How CNOs Can Avoid Nurse Turnover and Knowledge Gaps

Retired nurses offer coaching and mentoring to Novant Health's novice nurses to solve retention challenges.

Editor's note: This article appears in the October-December 2023 edition of HealthLeaders magazine.

With nearly one-third of overwhelmed novice nurses quitting in their first year nationwide, Amy Akers, RN, BSN, MBA, NEA-BC, vice president and chief nurse executive at Novant Health New Hanover Regional Medical Center, is working to buck that trend by bringing retired RNs back to the floor through its Emeritus Nursing Program to help inexperienced nurses succeed and stay.

The program not only helps solve retention challenges, but also retains the expertise of experienced nurses to avoid knowledge gaps that can occur when nurses retire and new nurses join the care team.

Novant's nurse emeritus program began to take shape during COVID-19 as Novant nurse executives were configuring care teams to have enough critical thinking skills and knowledge, says Akers.

The program officially debuted in January 2022 and has about 15 participants.

"As we are bringing many new grads into our building, we wanted people to be available that had experience, that could work side by side, be there for questions, help with critical thinking, and utilize new equipment," Akers says. "They were not to be a preceptor, because the new grad has a preceptor, but this is in addition to that—to be part of that care team."

"These nurses have the experience, knowledge, and critical thinking skills to work side by side with new nurses," Akers says. "They also bring the ability to help nurses work through problem solving."

Most of the teaching moments are small, confidence-building lessons, she says.

"I ran into one of our emeritus nurses recently who was working with a nurse who was probably a year into her career but had not had the opportunity to start many IVs. She had asked this nurse emeritus to go in and start the IV for her, but instead of doing so, the nurse emeritus went to the bedside and walked her through the process," she says. "This [newer] nurse did a fabulous job, felt more confident, and got the experience. That nurse emeritus helped her to get to that point."

"The other thing I love is seeing the education that the emeritus nurses are providing to the team members on the floor," Akers says. "They find new creative ways to educate and bring real-life situations that could occur with the specific population that they're working with."

Such guidance furthers the program's goal of helping less-experienced nurses successfully grow into, and find satisfaction from, their job.

"The nurse emeritus program works for retention," Akers says.

The program is primarily evaluated through performance reviews and direct team member feedback. And while Novant has observed a decrease in turnover across all of the units that participate in the emeritus nurse program, the program is just one portion of the health system's retention efforts, so it's unable to assign a specific cost savings or retention rate to the presence of emeritus nurses, according to the hospital.

A solid background

All of the emeritus nurses were bedside RNs at one time, Akers says, and bring at least a required decade of nursing experience to their roles as coaches and mentors.

"Some of them have been nurse leaders," she says. "We've got a real variety of where they retired from, or where they were transitioning their career into an emeritus nurse role, so we have all types."

"All of the [emeritus nurses] are working in the specialty that they worked in for the majority of their career," Akers says, "so if they've got a strong cardiac background, they're working on our cardiac floors or if they have a strong neuro background, they're working with our neuro teams."

Emeritus nurses are typically scheduled in four-hour shifts on their chosen workdays, but they can work longer or shorter hours if they prefer, Akers says. Their compensation is based on years of experience.

Novant recruits by posting the emeritus positions to online employment sites, but most of the participants have been recruited by word of mouth, Akers says.

"This is a way for them to remain part of the care team, and to have an impact on the care we're delivering and an impact on the community they're living in," Akers says, "so it’' just as fulfilling for the nurse emeritus as it is for the team itself."

'Go-to person'

Neurosurgery nurse Elizabeth Emshwiller, who retired from Novant after about 37 years of nursing, enjoyed two years of a relaxed retirement before she felt compelled to join the emeritus program about a year ago to coach and give less-experienced nurses a guiding hand.

"I coach, inspire, and mentor, and whatever needs to be done to educate the staff," she explains. "I am not at the bedside giving medicines; I do not have a patient assignment; I am not the primary care nurse for any patient; I do not fill in when there's a call-in. I am here for the coaching, inspiring, and mentoring."

Nurses who encounter a situation where they need assistance, or simple affirmation that they're providing the correct treatment, can quickly summon Emshwiller by facility phone.

"I'm a troubleshooter, a problem solver, and the go-to person on the floor," she says.

Having that "go-to person" can make all the difference for an inexperienced nurse, Emshwiller says.

"I remember when I was in their position, just graduating from school, and how I felt I wish there was someone to bolster me up," she says. "It definitely gives them confidence, and I'm hoping because of that, we won't lose as many nurses because there is somebody who can support and help them."