The Journal of Continuing Education in Nursing

Teaching Tips 


Karren Kowalski, PhD, RN, NEA-BC, ANEF, FAAN


An effective tool for the growth and learning of health care employees is coaching. This process can use either an external or an internal coach. The coaching process is usually formalized and consists of four phases. Some suggest that leaders should spend 40% of their time coaching their staff. [J Contin Educ Nurs. 2020;51(1):12–14.]


An effective tool for the growth and learning of health care employees is coaching. This process can use either an external or an internal coach. The coaching process is usually formalized and consists of four phases. Some suggest that leaders should spend 40% of their time coaching their staff. [J Contin Educ Nurs. 2020;51(1):12–14.]

Most of us associate the term coach with our favorite sport. Some of us who love basketball think of Coach K from Duke University and the coach of several Olympic Goal Metal teams, or if we are slightly more controversial, Coach Bobby Knight from Indiana University. Originally, the term coach described an instructor at Oxford University in the early 1800s who guided a student through a course or an examination. Nursing leaders at every level are responsible for the growth and the performance of their colleagues. In this process, it has been suggested by the Gallup organization (StrengthsFinder 2.0) that everyone could benefit from coaching. This process can support people in embracing change, learning from their work, growing professionally as human beings, and advancing in the workplace. Notice how coaching differs from mentoring (see the December Teaching Tips article by Karren Kowalski [2019b]). Coaching is much more structured and focuses on the present and the near future. Mentoring is much more casual and is focused more on the professional career and how to advance one's career within a specific organization or on the decision to change organizations.

To be an effective coach, it helps to have been coached at some time in one's career. I had a coach for close to 15 years. She was a master at asking questions and coached from the philosophic perspective that I had the answers inside of me and only needed encouragement to identify and implement them. She held me to my agreements regarding what actions I would take. She consistently questioned me to encourage me to learn from my experiences—what happened, what worked, what did not work, and what I would do differently in future situations. She supported me in delving deeper, to understand the motivation for my behavior and my reactions to difficult situations.

The Coaching Process

In coaching, the coachee comes to a session with specific goals and can report on what was accomplished from the previous session. The emphasis is on mutual respect, openness, empathy, and a strong commitment to speaking truthfully. Sometimes it is difficult to hear a truthful observation about behavior. When these observations are shared compassionately and from a point of view of personal responsibility, learning is maximized. Notice the collaborative relationship and a focus on possibilities rather than an authoritarian approach or one of a supervisor–subordinate perspective. From a philosophical perspective, the coachee is a complete individual who is naturally creative, resourceful, and whole and can discover solutions to problems and issues (Kimsey-House, Kimsey-House, Sandahl, & Whitworth, 2018).

Phases of Coaching

From the coach's perspective, coaching can be divided into phases. The first phase establishes the foundation for the coaching relationship through building a relationship, setting realistic expectations, observing coachee behavior, and establishing the practice of self-reflection for both the coach and the coachee (Kowalski & Casper, 2007). This is a cocreative relationship—a partnership founded on the belief that both are highly functioning individuals. The relationship can be established by learning and knowing about each other as individuals and understanding each other's background and strengths. A part of this process is setting realistic expectations for structured meeting times, such as the coachee being prepared with a specific agenda and a report on any commitments made in the previous coaching session. As much as possible, the coach bases conversations on his/her own observations of the coachee or the report by the coachee of specific situations. To facilitate discussions of learning, it is helpful if both the coach and the coachee enter into a process of reflective practice, which includes writing or journaling about specific events the coachee experienced and what happened during these events, and for the coach to reflect on how sessions progressed and what was learned about the effectiveness of specific questions and observations.

The second phase constitutes the body of the coaching process, which consists of an emphasis on being present and fully focused on the coaching process and the individual, creating a positive atmosphere. This involves the coach asking great questions (Kowalski, 2007a, 2007b, 2008a, 2008b, 2009a, 2009b), listening actively (Kowalski, 2019a), and sharing perceptions or observations graciously and supportively. Being present is defined as being totally focused on the coachee without interruptions such as telephones, computers, or people walking into the office. Interruptions translate into the coachee feeling unimportant or discounted. This focus correlates with creating a positive environment for the session. Positive use of the allotted time also supports the coachee to be prepared with an agenda rather than casually discussing whatever is on his/her mind. This ensures that important issues are discussed. The coach also focuses on the positive, to reinforce progress and changes, and to end each session with the coachee identifying a success since the last meeting. The coach uses powerful and thought-provoking questions. The purpose of these questions is to discover what the coachee is thinking and what they perceive about difficult situations, both about their own behavior and the actions of others. These questions are open-ended; for example, “What did you notice about…” or “What was your response to the other person and what stimulated that reaction?” Questions are complimented by active listening, which demonstrates respect and sensitivity for the coachee. The coach can reflect to the coachee a summary of what the coachee has said and an interpretation of the essence of the communication. Guidelines for a session can be found in Table 1.

Guidelines for a Constructive Coaching Session

Table 1:

Guidelines for a Constructive Coaching Session

The third phase is taking action, which includes suggesting options, requesting behavior changes, clarifying the action plan, and creating a supportive environment. Action can begin with the coach asking the coachee what the thought process is regarding a specific idea, event, or problem. The coach can also make suggestions, which could begin with “What if?” questions, such as “What if you did…” or “Have you thought about…?” and “What other possibilities could be considered?” The coach can also ask for specific behavior change, which might include an observation about specific behavior and how they would act differently in the future.

The final phase is completion or ending the coaching relationship. Coaching relationships are usually time limited. The contract is for a specific length of time, which can be extended as needed. However, these relationships do end, and there is value in purposeful completion of the coaching relationship. The completion process can be rewarding as an opportunity to summarize the learning and growth by both the coach and the coachee, as well as serve as an opportunity to express appreciation for learning and opportunities.

Internal and External Coaching

When the coach is internal to the organization, whether a human resources staff member or another employee, the greatest risk is the fear that confidentiality could be compromised. This is a serious concern and its importance must be emphasized. At the same time, the cost of external coaches when used for many personnel is often cost prohibitive. One possible alternative is to work slowly and gradually build the reputation of the coaching staff. If coaching is identified as a high priority, it would be beneficial to have the internal coaches experience formal coach training from an accredited coaching firm that is approved by the International Coaching Federation (2019). Another possibility is that trained coaches from the professional development department can support leaders in learning the basics of coaching to be used with their staff. In such situations, the leader could ask the employee if they would be amenable to some coaching. This is a way in which leaders can support their employees to learn and grow. With the rapidity of change today, we are all in a steep learning process. External coaches are outside of the organization, which is beneficial in that they pose no confidentiality or favoritism issues that internal employees may face.


Used within the nursing work-force, coaching provides a valuable method for the coachee to learn from their own experiences and processes, while the nursing leader can not only facilitate the learning but share their knowledge and experience. The four-phase foundation of the coach and coachee relationship works to build learning, know each other, and use each other's observations for the coachee's benefit. Finally, the outcome of the coaching relationship, in which the coachee can express appreciation and gratitude for the personal growth, can assure the coach about coaching skills and reinforce confidence in these abilities.


  • International Coaching Federation. (2019). The gold standard in coaching. Retrieved from
  • Kimsey-House, H., Kimsey-House, K., Sandahl, P. & Whitworth, L. (2018). Co-active coaching: Changing business transforming lives – The proven framework for transformative conversations at work and in life (4th ed.). Boston, MA: Nicholas Brealey.
  • Kowalski, K. (2007a). Guidelines for asking questions. The Journal of Continuing Education in Nursing, 38, 249. doi:10.3928/00220124-20071101-04 [CrossRef]
  • Kowalski, K. (2007b). The value of asking questions. The Journal of Continuing Education in Nursing, 38, 200. doi:10.3928/00220124-20070901-04 [CrossRef]
  • Kowalski, K. (2008a). Difficult questions in difficult situations. The Journal of Continuing Education in Nursing, 39, 16. doi:10.3928/00220124-20080101-10 [CrossRef]
  • Kowalski, K. (2008b). Tough questions: Recognize and resolve communication breakdown. The Journal of Continuing Education in Nursing, 39, 57. doi:10.3928/00220124-20080201-11 [CrossRef]
  • Kowalski, K. (2009a). More situations in which questions are valuable. The Journal of Continuing Education in Nursing, 40, 393. doi:10.3928/00220124-20090824-10 [CrossRef]
  • Kowalski, K. (2009b). Situations in which questions are valuable. The Journal of Continuing Education in Nursing, 40, 344–345. doi:10.3928/00220124-20090723-10 [CrossRef]
  • Kowalski, K. (2019a). Building effective teams. In Yoder-Wise, P. (Ed.), Leading and managing in nursing (pp. 336–357). St. Louis, MO: Elsevier.
  • Kowalski, K. (2019b). Mentoring. The Journal of Continuing Education in Nursing, 50, 540–541. doi:10.3928/00220124-20191115-04 [CrossRef]
  • Kowalski, K. & Casper, C. (2007). The coaching process: An effective tool for professional development. Nursing Administration Quarterly, 31, 171–179. doi:10.1097/01.NAQ.0000264867.73873.1a [CrossRef]17413512

Guidelines for a Constructive Coaching Session

How have you been since our last meeting?

What are your agenda items for this session?

Are there any interpersonal issues between the two of us that need to be addressed?

What are the three most difficult events you have experience since our last meeting?

Describe these events, including what worked for you and what you wished you had done differently.

Review any agenda items not covered.

Review the commitments the coachee has made since the last meeting and what the outcomes are.

Identify the three most important things to be accomplished prior to the next meeting.

Identify at least one success/achievement the coachee has had since the last meeting.

Confirm the time and place for the next meeting.


Dr. Kowalski is President and CEO, Kowalski and Associates, Larkspur, Colorado, and Professor, Texas Tech University, School of Nursing, Health Sciences Center, Lubbock, Texas.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Karren Kowalski, PhD, RN, NEA-BC, ANEF, FAAN, President and CEO, Kowalski & Associates; e-mail:


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