On average, 27.1% of new graduate nurses voluntarily quit during their first year of employment (Isguar, 2008). High rates of novice nurse attrition have been associated with feelings of isolation, vulnerability, and uncertainty (Boychuk Duchscher & Cowin, 2004). A literature review on the subject of RN turnover shows factors such as lack of peer and supervisor support, work conflict, limited opportunity, unfairness, and interpersonal conflict as predictors of dissatisfaction and intent to leave a workplace (Hayes et al., 2006).
Work environments that include peer support have a significant impact on nurse well-being as well as patient outcomes. For example, the American Association of Critical Care Nurses (AACN) Synergy Model of Patient Care (AACN, 2010) promotes teaching, coaching, and mentoring. Mentoring has been found to promote successful achievement of nurse competencies, improve staff retention (Kanaskie, 2006), and contribute to improved patient care and outcomes (Curley, 2007).
If mentoring and coaching can help create and maintain healthy work environments, a question arises for Christian nurses. Are there biblical best practices for mentoring and coaching?
MENTORING AND COACHING
Mentoring involves a deep interpersonal relationship that evolves over time and involves the holistic development of an individual. Laurent Daloz, hallmark educator and author on mentoring and adult learning theory, describes mentoring as a journey where the mentor is a trusted guide. Daloz identifies three primary roles of a mentor: to provide support, challenge, and vision. Daloz theorizes that if a person is exposed to constant high challenge without support, burnout is likely. If a person is exposed to low support and low challenge, stasis and apathy occur. If a person is exposed to great support but low challenge, they may find a place of comfort but will not become a high performer. The most desirable is a situation offering high support and high challenge—a mix that leads to confidence and vision (Daloz, 1999).
Coaching is similar but does not require the depth of relationship and is more focused on boosting performance and specific skill development. A coach helps with the "how to" but is often less personally involved. Coaching also can be situation oriented, responding to needs as they arise. In her book Mentoring in Nursing A Dynamic and Collaborative Process, Shelia Grossman defines coaching as, "Advice given to others generally on a regular basis but can be limited to even a onetime experience in order to assist a less experienced individual in accomplishing a goal" (Grossman, 2007, p. 89). The intensity of the relationship is identified as the primary difference between mentoring and coaching. Both mentoring and coaching have a place in the development of new nurses and in the development of healthy work environments.
Mentoring that offers high support coupled with high challenge, along with good "how to" coaching, creates a more supportive atmosphere for new nurses. Mentoring and coaching behaviors have the potential to transform unhealthy work environments into workplaces where healthy relationships, personal growth, competent practice, and high standards drive retention and quality patient outcomes. An examination of the mentoring and leadership of Jesus and the coaching and guidance of the Apostle Paul illuminates best practices relevant to mentoring and coaching in work environments today.
MENTOR LIKE JESUS
Jesus demonstrated a mentoring style worth emulating. He began his ministry by choosing 12 common men with potential. Jesus took these uneducated and inexperienced men through the stages of skill acquisition from novice to expert in less than 3 years. He developed close interpersonal relationships with and between them and fostered their holistic development. Table 1 suggests some elements of Jesus' mentoring style, discussed in greater detail below with application to nursing.
Jesus used common physical elements inserted into narratives to make concepts easy to understand. For example, he used the tiny mustard seed to illustrate the long-term powerful impact of the Kingdom of God (Matthew 13:31–32) and of personal faith (Matthew 17:20). Within the nursing profession opportunities for hands-on learning and simulation—taking common physical tasks and clinical situations, have been established as best practices for skill-based education. Jesus used parables or stories as a primary method of teaching. In healthcare, stories used for education are referred to as case studies. Like Jesus, nurses can help new staff to understand the human condition and complex clinical concepts through narratives and storytelling.
Questioning and helping others think is an excellent mentoring tool. Jesus frequently answered questions by asking another question. By asking questions, Jesus helped the disciples make sense of their questions. He encouraged the disciples to think beyond the simple. For example, when trying to help the disciples begin to solidify their faith, Jesus asked, "Who do you say that I am?" (Mathew 16:15). Using such questioning to expand the scope of thinking was a hallmark of Jesus' mentoring style. Within nursing, promoting critical thinking and effective decision making is essential. Encouraging holistic thinking and providing support for identification of relevant details within complex situations is important in creating positive outcomes for our patients. Asking good questions can help in developing critical thinking skills in novice nurses.
Jesus allowed the disciples to make mistakes and learn from their mistakes, but he did not allow them to suffer defeat (i.e., when Peter struck the servant of the high priest, Luke 22:49–51). Mistakes offer valuable learning, as long as mentors pay careful attention to what kind of mistakes are permitted. Mistakes in time management followed by reflective thinking, for example, could be "safer" mistakes that could promote better time management in the future.
Jesus demonstrated forgiveness and respect but held his disciples accountable, such as when Peter denied Christ (i.e., Matthew 26:33–35 then 26:69–75). Jesus accepted people for who they were, meeting them where they were, as in the example of Zacchaeus, the unethical tax collector (Luke 19:1–10). In response to acceptance and forgiveness, people developed new expectations for themselves and faith in God's ability to work through them. Imagine how much personal and professional growth can occur when nurses hold each other accountable or extend forgiveness to each other. Imagine the impact that could occur in nursing work environments if the mentoring behaviors of Jesus were adopted!
COACH LIKE PAUL
The Apostle Paul is credited with authoring 13 books in the New Testament including letters to new churches, new church leaders, and Christians struggling with their faith. Paul's role in the newly developing church was that of a coach. Paul wrote; "I long to see you so that I may impart to you some spiritual gift to make you strong—that is, that you and I may be mutually encouraged by each other's faith" (Romans 1:11–12, NIV). This is the essence of coaching! Paul effectively worked on boosting the performance of churches he led and enhanced the skills of new Christian leaders he coached. Table 2 offers some coaching behaviors used by Paul.
Paul often coached his protégées via letters. Today this letter writing activity or advising might happen through venues such as texting, pod casting, Twitter, FaceBook, blogging, or e-mailing. Nurses can easily "write" to each other offering words of encouragement and coaching.
In his letters, not only did Paul provide important education and support, but he created supportive relationships and built networks among new Christians. Paul sent church leaders from one geographic area to new churches in another geographical area to promote growth and encouragement. Paul provided updates through his letters about other new churches and encouraged churches to pray for and assist each other. He promoted frequent and skilled communication.
Paul provided another best practice example for coaching through the sharing of his personal story and experiences. Paul served as an especially helpful role model for those needing to understand the forgiving nature of God (Acts 9; Galatians 1:11–24). In nursing it is important that role models are able to share mistakes from their past, as well as their successes. Too often we project expectations of perfection. Sharing stories reassures other imperfect nurses that our human journey includes mistakes and forgiveness. People feel a connection with people who have had similar past experiences. Sharing personal stories and work challenges encourages personal connections that enhance true collaboration, an element of healthy work environments.
Effective coaches recognize differences and encourage individuals to develop personal strengths. Paul accepted Jews and Gentiles and ensured the equal and respectful treatment of all people (Romans 10:12–13). As greater diversity enters not only our patient population but also the professionals providing care, demonstrating and teaching cultural competence and respect will be essential coaching behaviors.
Paul recognized the importance of different gifts and encouraged the use of individual gifts (1 Corinthians 12:12). Nurses are not all blessed with the same gifts—a wonderful concept for teams and our patients. Paul identified and encouraged new leaders, for example, Timothy, a strong young Christian to whom Paul wrote and coached from afar (1 Timothy 4:12). If coaching can help build healthy work environments, an essential component will be support for new young leaders. The outdated philosophy of making staff put in their time as a staff nurse before progressing to a leadership role must be replaced by a culture of coaching and developing leadership potential as it is identified.
IMPROVING NURSE RETENTION
In keeping with Dolaz's model, both Jesus and Paul used support and challenge to inspire and develop vision in their protégés. If Jesus had merely supported the disciples, they would not have had the capacity and faith to carry on the vision and mission after his death and resurrection. Without Jesus' vision (Matthew 28:18–20), the early Church may not have survived the persecution it encountered. Without Paul's challenge and coaching, early Church leaders may not have been inspired or capable of carrying on God's vision "that all nations might believe and obey him" (Romans 16:26).
As a nursing retention strategy, providing support, challenge, and vision through effective mentoring and coaching is essential. If implemented, the mentoring and coaching best practices demonstrated by Jesus and Paul can help develop healthy work environments, which will support new nurses and decrease feelings of anxiety, inadequacy, and vulnerability.
Be an example: Mentor like Jesus, coach like Paul!
Boychuk Duchscher, J. E., & Cowin, L. S. (2004). The experience of marginalization in new nursing graduates. Nursing Outlook, 52
Curley, M. (2007). Synergy: The unique relationship between nurses and patients
. Indianapolis, IN: Sigma Theta Tau International.
Daloz, L. (1999). Mentor: Guiding the journey of adult learners
. San Francisco, CA: Jossey-Bass.
Grossman, S.C. (2007). Mentoring in nursing a dynamic and collaborative process
. New York, NY: Springer.
Hayes, L. J., O'Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J, Hughes, F., et al. (2006). Nurse turnover: A literature review. International Journal of Nursing Studies, 43
Isguar, B. (2008, June). What works: Healing the healthcare staffing shortage
. Paper presented at the National Conference of Nursing Workforce Leaders, Denver, CO.
Kanaskie, M. L. (2006). Mentoring—A staff retention tool. Critical Care Nursing Quarterly, 29
Keywords:Copyright © 2010 InterVarsity Christian Fellowship
mentoring; coaching; nurse retention; staff development