Nurse Manager Coaching Improves Practice Environment Scores

Nurse Leader Insider, July 19, 2018

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By Jennifer Thew, RN
Originally appear at HealthLeaders.

Just three years ago, the nursing unit that nurse manager Lincy M. Philip, MSN, RN-BC, oversees at Cohen Children's Medical Center in New Hyde Park, New York, was in dire straits.

Among the challenges was a move to a newly designed unit, resulting in challenges that disrupted workflows and teamwork. Along with the move came higher-acuity patients, but not the additional staff to care for them.

"We were a unit that was typically staffed with one charge nurse and four nurses, and now we needed at least one charge person and anywhere from six to seven nurses. We didn't have that coming into the new building," she says.

In addition, the staff members were dealing with an extremely confrontational parent of a patient with a months-long hospital stay while Philip was on maternity leave.

Despite various interventions with the parent such as interdisciplinary team meetings that included a chaplain and social worker, the parent continued to be suspicious, verbally abusive, and intimidating to the staff.

"Apparently, this patient had bucked all the systems and the staff felt so broken that trust from all angles was just completely severed," she says. "[They felt] there was no doctor that they could rely on, no nursing administrator they could rely on. Perceived or real, this is how they felt."

During the discord, the unit's NDNQI mean practice environment score dropped to 2.58 in 2015 down from 2.80 in 2013.

Today, however, the unit has recovered from its most difficult days with the help of the organization's internal coach, a position created in response to the unit's work environment situation. 

Internal Coaching Results
From 2015 to 2017, Cohen's NDNQI scores have improved, supporting the effectiveness of internal coaching:

  • Nurse manager ability, leadership, and support of nurses went from 2.27 to 2.92 
  • Staffing resource adequacy went from 1.96 to 2.74    
  • Feeling that one is treated with dignity and respect went from 3.79 to 4.32
  • Feeling recognized and thanked increased from 2.71 to 3.41
  • The mean practice score went from 2.58 to 3.04

"I can honestly say nobody expected [these] outcomes," Philip says.

An Innovative Role Is Born
Traditional interventions didn't seem to help the unit. Even though the patient had left the unit and Philip had returned from maternity leave, the mean practice environment score drop in 2015 indicated the staff members were still carrying scars from the series of chaotic events.

So Carolyn Quinn, RN, MSN, NE-BC, who was the chief nursing officer at the time, decided to try something new.

She contacted Phyllis Quinlan, PhD, RN-BC, to do group coaching with the staff. At the time, Quinlan was the director of education at one of Northwell's subacute sites, but she also had her own independent coaching business. 

"I got the phone call, and essentially the request was, 'We're having a communication issue here. Do you coach groups? Do you think you can come over and give us a hand?' " says Quinlan, who is now Cohen's manager for clinical transformation/internal coach.

Quinlan met with the staff multiple times and arrived at an assessment similar to Philip's.

"They didn't have a communication issue. They had a trust issue, which, of course, can be much more difficult to remedy," Quinlan says. "That was very difficult for [Quinn] to hear. That's the last thing any CNO wants to hear, 'My staff doesn't trust leadership. ' "

As a result of her initial work with the unit, Quinn soon hired Quinlan to become the organization's manager for clinical transformation/internal coach.

"We literally invented this role from the ground up," Quinlan says.

What Internal Coaching Is
To explain her role at the organization, Quinlan starting rounding and speaking about emotional intelligence at the monthly nurse leadership meetings, which included the senior director of operations for nursing all the way down to the assistant head nurses.

"Coaching is a process of supporting personal growth so that [the person] can become more emotionally competent and, therefore, [more] effective," Quinlan explains.

Quinlan began working with nurse leaders to develop their emotional intelligence so they would have the skills to address issues with their staff. Philip was Quinlan's first client.

The two began meeting for 30- to 60-minute sessions to work on Philip's self-awareness and identifying Philip's strengths.

During a coaching session, Quinlan may ask questions such as:

  • What are your strengths?
  • How would you use those strengths?
  • Are you overusing or underusing those strengths?    
  • What happens in the unit that triggers you?
  • What frustrates you?  
  • How do you react to frustrations?

"The coach's role is to create [an] accepting environment where there is no judgment; there is just insight by trying to shed some light on individual blind spots," Quinlan explains about the process.

'Chewing on Glass'
In the sessions, Philip says Quinlan would help her break down a situation and see what she did right but also what she could do differently, a process they refer to as "chewing on glass."

"[Phyllis is] able to hone in on the things that you don't necessarily want to talk about and pull it out of you in a way [so that you can] reflect," Philip says.

In addition to insight, Quinlan also provided Philip with tools and strategies to make changes.

"One of the things I did with Lincy was to help her have a pause," Quinlan says. "She didn't realize that every now and then you would be talking to her and she was wearing her frustration about something that happened 20 minutes ago, not necessarily something that happened in this conversation, but she was still upset about a previous conversation."

For her part, Philip says coaching helped her become a better listener.

"One of the concrete things that Phyllis would say was try to stay quiet more," she says. "And so, when I would go and check in with the staff, I would first ask them about their family. I would name their kids and their husband, or ask what they did that weekend. Then from there, we'd talk about nursing stuff."

Philip says that helped the staff feel cared about and, as a result, they would share issues or concerns with her in a more genuine way.

"The communication went from being this muddied, turbulent cacophony to now we can

finish each other's sentences and still disagree about something," she says.

Philip encourages other nurse executives to make coaching available to their nurse managers.

"To the CNOs, I would say be daring and take a chance. Carve out the time and the resources to give [coaching] to your No. 1 influencer of healthcare and morale on your [units]." Your nurse manager is your most useful resource, but also your most overworked, underutilized resource."

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