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The case for nurse coaching

March 27, 2013
by Alan Richman
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Communities report improvements in resident care, reduced employee turnover and better morale
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What do the following situations have in common?

  • A nursing home resident with high blood pressure refuses to take his medication.
  • The daughter of an assisted living resident reports that her mother isn’t eating properly because she “hates” the food being served in the dining room.
  • One of your most skilled nurses demonstrates one critical flaw—frequent tardiness.

The connection is that no lasting solution to such challenging situations can be achieved without the cooperation of the individual involved. Let’s look at a proven method for gaining the necessary cooperation.

In recent years, a new approach has been added to the kit bag of thousands of nurses and scores of nurse supervisors across the country. Called nurse coaching, this relatively new discipline is intended to assist a nurse in the fulfillment of his or her primary responsibilities.

As defined by Susan Misiorski, national director of coaching and consulting for Bronx, NY-based PHI, an organization that provides consulting services to both the home and residential care industries, coaching focuses on building “a relationship-centered approach to supporting the growth and development of others.”

Rather than “telling someone what to do,” the nurse coach seeks to awaken an individual’s sense of self-awareness and self-management. In other words, Misiorski suggests, the idea is to get the person to acknowledge the problem and buy into a viable course of corrective action.

AT THE CORE

Misiorski says core coaching skills needed to attain this goal include:

  • Active listening: Use of good body language, paraphrasing and asking open, curious questions
  • Self-awareness: Regarding strengths, personal styles, judgments/assumptions and blocks to listening
  • Self-management: The ability to maintain control in emotionally charged situations and the ability to manage judgments and listening blocks in order to maintain focus on the other person
  • Feedback: The ability to offer all feedback (both positive and constructive) while being clear and direct and using language free of blame and judgment

“Nurse coaches walk with clients through a discovery process,” suggests Barbara Dossey, co-director of the International Nurse Coach Association. Dossey, who has a long string of credentialed initials following her name, including PhD and RN, says the goal of nurse coaching is to help clients tap into their own creativity, become more resilient and reduce anxiety and the fear of frustration. “Using our core competencies, we try to connect with patients’ strengths, help them recognize what they want to learn, and encourage them in what they want to do with their lives,” Dossey explains. She adds, “Coaching is an ideal model to help understand patients’ desires, constraints and barriers, and then use the knowledge to develop an ongoing plan of care.”

To the uninitiated it might seem that nurse coaching is nothing more than advising and counseling patients—something that nurses have been doing for centuries, if not millennia. Dossey disagrees, noting, “While many nurses have naturally used coaching skills to support their patients over the years, the practice of nurse coaching is just beginning to emerge as a distinct role, with specialized training and broader recognition.”

It now even has its own accreditation efforts, including the Integrative Nurse Coach Certificate Program, the PHI certificate of completion, and, since this past January. a professional certification as a coach that can be earned through the American Holistic Nurses Credentialing Corporation. In addition, the American Nurses Association (ANA) has published a book on the subject entitled The Art and Science of Nurse Coaching: The Provider’s Guide to Coaching Scope and Competencies.

WHAT COACHING IS NOT

Gail Donner, RN, PhD, and Mary M. Wheeler, RN, MEd, PCC, the authors of Coaching in Nursing: An Introduction, make a distinction between coaching and advising, counseling or mentoring. They say that unlike these other techniques, coaching is time-limited and focused on conversations in which the client often takes the lead.

In their book, they state, “[T]he coach acts like a midwife: supporting, encouraging and helping the client through the experience while acknowledging the client as the expert and the person ‘making it happen.’”

A NEED TO COMMUNICATE

At its most elemental level, coaching is about communicating. In practice, here is an example of how it works and what it may do for an LTC environment:

Mrs. Jones, a resident, wants to sleep late every day and have a light breakfast of tea and toast. Her daughter insists that the staff get her mother up by 8 a.m. for a full breakfast including bacon, eggs, toast and juice. The nurse coach doesn’t tell anyone what to do—not staff, mother or daughter. Instead, she listens intently and assesses the situation. Asking open-ended questions that cannot be answered with a yes or no, she urges each party to express needs, desires and feelings. She offers all an opportunity to suggest ways to modify their position. She encourages each to consider the perspective of the others and gives them a chance to come to a mutually agreed-on solution. Once this option has been implemented, the nurse coach continues to check back to make sure everyone is satisfied with the arrangement.

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