Guest Editorial: Unlocking potential – coaching as a means to enhance leadership and role performance in nursing
Coaching is a new and rapidly expanding professional development approach, which works with individuals, or groups, to facilitate them to maximize their potential and skills, enabling them to become more productive, more effective and more creative. This has particular benefits within the workplace as creativity and innovation are key to the success of dynamic and successful organizations. Within health care, coaching can assist professionals to cope with, and steer, the increasingly complex, multi-faceted and changing organizations which are characteristic of contemporary health services (McNicholl 2002).
The challenge to develop effective leaders of nursing, is common in many countries (Lorentzon & Bryant 1997, McKenna et al. 2004, McAlearney 2005). The NHS Plan (Department of Health 2000) emphasized the need to develop new ways of working which involve every team member being engaged in improving care and modernizing services. Effective leadership was identified as of paramount importance, together with a recognition of the need for lifelong learning and continuing professional development, which is specific to the role and responsibilities of individuals (Department of Health 2004). All healthcare organizations should have in place plans for the learning and development of staff at all levels. However, although leadership courses are available, they are often seen by nurses as academic as not directly relevant to the real world of practice. Cook (2004) suggests this is because they involve generic, decontextualized learning and do not address the unique problems encountered in particular clinical settings. In addition there are often resource issues involved in releasing senior staff to attend courses at an academic institution.
Coaching has enormous potential benefit for nurses, particularly those in leadership roles, as it is a powerful tool to promote personal and professional development fulfilment and effectiveness; tapping into the resources of the whole human being for the benefit of the individual employee and the organization itself. Frequently used as a human resources development strategy and management approach in a wide-range of organizations, the value of coaching is starting to be recognized within healthcare organizations and appears likely to become more widespread.
What is coaching?
Downey (2003) (p. 21) defines coaching as ‘the art of facilitating the performance, learning and development of another’. Most coaches would agree that coaching is a unique and individually tailored intervention that enables individuals to explore and address real-life challenges and to develop their own vision and sense of purpose. The theoretical underpinnings of coaching lie predominantly in the perspectives of cognitive-behavioural psychology and humanistic psychology. Cognitive-behavioural approaches suggest that people can develop and experiment with different alternative viewpoints and behaviours which may be more effective in seeking solutions to previously challenging situations (Neenan & Dryden 2002). Humanistic theory emphasizes the capacity of individuals to learn for themselves, to think for themselves and to be creative (Rogers 1951, Maslow 1987).
How can coaching benefit nursing?
Coaching is about empowering people to take responsibility for themselves and make necessary changes in their professional and personal life. It promotes the view that the goals of organizational effectiveness and personal fulfilment are not incompatible; rather that the one supports the other. Two particular characteristics: action and learning are central to its capacity to advance change (Whitworth et al. 1998). However, unlike reflective practice and clinical supervision, which share a reflective approach, coaching is highly focussed on individuals designing their future – and that of their organization – and achieving excellence through setting personally and professionally challenging goals and committing to taking the actions necessary to achieve them. Coaching also places premium value on the importance of well-honed communication and interpersonal skills, which are essential to motivate and inspire others. Many coaches emphasize supporting individuals to learn these skills of personal and professional self-management, and interpersonal communication, so they can continue to practice them themselves, and pass them on to others, once the coaching relationship has ended (Whitworth et al. 1998, Nelson-Jones 2007).
Within a coaching relationship, therefore, a lead nurse may meet regularly with a coach and, in this confidential, non-judgemental and non-directive relationship, has the opportunity to analyse the everyday problems and challenges they face. The coach will help them to develop a vision of what they wish to achieve, understand the key issues involved in the situation, consider the options that are available to them and make better, and more informed, decisions about the actions they need to take and how to overcome the challenges which exist. Undertaking action and reviewing its impact in the real world of practice is central to the coaching contract. The learning that occurs generates new skills, resourcefulness and confidence, as well as a greater openness and commitment to change. A secondary benefit can be that, in addition to working on improving their own performance and effectiveness, individuals learn to develop and use the skills they have acquired from the coaching experience – clarity of thinking, commitment to action and enhanced communication skills – to create more constructive relationships, and an empowering organizational culture, within their own clinical setting.
Those who experience coaching frequently find it to be a powerful and empowering experience that rekindles motivation, fulfilment and autonomy, with subsequent beneficial consequences for patient care and organizational effectiveness. Within health services that are driven by targets and efficiency drives, this unlocking of human potential can breathe life, energy and enthusiasm back into the world of work. Nursing needs leaders who can inspire and motivate others and act as role models. Because of its infancy as an intervention, research into coaching is minimal. However, a small qualitative study (Reid Ponti 2006) found that nurse leaders who had experienced coaching described it as an effective way to identify, explore and correct behaviours that hampered their performance, which helped them to improve their effectiveness and that of their organization as a whole.
In the UK, the National Health Service has for some time provided coaching for those in Chief Executive roles. However, organizational effectiveness is dependent on the quality of leadership which exists at all levels (Firth-Cozens & Maubray 2001). Many nurses working in lead positions within the NHS, such as directors of nursing, nurse consultants, modern matrons and unit managers, have had little training in leadership skills. However health services are multi-faceted organizations which are constantly changing and developing and those in leadership roles at all levels must function within a service characterized by the range and diversity of stakeholders, complex resourcing arrangements and frequently changing priorities. Coaching can assist nurses in leadership roles to function more effectively as key members of the healthcare organization and contribute towards shaping the organization's values, strategy and direction. It can also help them to acquire the highly developed interpersonal skills which are needed to make this contribution and to manage themselves, their staff and their units effectively.
The way forward
The current context of health care in the UK, and elsewhere, is complex, demanding and often characterized by limited resources. Recruitment and retention are frequently problematic. Coaching can help nurses in leadership roles, at a variety of levels, to find constructive ways of dealing with these challenges with benefits for the individual and the organization. Coaching can take place on a one-to-one basis, or within a group Action Learning Set, where the coach facilitates a team of peers to work together towards a mutually agreed goal – such as resolving a clinical issue or designing and implementing a practice-based innovation – or to work on individual professional challenges.
In addition, while this editorial has focused on coaching to enhance nursing leadership, coaching also has potential benefits for clinical care and health promotion. The current context of health care, with its emphasis on patient-led care and patient empowerment, requires nurses who are able to develop partnerships with patients which recognize individuals’ autonomy and need to make their own decisions about their lifestyle and behaviour. The communication skills and emphasis on autonomy and personal responsibility that coaching involves would be invaluable in assisting nurses to engage in the real partnerships with patients that underpin the provision of the highest quality, patient-centred care.