The Role of Coaching in the Development of Nurse Managers

Sunday, 8 November 2015: 4:40 PM

Liz Westcott, DCM, MSc, RN, RNT
Nursing, Oxford Brookes Unievrsity, Oxford, Oxon. OX3 OFL, United Kingdom

This presentation will share the results of empirical research undertaken into the role that coaching is playing in the development of nurse managers.  

Background: The role of the nurse manager is pivotal to maintaining good patient care.  The term nurse manager is being used to denote first level line managers such as ward sisters, charge nurses, ward managers and community leaders.  Health care managers currently face pressure from the public, professional and regulatory bodies, advances in technology, reductions in public funding and an ever-increasing and aging population.  Within this pressured environment, nurse managers have a pivotal role in the management and leadership of staff and the quality of patient care.

Nurse managers manage very complex settings and their leadership and management is essential to the maintenance of high standards and patient safety.  However, they usually undertake this position as their first line management role and often have very little training before they are appointed and little when they are in post.

It has been identified that the style and qualities of the nurse manager will have a considerable influence on team ethos and behaviour.  It has also been suggested that leadership style influences the culture of a practice area and therefore, has an effect on the quality and standard of care.  Additionally studies by the RCN report that nurse managers have been found to be unclear about what is expected of them in their leadership and management role; with this lack of clarity being compounded by time pressures, lack of resources and complicated lines of authority.

It has been well documented that nurse managers feel inadequately prepared for their line manager role and that this hinders their ability to perform their roles effectively.  The importance of some preparation prior to a manager being appointed has been identified, so they can be better prepared to succeed in their new role.  If this pre-preparation is in place it is suggested that managers can then better contextualise the learning they undertake once in post.

Coaching is one of the key approaches through which leadership within organisations can be developed.  Effective coaching can be used by employers to retain key employees and helps to create a cohesive workforce, which will work effectively even when under pressure.

Coaching has undergone a major change and is now actively sought by employees rather than being seen as a remedial process for underperformance.  Coaching is also now seen as one of the most effective methods for managing talent and is seen as an opportunity for leaders to have insightful conversations and reflect on their performance.

In the public services, coaching has been offered to executive management and high potential level staff for a number of years but is still only just emerging as an option for middle managers and nurse managers.

Aim : To explore the role that coaching is playing in the development of nurse managers.

Methods: This mixed methods research used a pragmatist paradigm and gathered data from a quantitative survey of 100 healthcare providers and qualitative interviews of nurse managers, coaches and directors of nursing during 2013. A probability, stratified sampling approach was used to recruit directors of nursing to the survey. For the qualitative interviews, a ‘non-probability approach’ to sampling was used.  Sampling was purposeful with an element of snowballing and convenience sampling methods. The nurse manager group comprised staff who had been nurse managers for between two and five years when they received coaching. This study adhered to the three dimensions identified for ethics in research; procedural, ethics in practice and professional codes.  Thematic analysis was the framework used for data interrogation.  Once  cross-cutting themes were identified, the interviews were re-analysed, using pattern coding, to identify how each group viewed these and what patterns had emerged. 

Results: The survey results appeared to suggest that a development programme was offered to NMs within 6 months of appointment in only 50% of the organisations.  This suggests from this sample that development is still not widespread and mandatory.  

The interview analysis showed that coaching developed resilience, leadership and a coaching culture in health care settings as well as improvements in patient care.

Discussion: Coaching is not widespread for nurse managers in many organisations but may have a big impact on nurses, patients and organisations if adopted.  

The importance of the first line managers having development and adopting a coaching style of management.  Coaching helps with difficult decision making, 360-degree line management and project management.  The value of a coaching style in clinical supervision and mentoring to develop skills and performance was identified.  Coaching leads to transformation of the nurse manager and their team but needs to be accessible to all and can be introduced as part of a development programme. 

It was found that there is a perceived added value that a nurse as a manager brings to a management role in terms of reflection ability and the natural caring style that comes from being a nurse. Organisations other than health care could learn from the caring side of nursing as a useful asset and is reflected in the value of using a coaching style of management.  In essence, using a coaching style isn’t being a soft manager but is getting the best out of staff.

Coaching improves and maximises resilience, self-efficacy, self-confidence, and self understanding and can help in the very difficult transition to NM role.  It was identified the line manager should not be the nurse manager’s coach but should have a coaching style of management

There appears to be an unrecognized, ‘by-product’ link, between support for coaching NMs – transformative leadership – improved patient care.  Coaching can help in a shift to problem focused coping and can help with moving from vulnerability to resilience

Conclusions: Coaching of nurse managers and developing a coaching culture gives clear benefits to themselves, their patients and the organisation.  All nurse managers should be advised to have coaching when they take on the new role, when they move into any subsequent role or when they embark on major projects.  Organisations should ensure that formalised coaching is not undertaken by the nurse managers’ line manager.  Nurse managers should be encouraged to use a coaching style of management with their direct reports and peers.

 Organisations should ensure that any coaches used for nurse managers have undergone training and undertake supervision.  There should be an Identification in the UK, of the differences between coaching, mentoring and clinical supervision and develop a clear framework to show this.  Finally all health care organisations should  engender a coaching culture in their staff.