Prior to the 1980s, the term coach was used to refer to a role in the field of human performance, specifically in the field of athletics. Coaches training athletes for the Olympic games began introducing relaxation, imagery rehearsal, and somatic awareness practices to enhance athletic performance. Winners of the Olympic games popularized these practices.

During the 1960s, with the beginning of the human potential movement, coaching moved outside of sports and into organizational settings. There was an increased demand for greater productivity and enhanced employee performance. This led to programs and coaching designed to promote employee self-development. Additionally, there was a desire to be able to measure and document the effectiveness of these initiatives in meaningful ways. New challenges emerged with the increase in technology, globalization, and multicultural teams located in different countries. Professional coaching and executive coaching became important factors in business. Formal coaching programs were still in their infancy.

By the 1990s, formal coaching programs, courses, and certifications emerged outside of the nursing profession. Most recently, many nurses have added coaching skills to their professional nursing practice. The time has arrived for nurse coaching to be recognized as embedded within the nursing profession and to be fully integrated into all nursing curricula. Criteria for training programs for professional nurse coaches need to be determined and a credentialing process must be developed.

The U.S. healthcare system is undergoing a transformation from a disease-focused system to one focused on wellness, health promotion, and disease prevention. In 2010, the Patient Protection and Affordable Care Act (PPACA) became law (HR 3590).² The language in Section 4001 includes partnerships with a diverse group of licensed health professionals including practitioners of integrative health, preventive medicine, health coaching, public education, and others. In 2011, the United States announced the release of the National Prevention and Health Promotion Strategy, a comprehensive plan that will help increase the number of Americans who are healthy at every stage of life.³ Health coaches are emerging in the health professions and the lay community.

Nursing, recognizing the importance of this emerging role, is stepping forward and claiming its rightful position in this major shift from disease care to disease prevention, improved health, and enhanced well-being. Nurses constitute the largest group of healthcare providers and are uniquely situated for this role. Professional nursing practice is rooted in efforts to assist clients to achieve optimal health. Nurses partner with clients to assess, strategize, and plan. Nurses utilize professional nursing knowledge and skills in their role as nurse coaches.

Professional nurse coaches are emerging as leaders who are informing governments, regulatory agencies, businesses, and organizations about the important part they play in achieving the goal of improving the health of the nation and health at a global level. For example, in 2009, the International Council of Nurses (ICN), a federation of more than 130 national nursing organizations representing millions of nurses worldwide, partnered with the Honor Society of Nursing, Sigma Theta Tau International (STTI) that represents more than 125,000 nurses worldwide, and published Coaching in Nursing.⁴ Professional nurse coaches are taking the lead and engaging clients in self-care and management of healthcare practices and outcomes. Some examples of professional-led nurse coach programs and books are the Bark Coaching Institute,⁵,⁶ the Integrative Nurse Coach Certificate Program (INCCP),⁷,⁸ and the Watson Caring Science Institute Caritas Coach Education Program.⁹

The first edition of Professional Nurse Coach Role: Defining the Scope of Practice and Competencies brings the nurse coach role in healthcare reform to the forefront.¹ It demonstrates nursing’s proactive stance in healthcare transformation and clarifies nursing perspectives concerning the role of the nurse coach in four key ways: (1) it specifies the philosophy, beliefs, and values of the nurse coach and the nurse coach’s scope of practice; (2) it articulates how Professional Nurse Coach Role: Defining the Scope of Practice and Competencies aligns with the American Nurses Association Nursing: Scope and Standards of Practice, 2nd edition;¹⁰ (3) it provides the basis for continued interdisciplinary conversations related to professional health and wellness coaches and lay
health and wellness coaches; and (4) it provides the foundation for an international certification process in professional nurse coaching.

Nurse coaches are guided in their thinking and decision making by four professional resources. The American Nurses Association (ANA) Nursing: Scope and Standards of Practice, 2nd edition, outlines the expectations of the professional role of registered nurses and the scope of practice and standards of professional nurse practice and their accompanying competencies.¹⁰ The ANA Code of Ethics for Nurses with Interpretive Statements lists the nine provisions that establish the ethical framework for registered nurses across all roles, levels, and settings.¹¹ Nursing’s Social Policy Statement: The Essence of the Profession conceptualizes nursing practice, describes the social context of nursing, and provides the definition of nursing.¹² Holistic Nursing: Scope and Standards of Practice from the American Holistic Nurses Association (AHNA) and ANA provides the philosophical underpinnings of a holistic nurse coaching practice.¹³

Nurse coaches work with people to help them improve their overall wellness and gain an enhanced sense of well-being, balance, and satisfaction in their lives. Nurse coaching helps clients to flourish by making healthful choices and adopting healthier behaviors. Wellness is integrated, congruent functioning aimed at reaching one’s highest potential. Human flourishing is when an individual finds and creates meaning in life and identifies his or her purpose in life, however defined; it includes taking charge of one’s own health. Nurse coaches see clients as whole beings, each with the capacity to connect deeply with her or his own inner wisdom and truth.

As described in the Theory of Integral Nursing (see Chapter 1), nurse coaches can use an integral perspective that is a comprehensive way to organize multiple phenomena of human experience and reality in four areas: the individual interior (personal/intentional), individual exterior (physiologic/behavioral), collective interior (shared/cultural), and collective exterior (systems/structures).²⁰,²¹ The nurse coach has insight into her or his own way of orienting in the world. This awareness extends to recognizing personal preferences and biases within each quadrant.

Self-development (self-reflection, self-assessments, self-evaluation, self-care) promotes the recognition of what is going right in life, allowing for the celebration of little successes each day. Coaching is an opportunity to promote and acknowledge success, however small, and then to build on that to achieve further success.

In coaching sessions, the client may also access vulnerable moments and share pain and suffering. Pain is a physical and/or emotional discomfort or experience; suffering is the story people create around pain.²² Signs of suffering may be physical, mental, emotional, social, behavioral, and/or spiritual. This is why it is so important for nurse coaches to develop a reflective practice to strengthen their own capacity to sit with the pain and suffering clients express without trying to fix the discomfort. A useful saying is “soft front and strong back.” This relates to the nurse coach’s skill and capacity to bear witness and engage in inner stillness, to be with the suffering and the sufferer fully in the moment, bearing witness without judgment.

Clients seek professional coaching for many reasons, including to help them explore possibilities and new directions in life, to celebrate successes and identify opportunities for personal and professional development, to enhance quality of life, and to improve relationships. Clients who come for coaching for such reasons usually are not focused solely on problems to overcome or issues to manage but are seeking opportunities to enrich a current way of being.

Other clients come with specific problems and health challenges, seeking nurse coaching to improve management of acute or chronic conditions. Their challenges may be related to selfesteem and self-image, fear and self-confidence, and general adaptation to actual or perceived changes. Other clients seek coaching to learn to handle personal and workplace challenges and stressors or to learn new behaviors in relation to improving health through nutrition, exercise, weight management, enhanced sleep, or
stress management. An important area for nurse coaching is in working with clients who are facing end-of-life issues, either their own or those of loved ones, as well as those clients who are living with loss and grief.