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Methods: After Institutional Review Board approvals from the University of Texas at Austin and the hospital system, the nurse leaders were sent an email explaining the project. At the end of the email they were provided with an individualized link to the Relational Coordination and Coaching Survey. The survey consisted of the seven components of relational coordination and the 39 item Yoder Coaching Survey as well as nine questions about the demographic characteristics of the participants. Data were analyzed using SPSS v. 20.
Results: Two hundred ninety-four nurses in leadership positions were invited to participate and 149 completed surveys were analyzed for a response rate of 50.6%. Response rates for the individual hospitals ranged from 27% to 73%. The nursing leader respondents were in the following roles: unit supervisor (n = 76), nurse manager (n = 38), director (n = 28), and chief nurse executive (n = 7). Most of the participants were female (n = 126; 86%), Caucasian (n = 116; 79%); had a Bachelor’s degree (n = 84; 57%), and were 40-49 years of age. The participants reported they had worked in their current position for 7.6 years and they worked for their current immediate supervisor for 5.5 years; 56% (n = 84) said they interacted with their boss daily. The only demographic characteristic that was correlated with the coaching survey scores was the amount of time they had worked for their current boss (r = .18; p = .045).
Participants’ coaching survey scores ranged from 85-153 (M = 129; SD = 16). The items that had the highest mean scores were: is approachable (open door policy) (3.76), is committed to continuous improvement (3.76), has integrity (3.73), promotes an environment of excellence, rather than doing the minimum (3.67), and demonstrated trust in you (3.66). The coaching survey items that had the lowest mean scores were: gives you feedback to clarify performance expectations within the first three months of the rating period (1.14), keeps winning and losing in perspective (2.90), gives you public recognition on excellent performance (2.93), enters into an agreement with you about actions needed to solve your performance problems (2.96), and encourages you to take a risk to implement your ideas (2.99). There were statistically significant correlations between coaching and several of the communication RC components however, the correlations were small and of little administrative significance. Some of the relationship components of RC were moderately correlated with the coaching scores (r =.49 - .55; p<.0001). Additionally, the coaching survey demonstrated excellent internal consistency when used with nursing leaders (α = .96).
The findings from this project were verbally briefed to the senior nursing leaders of the hospital system and they each were provided with 70 page detailed reports regarding the coaching and RC scores among and within their nursing leadership teams. These senior executives saw the value in assessing both coaching and RC within and between their leadership teams. They also quickly recognized opportunities for improvement at all managerial levels among the nursing leaders. They requested the findings be reported to all members of their nursing leadership teams and they are determining what educational and team building activities might be appropriate to address the areas needing improvement.
Conclusion: The nursing leaders who participated in this project had demographic characteristics that are consistent with nursing leaders across the state of Texas and across the nation. Most nurse leaders in the United States are Caucasian females between the ages of 40-55. The data demonstrated that some coaching and RC behaviors were taking place among the leadership teams but there are opportunities for improvements in both areas. The two larger hospitals had better coaching and RC scores; this may have been because the chief nurse executives had recently completed Doctor of Nursing Practice degrees and they supported greater communication and empowerment within their hospitals among all nurses, not just the nursing leaders. It makes sense that the correlations between the coaching scores and the communication aspects of RC were lower than the correlations between the coaching scores and the relationship components of RC. Coaching is, after all, a career development relationship, comprised of components that are indeed relational whereas the communication components of RC are more utilitarian or transactional in nature.
Coaching is an important CDR that is often not clearly understood by nurses and other leaders in healthcare environments. Coaching coupled with RC can help create a work environment where healthcare team members can have better communication and stronger relationships, which serves to potentially improve care quality and safety. This was the first examination of coaching and RC among nursing leadership teams. More research regarding such activities needs to take place to determine if coaching and RC do make a difference in patient outcomes. Educational and RC team building activities need to be explored as interventions to improve not only the care coordination among front-line clinicians such as nurses, physicians, social workers, etc., but also to improve overall organizational effectiveness through better inter-professional career development in healthcare.
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