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AORN Journal
Volume 117, Issue 6 p. 396-398
Leadership Insights
Free Access


LEVERAGING LEGACY NURSES


First published: 26 May 2023
https://doi.org/10.1002/aorn.13934
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The perioperative nursing shortage remains a challenge for nurse leaders,
particularly because it is unlikely to end anytime soon. According to a 2022
Nursing Solutions, Inc, staffing and retention report, nurse turnover in
surgical services was 18.8% in 2021, up from 13.2% in 2020.1 In addition,
perioperative nurses continue “to be the most difficult to recruit”1—filling an
open position for an experienced perioperative nurse takes an average of
97 days. Although this average is down from 111 days in 2021, it remains a
lengthy time frame, and the report projects the number of days will remain
elevated because of the nursing shortage.

One strategy for addressing the perioperative nursing shortage is for leaders to
leverage the expertise of perioperative nurses who are approaching retirement or
have already retired. To learn more about this option, the AORN Journal spoke
with Joanne Oliver-Coleman, BSN, RN, CNOR(E), a retired nurse with more than
60 years of perioperative experience, including as an OR staff nurse and
manager, in positions with various health care companies, and as a consultant to
facilities and industry partners. Although retired, Oliver-Coleman continues to
mentor other nurses through her business, Healthcare Resources, in Houston,
Texas, and she remains active serving the profession. In 2022, she convened a
“think tank team” that includes seven AORN past-presidents; three former AORN
Board members; two current AORN Board members; a perioperative professor at a
large baccalaureate school of nursing; a representative from the AORN Retired
Nurses Specialty Assembly; an RNFA; and a young, active AORN member to discuss
the role that “legacy nurses” might play in addressing the shortage.

AORN Journal: Who are legacy nurses?

Oliver-Coleman: Legacy nurses are nurses who are 55 years of age or older who
may be getting ready to retire or have already retired—that is, preretirement,
transitioning-to-retirement, or postretirement nurses. Many of these nurses want
to continue to contribute to the perioperative profession, and the think tank
team identifies opportunities for them to do so.

AORN Journal: What actions can leaders take at the preretirement stage to make
full use of “older” nurses’ talents?

Oliver-Coleman: Organizational leaders can support older nurses in many ways,
including by providing flexible hours and supporting job redesign for
perioperative nurses to reduce heavy workloads. It's also important for
perioperative leaders to understand these nurses’ needs; they can do this by
conducting surveys and focus groups and structuring pay and benefits after
retirement—for example, by offering part-time employment.

Leaders can consider offering older nurses roles that are less physically
demanding, such as family liaison nurse, internal audit reviewer, relief
floater, educator, and scheduling coordinator. Another option is to have them
work on updating policies and procedures. These various roles can often benefit
an organization in many ways. For example, at one hospital, an older nurse no
longer had the physical stamina to work in the OR but didn't want to retire, so
the nurse leader created a new nursing position and put her in charge of
scheduling. Because of the older nurse's expertise in areas such as turnover
time and specialty service requirements, scheduling accuracy improved
tremendously. Other options include having the nurse work with the sterile
processing department to streamline instrument sets for efficiency or manage the
surgery progress board because they have the knowledge to adjust staffing as
needed. Both examples draw from legacy nurses’ extensive skill sets.

Mentorship is also important. Sometimes younger nurses don't have as broad a
perspective as a more experienced nurse because they weren't exposed to
perioperative nursing in school or simply do not yet have a wide knowledge base.
For example, they may not possess comprehensive knowledge of all the items they
need to check on a patient, such as pedal pulses after positioning a patient in
stirrups. A legacy nurse can also support less experienced staff members and
help them see how important empathy is to the “bigger picture” of patient care.

AORN Journal: What about during the transition-to-retirement stage? What can
leaders do there?

Oliver-Coleman: Nurses at this stage are often thinking about the joy of not
having to come into work every day but aren't necessarily ready to fully retire.
Nurse leaders can meet these nurses’ needs and benefit the organization through
creative options like splitting a staff position between two people. One nurse
could work in the morning, the other in the afternoon. This would ease the
physical stress on the older nurse and not affect the budget. In other
instances, nurses might work a few days a week, or the nurse could spend less
time in the OR and more time working on tasks such as revising surgeon
preference cards for a particular procedure. All of these examples can help ease
the nurse's transition into retirement.

This is also a time when leaders should think about how they can transfer some
of the experienced nurse's knowledge to other staff members before they retire.
That might mean allocating time for experienced nurses to mentor potential
successors and to create documentation for others to follow. Another example is
to have the experienced nurse make a video of how they perform a particular
task, such as updating preference cards, or they can create a resource book that
staff members can refer to after the nurse retires. Perioperative leaders can
offer many of the same opportunities I mentioned for the preretirement stage.
Leaders should also conduct exit interviews when the nurse retires to determine
what worked for making the transition smoother.

AORN Journal: Now let's turn to nurses who are retired. What are your thoughts
for how leaders can use their expertise?

Oliver-Coleman: Leaders may find that even nurses who are fully retired may be
interested in coming back to help as a volunteer or as a paid staff member. For
example, a nurse who is an expert in a particular specialty might be willing to
spend time with recently hired staff members to orient them or to serve as a
mentor to a younger staff member. A leader may also have retired nurses fill in
as per diem staff members. Leaders in schools of nursing can have a retired
perioperative nurse speak to students about a career in perioperative nursing.
Another idea is to have them assist in the simulation laboratories, where their
experience can help make scenarios more realistic.

Sometimes, volunteer opportunities can lead to paid positions. I know of two
retired nurses who volunteered to serve as family liaison nurses. The volunteer
program became so successful that it ended up leading to paid positions.

Leaders may also think about contracting with retired nurses to complete a
specific project. If you're trying to improve flow and efficiency in an OR, it's
more effective to have someone who knows your organization work on this project
instead of hiring outside experts. It is also likely to be less expensive.

AORN Journal: How do the variety of options we've talked about benefit retired
nurses themselves?

Oliver-Coleman: The transition into retirement can be a lonely one, especially
if unexpected events occur, such as the death of a spouse. There also may be a
feeling of “nobody needs me anymore.” By continuing to participate in the
profession, retired nurses can feel they are contributing and keep their minds
active. One advantage is the freedom to choose what they want to do, when they
want to do it, and how many hours they want to spend doing it.

AORN Journal: What are some other opportunities that retired nurses can think
about?

Oliver-Coleman: Advocating for expanding perioperative education in
undergraduate nursing programs and raising awareness about the field of
perioperative nursing in general. The more we talk to students in high schools
and nursing programs about perioperative nursing, the more likely newly
graduated nurses will enter into the profession. Retired perioperative nurses
can also work as guest lecturers or serve as adjunct faculty. Retired nurses
should consider which areas of their expertise they feel are the strongest and
then seek opportunities in those areas (eg, management, education, legislation,
speaking, specific subject matter or surgical specialty).

AORN Journal: What is your advice to legacy nurses?

Oliver-Coleman: Stay active and be involved in as much as you can, whether it's
working at a facility helping with legislative issues related to perioperative
practice or writing, speaking, and mentoring. These are things that keep your
mind active, and you're going to live a lot longer if you stay active and
involved. What better way to stay involved than to share your wealth of
perioperative knowledge and experience with those who need it most?

AORN Journal: What final advice do you have to nurse leaders related to their
approach to legacy nurses?

Oliver-Coleman: Take advantage of the experts you currently have but don't
overuse them, because this can result in staff members leaving earlier than they
planned. That's where job-sharing and allowing part-time work comes into play.
Use the plethora of information they possess to assist your current staff
members. Remember to recognize legacy nurses for what they do well and avoid age
bias; for example, don't assume that someone older isn't going to be good with
technology. Probably the most important thing is to listen to what staff members
are telling you when you talk to them one-on-one and through surveys.

AORN Journal: When you look to the future, how do you envision perioperative
leaders and retired nurses being able to connect?

Oliver-Coleman: My dream is a national database that would connect those who
have opportunities available with retired nurses who are interested in
volunteering. Retired nurses are full of information that we need to be able to
access and use.

AORN Journal: Tell our readers a bit about your own retirement journey.

Oliver-Coleman: I've been retired for 10 years but have remained actively
committed to AORN. I'm also working with six mentees, talking to nursing
students about perioperative nursing, and speaking to perioperative leaders and
AORN groups about legacy nurses. I've worked with an area hospital to develop
practice standards, and we're currently working on policies and procedures
related to surgical smoke evacuation. Part of my work on surgical smoke
evacuation is educating legislators about the issue. They have no idea how
dangerous surgical smoke is, so I've been centering a lot of my work on this
topic.

I feel very strongly about my work with legacy nurses. There is a lot written
about the nursing shortage but very little about how we can use the expertise of
legacy nurses, including those who are already retired, to begin remedying the
problem.

REFERENCE

 * 1 2022 NSI National Health Care Retention & RN Staffing Report. NSI Nursing
   Solutions, Inc. March 2022. Accessed March 13, 2023.
   https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf



Volume117, Issue6

Special Focus Issue: AORN Post‐Conference

June 2023

Pages 396-398




 * REFERENCES


 * RELATED


 * INFORMATION


RECOMMENDED

 * Preparing the Next Generation of Perioperative Nurses
   
   Sharon Chappy PhD, RN, CNOR, Patricia D. Madigan MSN, RN, CNOR, Deborah S.
   Doyle MSN, RN, Laurie A. Conradt BSN, RN, CNOR, Nathan C. Tapio BSN, RN,
   CNOR, 
   AORN Journal

 * A Phenomenographic Approach to Understanding the Expertise of Perioperative
   Nurses
   
   Boo Hyo Park MS, RN, Sung Ok Chang PhD, RN, 
   AORN Journal

 * Student Nurses in the OR: Improving Recruitment and Retention
   
   Holly M. Helzer Doroh RN, BSN, Janean Carter Monahan PhD, CNOR(E), 
   AORN Journal

 * A Perioperative Specialty Elective to Address the Perioperative Nursing
   Shortage: Student Perspectives and Outcomes
   
   Jessica Reuter DNP, RN, EBP-C, NBC-HWC, Tara Spalla King PhD, RN, 
   AORN Journal

 * Guidelines in Practice: Positioning the Patient
   
   Jennifer Speth MSN, RN, CNOR, 
   AORN Journal


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PUBLICATION HISTORY

 * Issue Online: 26 May 2023
 * Version of Record online: 26 May 2023
 * Manuscript accepted: 29 March 2023
 * Manuscript received: 29 March 2023




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