of ergonomic workspaces tailored
to the specific needs of older nurses were identified as supportive
for older nurses' practice (Gabrielle et al., 20 08a; Mion et al., 2006).
Nonetheless, the lack of workplace initiatives made it difficult
for nurse managers to provide older nurses with flexibility (Helaß
et al., 2022; Powell, 2010) and older nurses were primarily relying on
their own efforts to continue to practice (Clendon & Walker, 2016;
Gabrielle et al., 2008b; Letvak, 2003).
5 | DISCUSSION
This systematic review sheds light on the pervasive presence of
ageism within older nurses' practice settings. The findings in the
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
20 
|
    CHEN e t al.
first theme highlighted that ageism is not only perpetuated by
older nurses' colleagues, as reported by Denton et al. (2021), Mion
et al. (2006) and Sinoski et al. (2020) but also by a significant incon-
gruity in how older nurses perceive their competencies and how their
managers perceive them. Notably, many older nurses took pride in
their extensive clinical experience (Helaß et al., 2022; Letvak, 2003).
Yet, their managers failed to recognise the value of supporting their
continuation of practice (Fragar & Depczynski, 2 011; Letvak, 20 03;
Li et al., 2020; Price & Reichert, 2017 ). This discrepancy is further
exacerbated by instances where older nurses were advised to lower
their employment expectations (Denton et al., 2021). These nega-
tive age stereotypes about older nurses could result in them work-
ing in a setting where their skills and knowledge are not respected
or acknowledged by their co- workers, and their contribution is not
recognised by management, evoking emotional upset (Walker &
Clendon, 2013).
Our review found older nurses were unsupported by their man-
agers in accessing training and promotions and were excluded from
the decision- making process regarding organisational restructuring
(Fragar & Depczynski, 20 11; Price & Reichert, 2017 ). These ageist
practices were found to be associated with low job satisfaction,
intentions to leave, poor organisational performance and attrition
from the nursing workforce (Bilinska et al., 2016; Cadiz, 2010). Thus,
older nurses may practice in environments where relationships with
younger colleagues are challenging, with unsupportive management,
and inequitable access to resources. Additionally, these factors were
important indicators impacting nurses' work motives, the length of
their work lives and perceived organisational support as evidenced
in the wider literature (Armstrong- Stassen & Ursel, 2009; Baljoon
et al., 2018; Nurmeksela et al., 2022). The lack of organisational sup-
port has been found to correlate with low career satisfaction and
turnover among older workers (Armstrong- Stassen & Ursel, 2009).
The findings of this systematic review indicate that older nurses'
continuation of practice can be supported by maintaining a positive
personal outlook, building meaningful relationships at work and pro-
moting an age- inclusive work environment (Clendon & Walker, 2016;
Denton et al., 2021; Gabrielle et al., 2008a; Letvak, 2003; Mion
et al., 2006; Sinoski et al., 2020). These findings indicate supporting
older nurses' continuation of practice requires strategies at personal,
interpersonal and organisational levels. We also identified that the im-
pacts of ageism in older nurses' practice settings are multifaceted since
it has effects on older nurses' emotional well- being, relationships with
co- workers and retention (Bilinska et al., 2016; Cadiz, 2 010; Walker &
Clendon, 2013). Therefore, implementing policies that support older
nurses' continuation of practice may have positive effects on address-
ing ageism. Nonetheless, despite the impact of ageism, we could not
identify studies that directly address interventions or strategies that
could be used to combat ageism. This could indicate that ageism is
often overlooked and unchallenged in older nurses' practice settings.
The global report on ageism (WHO, 2021) recommends combat-
ing ageism through policies and laws, educational activities and in-
tergenerational interventions. Although there is limited research on
organisational support aimed at addressing ageism in older nurses'
practice settings, studies in other disciplines show the importance of
organisational policies and practices that promote age diversity and in-
clusivity as well as the provision of training and development opportu-
nities for older workers (Franz, 2023; Marcaletti et al., 2023; Nedeljko
et al., 2023; von Humboldt et al., 2023 et al., 2023). For example,
Marcaletti et al. (2023) found that older workers were more likely to
continue working when they received organisational support, such as
flexible working arrangements and access to training and development
programmes. Nedeljko et al. (2023) also highlighted the effectiveness
of ergonomic adjustments and technology assistance in supporting
older workers' extended work lives. Furthermore, Franz (2023) em-
phasised the need for organisational policies that address age- based
stereotypes and discrimination, as well as promoting intergenerational
collaboration and knowledge- sharing among age- diverse workforces.
Organisational support plays a critical role in promoting older
workers' continuation of practice and ensuring a diverse and inclu-
sive workforce. In older nurses' practice settings, organisational- led
initiatives may be needed to develop age- inclusive policies and offer
training services to foster intergenerational collaboration within the
age- diverse nursing team. Further, an age- inclusive work environment
could benefit nurses of all ages and potentially extend their work lives
until or beyond the official retirement age. However, there is scant re-
search on older nurses' awareness and perceptions of such policies and
practices in their practice settings and whether the implementation
of such policies and practices is effective in supporting older nurses.
The lack of a clear and consistent definition of older nurses may also
hinder the development of relevant organisational policies and pro-
grammes. Future research should focus on identifying older nurses
in their practice settings and exploring organisational- level initiatives,
programmes, policies and other forms of support needed to address
ageism and enable older nurses' continuation of practice.
5.1  | Strengths and limitations
This systematic review adhered to a rigorous and robust methodology
provided by JBI. Further, Covidence facilitated the identification and
removal of duplicate studies, enhancing the efficiency and accuracy
of the screening process. One of the key strengths of this review is
its international focus. It included studies from diverse geographical
regions, contributing to a comprehensive understanding of ageism in
older nurses' practice settings beyond a single cultural context. Lastly,
the systematic search strategy yielded a substantial number of studies
that met the inclusion criteria, allowing for a comprehensive analysis
and synthesis of data relevant to the review question and aims.
While this review provides valuable insight into ageism in older
nurses' practice settings, it is important to acknowledge some limita-
tions. Firstly, our search was limited to English language publications,
potentially excluding relevant studies published in other languages.
Secondly, the absence of a consistent definition of older nurses in
the literature resulted in our review including studies with popu-
lations that differed in age. This variability in age could affect the
applicability of the findings to specific age groups of older nurses.
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21
CHEN et al.
Additionally, due to the limited availability of studies that explicitly
focused on ageism in this specific population, we had to include
studies covering a range of related topics, which may have diluted
the data we could extract. Finally, while we conducted a thorough
search of peer- reviewed literature, searching the grey literature may
have further strengthened our findings.
6 | CONCLUSION
Overall, our review highlights the negative impact of ageism on older
nurses' career development, well- being and ability to continue to prac-
tice. Future research should focus on identifying older nurses in the
organisations and explore organisational initiatives and policies aiming
at addressing ageism and enabling their continuation of practice. In ad-
dition, healthcare organisations should develop and implement poli-
cies and interventions to combat ageism. This may foster age- inclusive
workplaces that could help retain nurses of all ages, this could have
serious implications for relieving the global nursing shortage.
AUTHOR CONTRIBUTIONS
Conceptualisation: CC, KS, SN1, SN2; Literature search: CC, KS, SN1,
SN2; Screening of papers and data extraction: CC, KS, SN1, SN2, JM;
Formal analysis: CC, KS, SN1, SN2, JM; Writing- original draft prepara-
tion: CC; Writing—review and editing: CC, KS, SN1, SN2, JM. All au-
thors have read and agreed to the final version of the manuscript.
FUNDING INFORMATION
None.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
DATA AVAIL AB ILI T Y STATE MEN T
Dat a sharing is not applicable to this article as no new dat a were cre-
ated or analyzed in this study.
ORCID
Chunxu Chen https://orcid.org/0000-0001-6018-0179
Kay Shannon https://orcid.org/0000-0003-1062-2578
Sara Napier https://orcid.org/0000-0001-7044-6778
Stephen Neville https://orcid.org/0000-0002-1699-6143
Jed Montayre https://orcid.org/0000-0002-2435-8061
TWITTER
Chunxu Chen chunxu530
Kay Shannon KayShannon14
Stephen Neville Stephen_Neville
Jed Montayre JedMontayre
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SUPPORTING INFORMATION
Additional supporting information can be found online in the
Supporting Information section at the end of this article.
How to cite this article: Chen, C., Shannon, K., Napier, S.,
Neville, S., & Montayre, J. (2024). Ageism directed at older
nurses in their workplace: A systematic review. Journal of
Clinical Nursing, 00, 1–24. https://doi.org/10.1111/
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APPENDIX
SEARCH STRATEGIES
Database and date CINAHL 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) N1 (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) N2 (conflict* OR tension* OR diversit* OR relation*)
OR
(age) N2 (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 159
Database and date Scopus 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) W/1 (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) W/2 (conflict* OR tension* OR diversit* OR relation*)
OR
(age) W/2 (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 1475
Database and date MEDLINE 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) N1 (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) N2 (conflict* OR tension* OR diversit* OR relation*)
OR
(age) N2 (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 146
Database and date PsycINFO 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) ADJ1 (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) ADJ2 (conflict* OR tension* OR diversit* OR relation*)
OR
(age) ADJ2 (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 313
Database and date Google S cholar 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) AND (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) AND (conflict* OR tension* OR diversit* OR relation*)
OR
(age) AND (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
13652702, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocn.17088 by Auckland University Of, Wiley Online Library on [11/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
24 
|
    CHEN e t al.
Database and date Google S cholar 5 May 2022
Parameters Year (2000–2022)
Total search results 7
Database and date ProQuest 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) NEAR/1 (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) NEAR/2 (conflict* OR tension* OR diversit* OR relation*)
OR
(age) NEAR/2 (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 22
Database and date nzres earch. org. nz 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) AND (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) AND (conflict* OR tension* OR diversit* OR relation*)
OR
(age) AND (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 4
Database and date O A T D . o r g 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) AND (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) AND (conflict* OR tension* OR diversit* OR relation*)
OR
(age) AND (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 16
Database and date EThOS 5 May 2022
Key search terms (old* or experienced* or ‘late career’ or ‘late- career’ or seasoned or senior) AND (nurse or nurses or nursing)
AND
(ageism OR agism OR ageist OR ‘age discrimina*’ OR ‘age prejudice*’ OR ‘age identit*’ OR ‘age stereotyp*’ OR ‘age
attitude*’ OR ‘age dynamic*’ OR ‘ageist stereotyp*’ OR ‘agist stereotyp*’)
OR
(intergenerational OR generational OR workplace) AND (conflict* OR tension* OR diversit* OR relation*)
OR
(age) AND (discrimina* OR stereoty* OR bias* OR attitude* OR favouritism OR favouritism OR conflict)
Parameters Year (2000–2022)
Total search results 73
APPENDIX (Continued)
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... The same happens with aging: older nurses are often the targets of incivility in the workplace. The health and well-being of older nurses, as well as their ability to continue practicing, may be impacted by prevalently negative opinions and beliefs about their ability and skill in their occupational environments [94]. Therefore, we can affirm that the association between WA and WV observed in various studies should be interpreted primarily as a tendency to violence in workers who are unable to satisfy work demands. ...
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... This form of discrimination is part of a culture of ageism that has become systemic in nursing. Several studies identify ageism among nurses in the clinical arena (Chen et al., 2024;Denton et al., 2023;Ben-Harush et al., 2016 ). It is naïve to believe that these same beliefs are not present in academia. ...
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Healthcare personnel must face two problems of growing importance: violence in the workplace and the loss of work ability due to ageing of the workforce. Studying the relationship between these two phenomena can help to prepare effective prevention measures. In a public health company, we asked nurses to self-assess their work ability using the Work Ability Index (WAI) and we analysed the relationship between this indicator and the violence experienced in the previous and following years. 321 out of 344 nurses (99.3%) participated. In a logistic regression model, the WAI score was a significant protective factor for violence experienced in the previous year (OR=0.94 CI95%=0.90; 0.98 p<0.01) and in the following year (OR=0.88 CI95%=0.84; 0.92 p<0.01). In a hierarchical logistic regression model, social support acted as a protective factor (OR = 0.87 CI95% = 0.79; 0.95 for violence experienced in the previous year), while occupational stress was a significant determinant of the risk of aggression (OR=3.65 CI95%=1.90; 7.03 in the previous year, OR=3.54 CI95%=1.801; 6.947 in the following year). The difficulties that nurses encounter in carrying out their growing work demands in an environment that is not promptly adapted to their changing physical and mental conditions can lead to an increased risk of violence. Prevention of workplace violence should include organizational and ergonomic measures that reduce stress and increase staff support and work ability.
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Aim This study aimed to identify and compare age stereotypes of registered nurses and supervisors in clinical inpatient settings. Design Generic qualitative study using half-standardized interviews. Method Nineteen face-to-face interviews and five focus groups (N = 50) were conducted with nurses of varying levels at a hospital of maximum medical care in Germany between August and November 2018 and were subjected to structured qualitative content analysis. Results Reflecting the ageing process and cooperation in mixed-age teams, nursing staff and supervisors defined similar age stereotypes towards older and younger nurses reminiscent of common generational labels ‘Baby Boomers’ and Generations X. Their evaluation created an inconsistent and contradictory pattern differing to the respective work context and goals. Age stereotypes were described as both potentially beneficial and detrimental for the individual and the cooperation in the team. If a successfully implemented diversity management focuses age stereotypes, negative assumptions can be reduced and cooperation in mixed-age teams can be considered beneficial. Conclusion Diversity management as measures against age stereotypes and for mutual acceptance and understanding should include staff from various hierarchical levels of the inpatient setting.
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