Feature | April 17, 2007| Catherine Robinson-Walker, MBA, Master Certified Coach, Sarah S. Detmer, M.S., R.N.

New Strategies for Retaining Nurses

Authentic coaching can keep nurses in your game.

Among the challenges that face us in healthcare, retaining our best and brightest nurses is close to the top of the list. Nurse turnover is very expensive and seriously impacts the bottom line of every healthcare organization.
It is also very expensive to our patients. When the nurse manager is not able to meet the staffing goals for the care of the caseload, the care gets prioritized and corners get cut.
Consistent attention has been paid in the literature and at management meetings regarding turnover and performance. Best practices have been encouraged from increased pay rates to opportunities for advancement such as clinical ladders. Where these approaches have been used, some success has been realized. Perhaps we need to explore a new skill with the objective of creating such a strong nurse engagement that the thought of leaving is out of the question, with the exception of personal life-changing events.
The data show that the factors influencing a decision to leave are most frequently found in the quality of relationships on the working unit, primarily relationships with the unit manager or supervisor.1 With the exception of pay rates or staffing ratios, all of the most common factors leading to turnover can be controlled or influenced by the nurse manager using coaching skills.
Coaching: What is It?
Coaching is a sustained learning strategy to help people enhance their skills, change their perspectives, behave differently and achieve their goals. Coaching is a process in which a coach works with learners to develop the learners' own resources, solutions and practices so they can obtain their own goals.2 The process is learner driven rather than coach driven. It is very important to distinguish coaching from supervision, counseling, teaching or therapy. The primary distinguishing factor is that coaching moves the learner toward his own real goals rather than those of the coach.
As a manager, it is very important to know which hat you are wearing: the supervisor, the teacher, or the coach. These terms are frequently used interchangeably but are in fact different. Coaching is empowering because its goals are learner directed and owned.
What Makes a Good Coach?
Given the distinct differences, coaching requires a different skill set and relationship with staff. Supervisors and teachers tell staff what to do. Coaches help the staff identify the goal and discover their own route to success. The character of the relationship the coach must have is based on mutual trust and respect. The characteristics that a coach brings to the coach/learner relationship include:
• Authenticity
• Honesty
• Consistency
• Clear and open communication
• Encouragement and recognition
• Credibility
• Flexibility
• Confidentiality
• An open attitude
• An ability for focused listening
• Emotional intelligence
The Skill Set
There are several essential facets that enable nurse managers to create an open and understanding dialog and develop a coaching atmosphere to which nurses want to belong.
(1.) Establishing the coaching agreement is the first step in a successful coaching relationship. It is critical that the scope and the purpose of the coaching are clear, that confidentiality is required and the measurements of success are identified. The contract can be formal or informal, extensive or brief and on the fly, but the boundaries must be mutually agreeable and attainable.
(2.) Communication skills are the basis for coming to an understanding and discovering possibilities. The coach should avoid authoritative or blaming language and establish a climate to promote mutual respect and support.
(3.) Listening as a coach requires listening generously in a focused way, suspending judgment and being aware of one’s own biases that impede understanding. The experienced coach listens for blind spots that the learner is unaware of.
(4.) Asking questions is a skill focused on identifying the facts, promoting reflection, discovering feelings and evaluating barriers to progress. Questions offer the coach the opportunity to probe for blind spots that can open up possibilities for the learner.
The evaluation of coaching can be both short and long term. At the end of a formal coaching session, the coach may ask the learner for feedback on the progress made during the session. When coaching “on the fly” the coach may want to reflect on the conversation to identify areas that may be improved.
Practice in coaching is critical to ongoing success. Reviewing specific sessions with another coach is very useful. Every coach needs a coach in order to discover his/her own blind spots and to assist with the short-term evaluation and improvement of skills.
The long-term evaluation involves the progress the learner makes toward the measurable goals he/she identified at the outset. There are a number of overarching goals that can be measured for success in a coaching environment. Reduction in staff turnover due to improved trust, better communication, staff empowerment and recognition is one example. Others include nurse empowerment and creativity leading to performance improvement, increased patient satisfaction scores, improved patient safety strategies and increased patient access. All eventually have a significant impact on the bottom line.

1 Goode, CJ. et. al. (2205) “The Pull of Magnetism: a look of the standards and the experience of a western academic medical center hospital in achieving and sustaining magnet status.” Nurs Adm Q. 29(3):202-213.
2 Robinson-Walker, C and Detmer, S. (2004) Coaching: the New Leadership Skill. Bala Cynwyd, Pa: Nurse Week.

Catherine Robinson-Walker, MBA, MCC, is president of The Leadership StudioË, a California-based firm that has trained and coached hundreds of national nurse leaders to be more effective on the job. She is a Master Certified Coach, the highest distinction awarded by the International Coach Federation. Fewer than two percent of all professionally trained coaches have earned this distinction. She co-created the “Institute for Patient Care Executives” at UC Berkeley, and the Center for Nursing Leadership, a joint venture with the American Organization of Nurse Executives. Catherine's book, “Women and Leadership in Health Care: The Journey to Authenticity and Power”, is a Jossey-Bass health series best seller. Catherine is the coaching columnist for AONE's professional journal, “Nurse Leader”, and she was named the 2006 “Friend of Nursing” by the Association of California Nurse Leaders. She can be reached at www.leadershipstudio.com.

Sarah S. Detmer, MS, RN, is a consult and principal with Mid-Atlantic Resource Associates. She specializes in leadership development for nursing in hospitals and community agencies. She has 30 years of experience in nursing administration in academic medical centers, health maintenance organizations and community hospitals. Her interim nursing administration practice in hospitals provides a rich opportunity to model a coaching style for teammates in senior management as well as front line managers and staff. She can be reached at [email protected]

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