american holistic nurses credentialing corporation...dec 30, 2020 · d) values all life...

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AMERICAN HOLISTIC NURSES CREDENTIALING CORPORATION

PROFESSIONAL NURSE COACH ROLE: CORE ESSENTIALS

© Not to be reprinted without permission

December 2020

AHNCC Nurse Coach Essential Knowledge

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BACKGROUND: NURSE COACH ROLE ESSENTIALS

A. Purpose of an Outline of Essential Knowledge

The Core Essentials for a Certification Program provides a general overview of the knowledge, skills,

behaviors, and attitudes needed for national certification in a specific role or specialty in professional

nursing. The Core Essentials presented here is for the Nurse Coach Role Certification Program.

B. Derivation of knowledge, skills, behaviors, and attitudes

Nursing practice is based on Standards of care (ANA, 2010); the competencies associated with each Standard specify the knowledge, skills, behaviors, and attitudes necessary to perform professionally (Appendix A). Core Values provide a context for implementation of the competencies. Thus, the Standards of Nursing provide the overall framework for professional nursing practice, and competencies specify knowledge, skills, behaviors, and/or attitudes needed for the practice as a professional nurse, and core values provide a context for practice.

The Standards are identified by the profession; the competencies are derived from the literature and interviews of expert (role or specialty) practitioners; and the core values are defined by the specialty. Competencies are prioritized and validated by a role-delineation study. Relations among the Standards, Competencies, and Core Values are mapped and validated by members of the specialty.

C. Structure of the Core Essentials Outline

The Nurse Coach Certification examination is based on the competencies (which specify or operationalize the Standards), and are mapped within the context of the Core Values. The competencies were derived through a review of the literaturei, primarily drawing from the seminal manuscript, The Art and Science of Nurse Coaching: The Providers Guide to Coaching Scope and Competencies. (2013). Hess, D., Dossey, Southard, M., B., Luck, S., Schaub, B., Bark, L. The literature

can be found at the end of this document. Each competency shown in the Core Essentials (below) is

the same as shown in Appendix A. However, they are organized according to the mapping by the Core

Values. Therefore, the listing of the competencies is not sequential, but instead, organized according

to the Core Values. For example, Core Value 1: Nurse Coach Philosophy, Theory, and Ethics has

multiple competencies associated with it. As shown in the example below, competency 1 is followed

by competency 19. Competencies 2-18 are mapped under Core Value 2: Nurse Coaching Process.

A. Core Value 1: Nurse Coach Philosophy, Theory, EthicsNurse Coach Philosophy and Theories

(1) Acknowledges, respects and affirms the client as the authority on his/herown health and wellbeing.

a) Acquires, comprehends and applies knowledge/skills related toclient as authority.


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(19) Acknowledges that new goals will emerge as the client unfolds over time.

In some cases, additional detail is provided after the competency. When this happens, it is indented and preceded by an alpha (e.g. a), number (e.g. 1), or a bullet (e.g. •). The additional information is provided to clarify the intent of the competency, and to specific information needed to clarify the depth of knowledge required to meet this competency.

D. The Certification Examination

The Essentials Outline provides study guidelines for the Nurse Coach certification candidate. A Preliminary Blueprint for the examination is provided in Appendix B. The Preliminary Blueprint, that provides the certification candidate information about the focus of the examination, was derived from the mapping of the competencies according to the Core Values. The Preliminary Blueprint will be adjusted according to the results of the RDS.

THE NURSE COACH CORE ESSENTIALS

A. Core Value 1: Nurse Coach Philosophy, Theory, Ethics

Nurse Coach Philosophy and Theories

(1) Centers and grounds self at the beginning of each coaching interaction.

a) Acquires knowledge/skills needed to center self.b) Uses centering activities/procedures prior to and throughout thecoaching process.

(2) Acknowledges, respects and affirms the client as the authority on his/her ownhealth and wellbeing.

a) Acquires, comprehends and applies knowledge/skills related toclient as authority.

(20) Acknowledges that new goals will emerge as the client transforms over time.

(32) Aligns own intention with the client’s goals.

a) Acquires knowledge/principles of intentionalityb) Develops skills related to setting intentionalityc) Sets intent to stay focused on client needs

(35) Remains fully present, centered, and grounded at the beginning and throughout thenurse coaching process.

a) Maintains an interested, open, and reflective approach to the client.


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b) Is comfortable with silence or pausing to assist the client withreflection and finding new understanding of next steps.c) Draws upon the precepts of the human energy field/system to assistclient in achievement of goals.

(36) Uses intentionality, aligned with client’s goals, throughout the coachingprocess.

a) Applies client-focused intentionality knowledge and skills in nursecoaching process.

(40) Accesses and trusts one’s own personal knowing (e.g. intuition and hunches/gutfeelings).

a) Develops skills needed to assess, trust multiple ways of knowing

(42) Demonstrates authenticity (honesty, sincerity, personal integrity).

a) Acquires knowledge and behaviors related to authenticity.b) Use self-reflection as way to acquire self-knowledge, self-

awareness, and gain inner-wisdom essential for enhancing self- authenticity.

(43) Demonstrates respect for client’s subjective experiences expressed as storiesand perceptions.

a) Develops and applies knowledge/skills needed to facilitate client’sself-expressed life stories.b) Uses documentation methods that provides information whileprotecting confidentiality.

(45) Acknowledges client resistance as an opportunity for self-awareness andgrowth.

a) Acquires, comprehends, and applies knowledge/skills related tosophisticated communication.

b) Understands resistance to change is a way of defending against fearof failure and/or fear of knowing.

(47) Uses holistic, sophisticated verbal and non-verbal communication skills, including(but not limited to) active listening, relevant use of language and focused questioning.(Core Value 3)

(51) Empowers the client’s goal attainment. (Core Value 3)

(95) Understands that clear, respectful, skillful, sophisticated communication is afundamental and essential component of the Professional Nurse Coach relationship.


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(97) Communicates with family, significant others, caregivers, health care providers, and

others to assist and enhance the client’s achievement of coaching goals, when requested by the client.

(98) Able to distinguish between telephone and internet-technology based healthcoaching, and telehealth (tele-education).

Nurse Coach Ethics

(63) Uses the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015),the Position Statement on Holistic Nursing Ethics (AHNA, 2012) to guide practice andarticulate the foundation of the Professional Nurse Coach Practice.

a) Clearly communicates to the client and others the distinctionsamong coaching, consulting, counseling, and teaching.b) Provides coaching in a manner that recognizes and respects theclient’s autonomy, dignity, rights, values, and beliefs.c) Maintains an effective coaching relationship that is congruent withthe coaching agreement and within the boundaries of professionalnursing practice.

d) Values all life experiences as opportunities to find personalmeaning and cultivate self-awareness.

(65) Acknowledges that principles of holistic, human caring are central to the NurseCoach’s practice.

a) Acquires and uses knowledge/skills essential to facilitate theholistic human caring process.

(66) Acknowledges that the nurse coaching process is based on a trusting,intimate nurse-client relationship.

a) Understands and applies factors related to development of atrusting, intimate relationship.b) Understands and applies factors related to maintenance of ongoingrelationship.

(67) Acknowledges that the nurse coaching process is a dynamic, systematic, andskilled process.

(68) Uses Holistic Nursing Principles to guide nurse-client interactions throughoutthe coaching process.

a) Continuously exhibits authenticity, honesty, sincerity, personalintegrity.

b) Maintains client confidentiality with legal and regulatoryparameters.


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c) Reinforces client as authority of own health and well-being.

d) Uses client’s worldview as framework for setting goals andoutcomes.

e) Supports the client in directing the agenda/focus of the coachingprocess.

f) Facilitates client in identifying strengths for change.

(69) Understands and effectively discusses with the client the ethical guidelines and

specific parameters of the Nurse Coaching relationship (e.g., logistics, fees, scheduling).

a) Uses ethics of Nurse Coaching to guide development, maintenance,and closure of Nurse-Client relationship.

b) Applies ethical business parameters of the Nurse Coachrelationship.

1. Developing and maintaining a nurse coach practice.2. Space requirements3. Advertisement4. Setting and keeping schedules.5. Accounting considerations including setting fees, maintaining records,third party reimbursement, and documentation.

(70) Facilitates client’s expression of new ideas, behaviors, and actions that may involverisk-taking and fear of failure.

(71) Clearly communicates and clarifies distinctions among coaching, consulting,counseling, and teaching to clients and others as indicated.

a) Acquires and communicates knowledge of coaching, consulting,counseling, and teaching parameters (including purpose, process,outcomes, and required expertise for each).

(72) Partners with clients to individualize the Nurse Coach Process

(74) Supports the client’s inner-wisdom, intuition, and innate ability for knowing what isbest for self throughout the Nurse Coach Process.(75) Implements the Nurse Coach Process in a manner that promotes the client’sautonomy, dignity, rights, values, beliefs, and strengths.(76) Maintains an effective coaching relationship that is congruent with thecoaching agreement and within the boundaries of professional nursing practice.

(77) Performs the nurse coaching process by integrating knowledge, skills,intuition, and judgment.

a) Acquires and uses evidence-based knowledge related to health processesassociated with common health problems, e.g. obesity, CAD, diabetes, etc.


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b) Acquires and uses evidence-based knowledge and skills related tofacilitating healthy lifestyle behaviors, changes/management.

1. Acquires and uses knowledge and skills necessary to motivateclients to embrace healthy lifestyle changes.2. Acquires and uses knowledge and skill necessary to haltingand/or reversing common health problems.3. Acquires and uses knowledge and skills necessary to preventcomplications related to chronic health conditions.4. Integrates and uses various types of knowledge as indicated byclient’s worldview and life situation.

(78) Values all life experiences as opportunities to find personal meaning andcultivate self-awareness, self-reflection, and growth.

a) Uses life experiences as learning opportunity.

(79) Maintains client confidentiality within legal and regulatory parameters.(108) Refers client to other professional and services as needed.(110) Considers the effect of one’s personal values, culture, spiritual beliefs,experiences, biases, and education on the Nurse Coach services provided to individuals,groups, and organizations.

a) Undergoes/practices continuous self-reflection, self-assessment asa way to learn about self in relationship to others.

(109) Provides Nurse Coaching services in a manner that is age-appropriate andsensitive to culture and ethnicity.

a) Seeks and uses developmental knowledge/skills to guide planningof interventions.b) Develops/uses cultural competencyc) Develops/uses appropriate consultation/referral resourcesthroughout coaching process.

B. Core Value 2: Nurse Coaching Process(1) Centers and grounds self at the beginning of each coaching interaction (Core Value 1)(3) Explores the client’s reason for seeking a nurse-coach relationship at this time.

a) Uses sophisticated communication skills needed to explore client’sconcerns, needs, fear-of-knowing, and/or fear-or-change.

(4) Assesses environment for distractions that might interfere with establishing asafe, trusting, intimate relationship.(5) Partners with the client to co-create a relationship that promotes trust,intimacy, and self-discovery.(6) Partners with the client to facilitate expression of the specific purpose of thecoaching process.(7) Partners with the client to facilitate expression of client’s strengths andresources related to purpose of coaching


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(8) Partners with the client to assess readiness for change.a) Acquires, comprehends and applies knowledge/skills related the individual’sreadiness to change.b) Clarifies stages of change: pre-contemplation, contemplation,preparation, action, maintenance.c) Accepts, explores, reinforces, and encourages client’s expression ofperceptions, concerns, beliefs, suggestions, etc.d) Recognizes incongruence between body language, words used, andthe tone of voice.e) Identify and clarify factors related to incongruence, e.g. fear-of-

failure, fear-of-success. f) Develop strategies needed to overcome incongruence.g) Develops strategies needed to overcome risk-taking.

(9) Partners with the client to assess the individual’s internal environment (feelings,perceptions, physical sensations) for distracters that might interfere with the coachingprocess.(10) Partners with client and seeks permission to explore areas of client vulnerability.

a) Acquires and uses communication knowledge/skill/strategies needed to gainpermission to explore areas of vulnerability.b) Identifies and clarifies areas of vulnerability and related factors.c) Seeks permission to explore areas of vulnerability.

(11) Uses multiple types of knowing, including intuition, when facilitating client’sexpression of needs.(12) Validates own intuitive knowing with the client when appropriate.(13) Assesses client’s needs and coping abilities using focused interviewing skills.(14) Uses appropriate evidenced-informed, whole person assessments techniquesand instruments to identify and clarify the client’s needs.

a) Acquires and use various assessment techniques/instrumentsb) Understands and considers various pros and cons of variousapproaches

(15) Assesses the match between the client’s needs and expectations, and thecoach’s knowledge and skills.(18) Interprets, analyzes, and synthesizes multiple sources of information acquired byidentifying patterns among client’s needs, concerns, and/or opportunities for change.(19) Documents the patterns detected in the analysis and synthesis of information in asafe and retrievable manner.(23) Facilitates clients to specify expected outcomes that are clear, action-oriented,realistic, and time-lined.

a) Facilitates client in setting outcomes/goals that are specific andmeasurable.


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b) Evaluates outcomes/goals for to ensure that they are realistic andaction-oriented.c) Sets appropriate timelines for evaluation of progress.

(24) Acknowledges that emergence of new goals will require revision of expectedoutcomes.

a) Process of new-goal emergence

(25) Facilitates clients’ exploration and discovery of alternative goals and expectedoutcomes.(26) Facilitates clients’ self-discovery, clarification, and validation of linkages amongtheir needs, the diagnoses, goals, and client’s expected outcomes(27) Partners with the client to co-create an agreement that identifies the specificparameters of the relationship, including the roles and responsibilities of the NurseCoach and the client.(28) Partners with the client to identify and plan for strategies needed to achievethe coaching goals, and effect the expected outcomes.

a) Acquires and applies knowledge/skills need to identify and plan for goalachievement.b) Identifying barriers to goal achievement.

• Overcoming barriers.c) Selecting appropriate strategies related to specified goals.d) Reworking coaching plan as indicated.

(29 Partners with the client to explore resources, laws, rules and regulations of their State Board of Nursing, related to the goals, strategies, and expected outcomes. (33) Partners with client to evaluate and minimize the potential effect of externaldistractions.(34) Partners with client to terminate or reschedule coaching session whendistractions interfere with effective coaching interactions.(44) Demonstrates respect and unconditional acceptance of client’s learning style andculture (e.g. beliefs, values and customs).(46) Chooses coaching strategies or techniques that can be most effective given thecircumstances and time frame.(48) Partners with the client to facilitate and reinforce learning important to goalattainment.(48) Uses relevant principles, models, and theories to facilitate learning and growth.(49) Uses relevant strategies and/or modalities that facilitate mind-body-spirit-emotion-environment integration.(53) Identifies and reviews client’s current status, planned goals, and expectedoutcomes.(54) Identifies with the client the next specific action steps and a timeline that willlead to achievement of desired goals.(60) Documents evaluation of progress and attainment of coaching goals.

a) Reviews previous data


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b) Compares past and current data/information.c) Identifies accomplishments, challenges, barriers, facilitators.d) Evaluates progress, need for change.

(55) Assists the client to assume control over own progress by reviewing negotiatedroles and responsibilities, including stated actions, results, and related time frames.(56) Partners with the client to review progress made during and betweencoaching interaction(s).

a) Inquires of the client if coaching session outcomes have been achieved.

b) Identifies the connection between where the client is and whereshe/he wishes to go.c) Identifies with the client the next specific action steps and atimeline that will lead to achievement of desired goals.d) Assists the client to manage progress by holding the clientaccountable for stated outcomes, results, and related time frames, whilemaintaining a positive and trusting relationship with the client.e) Determines with the client when the next coaching interaction willoccur.f) Periodically, prepares, organizes, and reviewinformation, including past and current actions, with the client thatpromotes achievement of client goals.g) ends the coaching interaction in an energetic, positive, andsupportive manner.

(57) Partners with the client to determine the time of the next coaching interaction.(58) Documents communications with client in a clear, concise, safe and easilyretrievable manner.(59) Assists the client to evaluate goal attainment in respect to planned expectedoutcomes.(60) Supports the client’s determination of progress and success.(61) Partners with client to use findings from the evaluation process to reassess client’sneeds, preferred strategies, goals and expected outcomes.

a) Assists the client to evaluate effectiveness of strategies in relationto the client’s responses and the attainment of the expected andunfolding goals.b) Supports client autonomy by recognizing the client is thedeterminant of progress and success.

(62) Documents evaluation of progress and attainment of coaching goals.

a) Tracks the client’s issues and concerns and/or opportunities forcoaching.b) Evaluates direction of change over time.

(64) Demonstrates expertise in the six components of the Nurse Coach Process:Establishing a relationship and assessing readiness for change, identifying


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opportunities, issues, and concerns, establishing client-centered goals, and expected outcomes, creating the structure of the Coaching Interaction, empowering and

motivating clients’ goal attainment, assisting client’s evaluation of goal attainment. (103) Promotes the success of others by utilizing effective Nurse Coaching interventions.(104). Demonstrates energy, excitement, and a passion for quality Nurse Coaching.(105) Demonstrates the ability to define a clear vision, associated goals and a plan to implement and assess progress toward expected outcomes.(106) Partners with others to promote nurse coaching as a way to enhance client outcomes.(107) Applies coaching skills with individuals and groups to identify and achieve individual, group, and organizational goals.(108) Refers client to other professionals and services as needed.(109) Utilizes The Art and Science of Nurse Coaching: The Providers Guide to Coaching Scope and Competencies (2013) to evaluate quality of practice.

a) Participates in quality improvement to enhance the ProfessionalNurse Coaching Practice.b) Contributes to the education of others concerning ProfessionalNurse Coaching Practice.c) Documents Nurse Coaching interactions in a responsible,accountable, and ethical manner that will facilitate quality review and promotion of effect Nurse Coaching practice.d) Uses creativity and innovation in Nurse Coaching to improve client outcomes.e) Analyzes organizational systems for barriers to effectiveimplementation of the Professional Nurse Coaching practice.f) Considers the effect of one’s personal values, culture, spiritualbeliefs, experiences, biases, and education on the provision of NurseCoaching services to individuals, groups, and organizations.g) Provides Nurse Coaching services in a manner that is appropriateand sensitive to culture and ethnicity.

(110) Recognizes that the Professional Nurse Coaching Practice is enhanced by ongoing self-development to promote physical, mental, emotional, social, and spiritual well-being.

a) Engages in self-evaluation of coaching practices on a regular basis, identifying areas of strength as well as areas in which additionaldevelopment would be beneficial.b) Obtains evaluative feedback regarding one’s own coaching fromclients, peers, and professional colleagues and takes appropriateaction based upon the feedback.c) Pursues Nurse Coach Certification as a way to promote and validatethe Nurse Coach role to colleagues, clients, and the public.d) Seeks personal and professional coaching to enhance quality ofNurse Coaching practice.


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e) Integrates knowledge from research on coaching into own practice.

C. Core Value 3: Nurse Coach Communication and Therapeutic Environment

Communication (16) Partners with clients to clarify their statements used to express their needs,concerns, strengths, and/or opportunities for change.

a) Acquires and uses sophisticated, holistic communication skillsneeded to facilitate the Nurse Coaching Process.b) Focuses on what client is saying (not saying) to understandmeaning.

1. Uses Deep Listening Skills•Accepts, explores, reinforces, and encourages the clientsexpression of perceptions, concerns, beliefs, suggestions.•Recognizes incongruence between body language.•Paraphrases, reiterates, and summarizes what clients havesaid to ensure understanding and clarity.•Focuses on the essence of the client’s communication whenclient becomes involved in long explanatory descriptions.•Allows the client to express strong feelings withoutjudgment in order to facilitate movement towardsachievement of goals.•Acknowledges client’s ambivalence to change and helpidentify barriers.

c) Uses powerful questions and feedback strategies to facilitate clientdiscovery, identification, and clarification of own needs, concerns,reasons for coaching.

(17) Confirms and validates clients’ needs, concerns, opportunities for change, andrelated strengths.(21) Facilitates clients to clarify and specify client-centered goals.(22) Supports the client’s discovery of new goals as growth occurs.(37) Maintains a curious, open, and a reflective approach to the client’s verbal andnonverbal cues.(47) Uses holistic, sophisticated, verbal and non-verbal communication skills,including (but not limited to) active listening, relevant use of language, and focusedquestioning.

a) Acquires sophisticated, holistic, verbal and non-verbalcommunication skills needed to facilitate the Nurse Coaching Process.b) Uses relevant language

1. Uses language, including metaphors and analogies, whichassist the client to explore perspectives, uncertainties, oropportunities for change.


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2.Uses language that is nonjudgmental, appropriate, andrespectful.3. Uses language that reflects the client’s worldview, beliefs, andvalues.

(51) Empowers the client’s goal attainment.(92) Uses creativity and innovation in Nurse Coaching practice to improve client outcomes.(93) Analyzes organizational systems for barriers to effective implementation of the Professional Nurse Coach Role.(94) Advocates for the use of The Art and Science of Nurse Coaching: The Providers Guide to Coaching Scope and Competencies to evaluate quality of practice.(95) Understands that clear, respectful, skillful, sophisticated communication is a fundamental and essential component of the Professional Nurse Coach relationship.(96) Uses sophisticated communication skills to enhance all aspects of theCoaching Process.(97) Communicates with family, significant others, caregivers, health-care providers, and others to assist and enhance the client’s achievement of coaching goals, when requested by client.

a) Uses Powerful Questioning skills/techniques1.Asks open-ended questions that create greater insight, clarity,and/or new possibilities and learning.2.Asks questions that move the client toward desired goals.3.Asks questions that evoke discovery, insight, commitment oraction (e.g. those that challenge the client’s assumptions).4.Uses inquiry for greater awareness, clarity, andunderstanding.

b) Uses direct communication1.Provides feedback in a clear and direct manner.2.Shares insights with client in ways that are practical andmeaningful.3.Explores client’s assumptions and perspectives to evoke newideas and discover new possibilities for action.4.Challenges the client to stretch and be challenged, whilemaintaining a comfortable pace with the client.

c) Uses integrated, holistic communication skills1.Supports the client’s inner-wisdom, intuition, and innateability for learning.2.Identifies with the client additional areas for learning thatfacilitates growth and development.3.Assists clients in uncovering ambivalence, concerns, typicaland fixed ways of perceiving self and the world, interpretationsof experiences, and differences.4.Facilitates clients to identify factors that impede change.


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5. Facilitates clients to identify strengths and opportunities forlearning and growth.6. Acknowledges and uses client resistance as an opportunity forself-awareness and growth.7. Shares information with client that facilitates him/her toconsider new perspectives.8.Encourages and supports the client to experiment and to apply whathas been learned from the coaching interaction.9.Assists clients to determine actions that will enable them todemonstrate, practice, and deepen new learning.10.Facilitates the client in taking action that will most effectivelylead to achievement of desired goals and prevent relapse.

(98) Able to distinguish between telephone and internet-technology based health-coaching and telehealth (tele-education).(99) Identifies and uses best practice guidelines for in-person coaching interventions.(100) Identifies and uses best practice guidelines for telephone health coaching.interventions.(101) Advocates for the role of the Nurse Coach at work and in professionalorganizations.(102) Develops emotional and spiritual intelligence to enhance leadership skills.(104) Demonstrates energy, self-confidence and enthusiasm, for quality NurseCoaching.(105) Demonstrates the ability to define a clear vision, associated goals, a plan toimplement and assess progress toward expected outcomes.

Coaching Environment

(41) Uses techniques and strategies to create and maintain a safe, supportiveenvironment that fosters intimacy and trust throughout the nurse coaching process.

a) Identifies factors that create a safe, supportive environment.b) Identifies techniques/strategies that facilitate maintenance offactors.c) Identifies barriers to a safe, supportive environment.d) Identifies strategies needed to prevent/decrease/eliminatebarriers.

(116) Evaluates factors such as safety, effectiveness, availability, cost and benefits,efficiencies, and impact on Nurse Coaching practice when suggesting options for theclient that would result in the same expected outcome.(117) Assists the client, as appropriate, in identifying and securing appropriate andavailable services to facilitate achievement of client goals.(118) Acknowledges that healthy environments encompass both the internal andthe external environment.


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a) Facilitates clients in identifying personal physical, psychological,emotional, cognitive, and spiritual resources needed to create healthyinternal and external environments.

(119) Recognizes that cultural, psychological, social, and historical factorsinfluence the internal and external environment.(120) Considers the internal and external environmental resources of self and clientregarding contribution to client goal achievement.

a) Evaluates external factors such as safety, effectiveness, availability,cost and benefits, efficiencies, and impact on Nurse Coaching practice whensuggesting options for the client that would result in the same expectedoutcome.b) Assists the client, as appropriate, in identifying and securingappropriate and available services to facilitate achievement of clientgoals.c) Facilitates client in identifying and evaluating internal resourcesneeded to achieve goals.

D. Core Value 4: Education, Research, and Leadership

Education (80) Seeks and participates in ongoing educational activities to enhance ownknowledge and skills needed to practice in the Nurse Coaching role.(82) Seeks self-development opportunities specific to identified areas for improvement.

a) Develops and uses a broad knowledge base related to holisticnursing care, integrative health, health systems, professionalcoaching competencies, counseling, health education, healthpromotion, and nursing practice issues.

(83) Documents and maintains evidence of Nurse Coaching competency.a) Comprehends purpose of continued education.b) Supports certification as means of documenting competency.

(84) Develops and utilizes a broad knowledge base related to holistic/integralnursing, integrative health, health systems, coaching, counseling, health education,and nursing issues.(85) Seeks and develops competencies required for national certification as aProfessional Nurse Coach.

a) Comprehends and articulates purpose of certification.b) Comprehends certification process.c) Understands and supports outcomes of certification.d) Actively seeks national certification as a Nurse Coach.

Research (86) Utilizes the best available evidence, including theories and research findings toguide and enhance the Professional Nurse Coaching Practice.


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(87) Participates with others to establish research priorities and to identifyresearch questions or areas for inquiry related to the Professional Nurse CoachingPractice.(88) Participates in research activities related to the Professional Nurse CoachingPractice.

Leadership (89) Participates in quality improvement by participating in on-going learning such aspeer, individual or group supervision or other professional developmentopportunities.(90) Contributes to the education of nurses, healthcare providers, and othersconcerning the Professional Nurse Coach Role.(91) Documents Nurse Coaching interactions in a responsible, accountable, and ethicalmanner to facilitate quality review and promotion of effective Nurse Coaching practice.(106) Partners with others to promote nurse coaching as a way to enhance clientoutcomes.

a) Develops cognitive, emotional, moral, and spiritual intelligence toenhance leadership skills.b) Promotes the success of others by using effective Nurse Coachinginterventions.c) Demonstrates energy, excitement, and a passion for quality NurseCoaching.d) Willingly accepts that mistakes will be made by self and others whentaking risks to achieve goals.e) Displays the ability to define a clear vision, associated goals, and a plan toimplement and measure progress toward goals.f) Acquires and uses effective communication and change skills withindividuals and groups to collaboratively identify and achieve individual,group, and organizational goals.

1. Change theory including phases of change2. Communication theory applied to change)

g) Works collaboratively with other health and wellness coaches in inter- professional development initiatives.

h) Collaborates with others to promote nurse coaching as a way to enhanceclient outcomes.

(111) Pursues Nurse Coach Certification as a way to demonstrate competency andto promote the Nurse Coaching role to employers, clients, and the public.

E. Core Value 5: Self-Reflection, Self-Assessment(38) Reflects on one’s own reactions to client throughout the nurse coaching process(39) Uses multiple ways of knowing throughout the coaching process, includingunknowing, reflective, and integrative knowing.

a) Developing Ways-of-knowing to self-reflection, self-assessment.b) Applying Ways-of-Knowing to facilitate own self-growth, development.


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(81) Uses routine, self-reflective practices to assess own strengths and opportunitiesfor improvement.(112) Engages in self-evaluation of coaching practice on a regular basis, identifying areasof strength, as well as areas in which additional development would be beneficial.(113) Obtains evaluative feedback regarding one’s own coaching from clients, peers,and professional colleagues and takes appropriate action based upon the feedback.


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APPENDIX A

NURSE COACH ROLE: STANDARDS OF PRACTICE

AND RELATED COMPETENCIES

ANA Standard 1. Assessment: The registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and/or the situation.

Professional Nurse Coach Role: Setting the foundation for coaching begins during the assessment phase of the coaching interaction. Assessment begins by becoming fully present with self and client before initiating the coaching interaction. Assessment proceeds to establishing relationship with the client and access to the client’s subjective experience/story and internal frame of reference through the cultivation and establishment of relationship. The Nurse Coach determines if the client’s concerns are appropriate for the coaching role. The Nurse Coach helps the client assess readiness for change. Assessment is dynamic and ongoing.

The Nurse Coach:

1. Centers and grounds self at the beginning of each coaching interaction

2. Acknowledges, respects and affirms the client as the authority on his/her own health and

wellbeing.

3. Explores the client’s reason for seeking a nurse-coach relationship at this time.

4. Assesses environment for distractions that might interfere with establishing a safe, trusting,

and intimate relationship.

5. Partners with the client to co-create a relationship that promotes trust, intimacy, and self-

discovery.

6. Partners with the client to facilitate expression of the specific purpose of the coaching process.

7. Partners with the client to facilitate expression of client’s strengths and resources related to

purpose of coaching.

8. Partners with the client to assess readiness for change.

9. Partners with the client to assess the individual’s internal environment for distracters that

might interfere with the coaching process.

10. Partners with client and seeks permission to explore areas of client vulnerability.

11. Uses multiple types of knowing, including intuition, when facilitating client’s expression of


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needs.

12. Validates own intuitive knowing with the client when appropriate.

13. Assesses client’s needs and coping abilities using focused interviewing skills.

14. Uses appropriate evidenced-informed, whole person assessments techniques and

instruments to identify and clarify the client’s needs.

15. Assesses the match between the client’s needs and expectations, and the coach’s knowledge

and skills.

ANA Standard 2. Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or the issues.

Professional Nurse Coach Role: The Nurse Coach and the client together explore assessment data to determine areas for change.

The Nurse Coach

16. Partners with clients to clarify their statements used to express their needs, concerns,

strengths, and/or opportunities for change.

17. Confirms and validates clients’ needs, concerns, opportunities for change, and related

strengths.

18. Interprets, analyzes, and synthesizes multiple sources of information acquired through the

assessment process to identify patterns among client’s needs, concerns, and/or opportunities for

change.

19. Documents the patterns detected in the analysis and synthesis of information in a safe and

retrievable manner.

ANA Standard 3. Outcomes Identification

The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.

Professional Nurse Coach Role: The Nurse Coach assists the client to identify goals that will lead to the desired change. The Nurse Coach values the evolution and the process of change as it unfolds.

The Nurse Coach:

20. Acknowledges that new goals will emerge as the client transforms over time.


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21. Facilitates clients to clarify and specify client-centered goals.

22. Supports the client’s discovery of new goals as growth occurs.

23. Facilitates clients to specify expected outcomes that are clear, action-oriented, realistic, and

time-lined.

24. Acknowledges that emergence of new goals will require revision of expected outcomes.

25. Facilitates clients’ exploration and discovery of alternative goals and expected outcomes.

26. Facilitates clients’ self-discovery, clarification, and validation of linkages among their needs,

the diagnoses, goals, and client’s expected outcomes.

ANA Standard 4. Planning The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Professional Nurse Coach Role: The Nurse Coach and the client develop a coaching plan that identifies strategies to attain goals.

The Nurse Coach:

27. Partners with the client to co-create an agreement that identifies the specific parameters of

the relationship, including the roles and responsibilities of the Nurse Coach and the client.

28. Partners with the client to identify and plan for strategies needed to achieve the coaching

goals, and effect expected outcomes.

29. Partners with the client to explore resources, laws, rules, and regulations of their State Board of

Nursing related to the goals, strategies, and expected outcomes.

30. Partners with the client to explore alternative strategies that will produce expected

outcomes, considering resources available, professional laws, rules and regulations.

ANA Standard 5. Implementation

The registered nurse implements the identified plan.

Professional Nurse Coach Role: The Nurse Coach supports the client’s coaching plan while simultaneously remaining open to emerging goals based on new insights, learning, and achievements. The Nurse Coach supports the client in reaching for new and expanded goals. The Nurse Coach utilizes a variety of specific communication skills to facilitate learning and growth.

The Nurse Coach:


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At the beginning of each interaction

31. Centers and grounds self at the beginning of each coaching interaction.

32. Aligns own intention with the client’s goals.

33. Partners with client to evaluate and minimize the potential effect of external distractions.

34. Partners with client to terminate or reschedule coaching session when distractions interfere

with effective coaching interactions.

Throughout the coaching process

35. Remains fully present, centered, and grounded throughout the coaching process.

36. Uses intentionality, aligned with client’s goals, throughout the coaching process.

37. Maintains a curious, open, and reflective approach to the client’s verbal and nonverbal cues.

38. Reflects on one’s own reactions to client.

39. Uses multiple ways of knowing throughout the coaching process, including unknowing,

reflective, and integrative knowing.

40. Accesses and trusts one’s own personal knowing (e.g. intuition and hunches/gut feelings).

41. Uses techniques and strategies to create and maintain a safe, supportive environment that

fosters intimacy and trust.

42. Demonstrates authenticity (honesty, sincerity, personal integrity).

43. Demonstrates respect for client’s subjective experiences expressed as stories and

perceptions.

44. Demonstrates respect and acceptance of client’s learning style and culture (e.g. beliefs,

values and customs).

45. Acknowledges client resistance as an opportunity for self-awareness and growth.

46. Chooses among a variety of coaching strategies or techniques that is expected to be most

effective given the situation at the time.

47. Uses sophisticated and holistic, verbal and non-verbal communication skills, including (but

not limited to) active listening, relevant use of language, and focused questioning.

48. Partners with the client to facilitate and reinforce learning important to goal attainment.


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49. Uses relevant principles, models, and theories to facilitate learning and growth.

50. Uses relevant strategies and/or modalities that facilitate mind-body-spirit-emotion-

environment integration.

51. Empowers the client’s goal attainment.

At the end of the coaching interaction:

52. Effectively records, organizes, and reviews information, including past and current actions,

with the client in a manner that facilitates the client in goal achievement.

53. Identifies and reviews client’s current status, planned goals, and expected outcomes.

54. Identifies with the client the next specific action steps and a timeline that will lead to

achievement of desired goals.

55. Assists the client to assume control over own progress by reviewing negotiated roles and

responsibilities, including stated actions, results, and related time frames.

56. Partners with the client to review progress made during and between coaching

interaction(s).

57. Partners with the client to determine the time of the next coaching interaction.

58. Documents communications with client in a clear, concise, safe and easily retrievable

manner.

ANA Standard 6. Evaluation

The registered nurse evaluates progress toward attainment of outcomes.

Professional Nurse Coach Role: The Nurse Coach partners with the client to evaluate progress toward attainment of goals.

The Nurse Coach:

59. Assists the client to evaluate goal attainment in respect to planned expected outcomes.

60. Supports the client’s determination of progress and success.

61. Partners with client to use findings from the evaluation process to reassess client’s needs,

preferred strategies, goals, and expected outcomes.

62. Documents evaluation of progress and attainment of coaching goals.


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Nurse Coach Professional Performance Competencies

ANA Standard 7. Ethics

The registered nurse practices ethically.

Professional Nurse Coach Role: The Nurse Coach integrates ethical provisions in all coaching interactions.

The Nurse Coach:

63. Uses the Code of Ethics for Nurses with Interpretive Statements (ANA, 2008), the Position

Statement on Holistic Nursing Ethics (AHNA, 2007) to guide practice and articulate the

foundation of the Professional Nurse Coach Practice.

64. Demonstrates expertise in the six components of the Nurse Coach Process: Establishing a

relationship and assessing readiness for change, identifying opportunities, issues, and concerns,

establishing client-centered goals, and expected outcomes, creating the structure of the

Coaching Interaction, empowering and motivating clients’ goal attainment, assisting client’s

evaluation of goal attainment.

65. Acknowledges that principles of holistic, human caring are central to the Nurse Coach’s

practice.

66. Acknowledges that the nurse coaching process is based on a trusting, intimate nurse-client

relationship.

67. Acknowledges that the nurse coaching process is a dynamic, systematic, and skilled process.

68. Uses Holistic Nursing Principles to guide nurse-client interactions throughout the coaching

process.

69. Understands and effectively discusses with the client the ethical guidelines and specific

parameters of the Nurse Coaching relationship (e.g., logistics, fees, scheduling).

70. Facilitates client’s expression of new ideas, behaviors, and actions that may involve risk-taking

and fear of failure.

71. Clearly communicates and clarifies distinctions among coaching, consulting, counseling, and

teaching to clients and others as indicated.

72. Partners with clients to individualize the Nurse Coach Process.

73. Facilitates integration of body-mind-emotion-spirit-environment in the Nurse Coach Process.


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74. Supports the client’s inner wisdom, intuition, and innate ability for knowing what is best for

self throughout the Nurse Coach Process.

75. Implements the Nurse Coach Process in a manner that promotes the client’s autonomy,

dignity, rights, values, beliefs, and strengths.

76. Maintains an effective coaching relationship that is congruent with the coaching agreement

and within the boundaries of professional nursing practice.

77. Performs the nurse coaching process by integrating knowledge, skills, intuition, and

judgment.

78. Values all life experiences as opportunities to find personal meaning and cultivate self-

awareness, self-reflection, and growth.

79. Maintains client confidentiality within legal and regulatory parameters.

ANA Standard 8. Education

The registered nurse attains knowledge and competence that reflects current nursing practice.

Professional Nurse Coach Role: The Nurse Coach attains knowledge and competency that reflects current Nurse Coaching practice.

The Nurse Coach:

80. Seeks and participates in ongoing educational activities to enhance own knowledge and

skills needed to practice in the Nurse Coaching role.

81.Uses routine, self-reflective practices to assess own strengths and opportunities for

improvement.

82. Seeks self-development opportunities specific to identified areas for improvement.

83. Documents and maintains evidence of Nurse Coaching competency.

84. Develops and utilizes a broad knowledge base related to holistic/integral nursing,

integrative health, health systems, coaching, counseling, health education, and nursing issues.

85. Seeks and develops competencies required for national certification as a Professional Nurse

Coach.


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ANA Standard 9. Evidence-Based Practice and Research

The registered nurse integrates evidence and research findings into practice.

Professional Nurse Coach Role: The Nurse Coach integrates evidence and research into Nurse Coaching practice.

The Nurse Coach:

86.Utilizes the best available evidence, including theories and research findings to guide and

enhance the Professional Nurse Coaching Practice.

87. Participates with others to establish research priorities and to identify research questions or

areas for inquiry related to the Professional Nurse Coaching Practice.

88. Participates in research activities related to the Professional Nurse Coaching Practice.

ANA Standard 10. Quality of Practice

The registered nurse contributes to quality nursing practice.

Professional Nurse Coach Role: The Nurse Coach systematically enhances the quality and effectiveness of Nurse Coaching practice.

The Nurse Coach:

89. Participates in quality improvement activities to enhance the Professional Nurse Coaching

Practice.

90. Contributes to the education of nurses, healthcare providers, and others concerning the

Professional Nurse Coach Role.

91. Documents Nurse Coaching interactions in a responsible, accountable, and ethical manner to

facilitate quality review and promotion of effective Nurse Coaching practice.

92. Uses creativity and innovation in Nurse Coaching practice to improve client outcomes.

93. Analyzes organizational systems for barriers to effective implementation of the Professional

Nurse Coach Role.

94. Advocates for the use of The Art and Science of Nurse Coaching: The Providers Guide to Coaching Scope and Competencies to evaluate quality of practice.


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ANA Standard 11. Communication

The registered nurse communicates effectively in a variety of formats in all areas of practice.

Professional Nurse Coach Role: The Nurse Coach employs skillful communication in all aspects of the coaching interaction.

The Nurse Coach:

95. Understands that clear, respectful, skillful, sophisticated communication is a fundamental

and essential component of the Professional Nurse Coach relationship.

96. Uses sophisticated communication skills to enhance all aspects of the Coaching Process.

97. Communicates with family, significant others, caregivers, health care providers, and others

to assist and enhance the client’s achievement of coaching goals, when requested by client.

98. Able to distinguish between telephone and internet-technology based health coaching and

tele-education.

99. Identifies and uses best practice guidelines for in-person coaching interventions.

100. Identifies and uses best practice guidelines for telephone health coaching.

ANA Standard 12. Leadership

The registered nurse demonstrates leadership in the professional practice setting and the profession.

Professional Nurse Coach Role: The Nurse Coach demonstrates leadership in the promotion of effective Nurse Coaching for clients.

The Nurse Coach:

101. Advocates for the role of the Nurse Coach at work and in professional organizations.

102. Develops emotional and spiritual intelligence to enhance leadership skills.

103. Promotes the success of others by utilizing effective Nurse Coaching interventions.

104. Demonstrates energy, excitement, and a passion for quality Nurse Coaching.

105. Demonstrates the ability to define a clear vision, associated goals, a plan to implement and

assess progress toward expected outcomes.

ANA Standard 13. Collaboration

The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice.


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Professional Nurse Coach Role: The Nurse Coach collaborates with others to assist clients in achieving goals.

The Nurse Coach:

106. Partners with others to promote nurse coaching as a way to enhance client outcomes.

107. Applies coaching skills with individuals and groups to identify and achieve individual,

group, and organizational goals.

108. Refers client to other professionals and services as needed.

ANA Standard 14. Professional Practice Evaluation

The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, and regulations.

Professional Nurse Coach Role: The Nurse Coach evaluates one’s own Nurse Coaching practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. The Nurse Coach is engaged in ongoing personal and professional self-development.

The Nurse Coach:

109. Utilizes The Art and Science of Nurse Coaching: The Providers Guide to Coaching Scope and Competencies (2013) to evaluate quality of practice.

110. Considers the effect of one’s personal values, culture, spiritual beliefs, experiences, biases,

and education on the Nurse Coach services provided to individuals, groups, and organizations.

111. Provides Nurse Coaching services in a manner that is age-appropriate and sensitive to

culture and ethnicity.

112. Engages in self-evaluation of coaching practice on a regular basis, identifying areas of

strength as well as areas in which additional development would be beneficial.

113. Obtains evaluative feedback regarding one’s own coaching from clients, peers, and

professional colleagues and takes appropriate action based upon the feedback.

114. Pursues Nurse Coach Certification as a way to demonstrate competency and to promote the

Nurse Coaching role to employers, clients, and the public.

115. Recognizes that the Professional Nurse Coaching Practice is enhanced by ongoing self-

development to promote physical, mental, emotional, social, and spiritual well-being.


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ANA Standard 15. Resource Utilization

The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.

Professional Nurse Coach Role: The Nurse Coach considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of Nurse Coaching services.

The Nurse Coach:

116. Evaluates factors such as safety, effectiveness, availability, cost and benefits, efficiencies,and impact on Nurse Coaching practice when suggesting options for the client that would resultin the same expected outcome.

117. Assists the client, as appropriate, in identifying and securing appropriate and availableservices to facilitate achievement of client goals.

ANA Standard 16. Environmental Health

The registered nurse practices in an environmentally safe and healthy manner.

Professional Nurse Coach Role: The Nurse Coach considers the impact of the internal and external environment of self and client when providing Nurse Coaching services.

The Nurse Coach:

118. Acknowledges that healthy environments encompass both the internal and the external

environment.

119. Recognizes that cultural, psychological, social, and historical factors influence the internal

and external environment.

120. Considers the internal and external environmental resources of self and client regarding

contribution to client goal achievement.


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APPENDIX B

PRELIMINARY BLUEPRINT FOR NURSE COACH CERTIFICATION: RELATIONS AMONG CORE VALUES, COMPETENCIES AND STANDARDS OF PRACTICE

1. Nurse Coach Philosophy,Theory, Ethics

2. Nurse Coaching Process

3. Nurse Coach Communication and Coaching Environment

4. Education, Research,and Leadership

5. Self-Reflection, Self-Assessment, and Self-Care

Competencies are associated with Standards 1, 3, 5, 7, 11, 14

Competencies are associated with Standards 1-7, 12-15

Competencies are associated with Standards 2,3,5, 10-12, 16

Competencies are associated with Standards 8-10, 12, 15-16

Competencies are associated with Standards 5, 8, 14

25% 41% 20% 8% 6%

A role-delineation study (RDS) was used to finalize the Nurse Coach Role Blueprint. Examination

revision occurs following each RDS.


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York: Penguin.

i The primary literature review was performed by Barbara Dossey and Darlene Hess and synthesized to produce the document, The Art and Science of Nurse Coaching: The Providers Guide to Coaching Scope and Competencies (2013). (A new edition is in process.) Darlene Hess, Barbara Dossey, Mary Elaine Southard, Susan Luck, Bonney Schuab, and

Linda Bark. Competencies for this study were drawn primarily from the …Art and Science of Nurse Coaching… document by Hess, Dossey, Southard, Luck, Schuab, and Bark, and

expanded through a secondary literature review by H. Erickson, M. Brekke, M. Smith, K.

Sandor, A. Rhodes, M. E. Southard, and M. Erickson.