Coaching for Competence Introduction The field of nursing is both a science and an art. New nurses graduate with, at least, acceptable basic competence. They are expected to have the ability to effectively communicate and make decisions in a complex environment with multiple demands on their practical comprehension. However, they usually lack the experience to apply this learned theory. This limited knowledge results in anxiety and difficulty in transitioning from the role of student to leader. How these students can best learn these skills is a topic that has come under considerable debate.

We know that most become overwhelmed with multiple tasks and not able to prioritize with critical thinking in a fast pace acute hospital. This begs the questions: How do we make that transition phase easier for them and the staff around them? How do we get the doing and thinking to intertwine together? The article, Coaching for competence, gives one example of how to foster critical thinking skills in novice nurses as well as establish a culture that would help its entire staff to grow and excel together. Model concept and implementation The nursing leadership of a 37-bed acute medical unit at the Mayo Clinic in Rochester, MN faced a challenge when they had significant numbers of new nurses hired during the year for a busy acute care general medical unit. The original policy for new nurses involved a six to eight week orientation with a preceptor who assisted new hires to assume complete care for an increasing number of patients.

Once the new hire was handling a full patient case load independently, a "resource nurse" with her own full patient assignment remained available for direction and guidance for the next four weeks. While this orientation process was considered extensive, an extended learning period was needed due to the number of new hires. For this reason, the leadership team began to devise a plan to blend the acts of thinking with doing. This plan needed to encourage and stimulate the new nurses to develop "self-directed, self-correcting, and innovative strategies in dealing with challenges". They were to develop competency and critical thinking in the novice nurses to a higher level of professional thinking.

Thus, a coaching concept model was developed by the nurse manager, clinical nurse specialist, and nursing education specialist Preparing to initiate the program Only staff members with solid work histories, who demonstrated sound clinical skills and a commitment to encouraging growth in novice nurses, were invited to become coaches. The goal of the unit coach was to build critical thinking skills and judgment in newer staff to allow them to become confident and competent more quickly. The coaches worked for three weeks along with the leadership staff to develop the program. A four hour training session was provided for each coach to build a general list of questions that would provoke critical thinking by the newer nurses.

When the time came, they launched the new program with a sports theme lunch, posters and the coaches wore symbolic whistles. The coaches were there to witness all actual practice, prompt thinking and evaluate the outcome. They were to ask questions from the nurses instead of telling. They were not to be disciplinary. Nurse leadership designed lists of preferred activities for the coaches. The coaches who were assigned this role were not to give patient care or be extra staff.

Rather, they would be assigned several new oriente es after they were done with their initial orientation. They were to be available for the new nurses to ask questions; they prompted the nurses to think and reflect on the best course of action. The initial implementation of this program demonstrated the need for the newer nurses to have this guidance available. The new nurses asked multiple questions and needed help in prioritizing care. Their lack of knowledge included areas of patient discharge arrangements, administration of medications, patient teaching resources and strategies. As the program continued, the charge nurses began to utilize the coaches for "directions for prioritizing, classifying patients for acuity, determining staffing needs, workplace competencies, documentation and charting".

The questions by the newer nurses and staff grew to more complex issues involving dealing with anxious patients and handling difficult situations like patient death. Evaluation and evolution The overall impact of the program was positive; the staff members felt that new hires were more competent and the newer nurses reporting less anxiety. After a new clinical nurse specialist was hired, the coaches moved to the evening shift. Finally, once the need for the coaches diminished, they returned to their previous positions. When a large number of new nurses were hired again, the staff wanted the coaching positions to return. As money was not available in the budget, this was not possible.

However, the principles and the methods used by the coaches were adopted by the preceptors. A subsequent program was developed from the coaching model that included training preceptors in coaching techniques, a preceptor handbook, a preceptor council with monthly meetings and a preceptor newsletter. Another outcome from this experience was a decrease in turnover in staff. While the innovative approach to the crisis faced at the Mayo Clinic may not be feasible as a regular program, a solid foundation for precept ing new nurses was developed as a consequence. Conclusion Historically, preceptors and coaches have served as liaisons between graduate nurses and the reality of the workplace. The function of coaches is to train new or transitioning nurses to function more efficiently in a short period of time.

This concept has become increasingly more important in recent years. In order to accomplish this goal, leadership must promote positive attitudes in the expert nurses toward accepting and functioning in the roles of coaches and preceptors. Without the support of a coach, novice nurses would not develop the ability to be creative or think critically. The overall conclusion of the coaching concept model demonstrates that patient care and nursing job satisfaction are significantly enhanced where critical thinking skills are fostered and promoted. In today's environment of nursing staff shortages, budget constraints and a higher patient acuity, this is no small task to accomplish. However, it is still our primary responsibility in our profession to take the actions necessary to enhance our practice.

Rather than being discouraged over the reality of our situation, we should become more creative in our solutions. This creativity was expressed in development of the coaching model. Finally; we found that nursing units that promote critical thinking, professionalism and cohesion will result in higher staff retention rate

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