What is a nurse health coach? (Part 1: What do nurses do?)
Check out Part 2: What do nurse health coaches do?
Aww the glory days of nursing, pre-Covid, when we could see each other’s goofy faces.
I’m sure I’m not the only nurse who didn’t have any idea whatsoever what nurses do until I was in nursing school — or actually, when I was in my last 2 months of nursing school clinical rotations, working alongside my preceptor for full 12-hour shifts, taking part in every dynamic of what she managed throughout their day. I had many days in nursing school when I thought, “This is insane. Do I really want to do this?” and those thoughts didn’t cease when I got my first job! Nursing is no cake-walk (especially bedside nursing), but most of us have an unrelenting desire to be of service to fellow humans.
Like many nurses, I chose the profession because I was passionate about health and wellbeing, and wanted to help people. I initially looked into studying Traditional Chinese Medicine (acupuncture), Western herbalism, or midwifery due to my holistic-minded background but as a low-income single mom, I decided I wanted to help everyone — not just people who can afford these complementary modalities. Honestly, I had no idea what it meant to be a nurse. I just knew that when I told people I wanted to be a nurse, I heard their stories about how a nurse touched their lives in a significant way — how a nurse treated them when they were sick, or cared for a family member, or advocated for them, or held their hand when a family member passed.
I wanted that. I wanted to be there for people when they feel scared, vulnerable, undervalued, and overwhelmed. Nurses are consistently ranked as being the most ethical and trusted profession, and I was drawn to a career aligned with the Buddhist precept of “right livelihood” in which we choose a way of earning a living that contributes to the common good. Years of working for corporate clients in advertising and marketing, although a fun and creative career, didn’t sit well with my desire to make a difference in this world.
The Internet’s idea of what a nurse does.
How peaceful this photo looks! Doesn’t it make you want to be a nurse? Maybe there are some nursing jobs that look like this, but many are not — except maybe the first semester of nursing school when we didn’t have to do anything clinical. We were just practicing therapeutic communication with our nurse’s patients.
The reality of nursing, however, is quite different from all those stock photos you see on Google Images, of nurses sitting at patients’ bedsides holding their hands. Being a nurse, at least in a hospital/clinical setting, is hectic, pressured, extremely physical work — and of course Covid has multiplied these challenges exponentially. Although there is great teamwork and it is an honor to be an integral part of the team caring for people at their most vulnerable, we sometimes don’t get to provide the kind of care that we wish we could because we are managing so much all at once. This repeated discrepancy between what we want to do and what we can do can lead to moral injury, common for nurses and physicians. My most upsetting days as a nurse have not been due to a patient’s condition, complicated care, or a patient’s or family’s physical/emotional needs — the worst days have been when I know my patients could use more support, and yet I only have time to attend to their most urgent needs. I know I’m not making the difference for them or comforting them the way I want, and that is very disheartening. There are many reasons for that — including inadequate staffing and support, patient acuity (how sick they are), and clogs in the hospital system. All of these reasons are why I am grateful for the advocacy of my nurse’s union, California Nurses Association (National Nurses United). Support for nurses = support for patients.
How do you become a registered nurse?
Registered nurses must have at least an Associates Degree (ADN) or a Bachelor’s Degree (BSN) in Nursing.
Some nurses start out with an Associates Degree, which requires pre-requisites such as anatomy, physiology, and microbiology before being able to apply for an ADN program at a community college. These excellent programs then require 2 years of full time in-class and clinical practice in a hospital setting, after which you take your state’s board exam to get your license as an RN. I chose this option because I could continue to work part-time while doing my pre-reqs part-time, and I had small children when I started. It’s also a lot more affordable than going straight into a BSN program, but it can take a lot longer because it can take a few years to get through all the pre-reqs, plus the 2 year nursing program.
Many of us with ADNs, after getting licensed, go back to a 4-year university for an “RN to BSN” program. These programs are often online, allowing a working RN to do schoolwork on their own schedule to complete the bachelor’s. There is rarely additional clinical education in an RN-BSN — it is mostly research, theory, public health, and management education.
Some nurses go straight into a BSN program at a 4-year university, without going to a community college. The Institute of Medicine released a report in 2011 recommending that at least 80% of working RNs be Bachelors-educated so that we can be “partners with other professionals in a complex and changing system.” Many hospitals won’t hire ADN nurses these days, but with so many nurses wanting to leave bedside nursing because of the devastation of Covid, I wonder if they’ll soften on that in the near future.
I had a wonderful education and experience in my ADN program, and I am grateful that I continued on to get my BSN. As a former vaccine-hesitant homebirthing hippie mama, it was during my BSN program that I shook off any remaining hesitancies because I learned more about how to discern scientific research and statistics.
There is also the option to get a Master’s or Doctorate in Nursing, and pursue Advanced Practice Nursing, such as:
Nurse Anesthetist
Nurse Midwife
Nurse Practitioner
Nurse Manager
What does a nurse do?
There are so many places for nurses! Most of us know about hospital nurses (aka “bedside nurses”), but there are many positions for nurses. Besides bedside nursing, there is:
case management
staff educator
nursing research
public health nursing
school nurse (etc!)
In an acute-care hospital setting, below are some of nurses’ duties and responsibilities. They vary per department and level of care or expertise. (P.S. I abbreviate “MD” for physician, but that can include a DO [Doctor of Osteopathy] an NP [Nurse Practitioner], or a PA [Physician’s Assistant] etc.)
Head-to-toe assessments of all body systems as soon as the patient is in our care, and throughout our care: neurological, cardiovascular, digestive, respiratory, urinary, musculoskeletal… (Or a focused assessment, if a patient is there for a specific urgent need).
Assessments and reassessments can be required from every 15 minutes to every 4 hours, depending!
Administer medications and treatments that were ordered by physicians. This includes oral, IV, intramuscular, tube feedings, breathing treatments, fluids, inserting catheters/tubes into many body parts…
This includes choosing to not giving ordered medications/treatments if we don’t feel the order is appropriate for our patient, or our patient’s current condition. Just because a doctor ordered it, doesn’t mean we should do it. Doctors are humans who can make mistakes, but also they don’t see the patients as frequently as nurses. We have to use our discernment, at every step.
Monitor vitals signs and any other signs/patterns of change or potential issues (changes in speech/cognition, color/pallor, urine output, energy levels, strength, etc). Implement interventions as needed, or notify MDs.
Monitor patient for side effects from medications/treatments, notify MDs of any concerns or use existing orders to manage potential/expected side effects (i.e. if we give meds to lower blood pressure or blood sugar, we have to monitor their BP or blood glucose. If it goes too low, we choose other interventions to stabilize. We call MD when necessary, if new interventions are needed).
Monitoring “input and output” to check kidney, digestive, and cardiovascular function. What goes in must come out!
Monitor patients for any changes in their condition. We have to understand the nature of the disease/injury/issue the patient is having so that we know what could happen. In the ICU, we often think, “What is the worst thing that could happen on my shift?” and prepare for that.
Since RNs are at the bedside more than any other practitioner, it is on us to notice changes in a patient’s condition that warrants interventions. Most interventions are based on orders from MDs, and many are parameters based on what could happen. For instance, if vital signs go below a certain level, give this treatment or medication… if pain is 7-10, administer this medication… if difficulty breathing, do this and call MD/RT. It is up to us to notice what is appropriate and needed. Some interventions don’t require MD orders — like if a patient’s blood pressure drops and they get dizzy/nauseous, RNs know to lie them down and put their feet above their hearts, or if feeling anxious, encourage slow deep breathing. We always start with non-medication therapies if possible and reasonable.
Draw blood, collect urine, collect sputum, etc for lab work. Monitor our electronic charting systems for lab results, and report concerning results to MDs.
Assist with bedside procedures such as cardioversions, intubation, lumbar punctures, etc…
Ambulating (aka walking) or otherwise ensuring our patients are mobile in whatever way they can be, to make sure they’re recovering from their procedures/surgeries/injuries/illnesses optimally. For bed-bound patients such as in the ICU, we have to turn patients every 2 hours to prevent skin breakdown (aka bed sores, rashes, skin tears, etc).
Hygiene! Assist patients to clean themselves to the best of their ability, or clean them ourselves. This includes wound care!
For many nurses: So much poop. Poop every day.
Educate patients and families about plan of care, discharge/home care instructions, medications, wound care, etc.
Coordinate our patient’s care, making sure everyone who needs to see the patient is seeing them in a timely manner. So many phone calls to doctors, physical therapists, respiratory therapists, social workers and others to advocate for our patients!
Assess, reassess, assess, reassess! If you’ve wondered the difference between an LVN/LPN (licensed vocational/practical nurse) and RN (registered nurse), it is assessment. LVNs perform many tasks including medication administration, but it is the RNs job to monitor and assess the patient’s condition.
Reporting to the next nurse caring for our patient! An accurate and complete (but concise) report to the next nurse is crucial, with the most important information about what you did and what the patient needs and the plan of care.
Preparing patients for surgeries and procedures, including health screenings/interviews.
Monitoring for a patient’s safety in their home-lives. We are “mandated reporters,” so if we suspect domestic abuse or child abuse based on a patient’s condition or if a patient directly tells us they are afraid to go home or afraid of their caregivers, we have to report it to the authorities. No fun, but nurses are often the only person a patient will trust with their safety. Many of us also receive education about looking for signs of human trafficking.
CHARTING CHARTING CHARTING. As they say in nursing school, “If you didn’t document it, it didn’t happen!” All charting is electronic these days, and we have to chart all vitals, assessments, interventions, and communications in a timely manner. The next nurse caring for the patient will likely check your charting to monitor for patterns in condition; doctors rely on our charting to decide on treatment; and if there are questions days/weeks/months/years later about what happened to your patient while in your care, there is a detailed record.
Precepting (teaching) newly graduated nurses, or nurses new to the unit.
#19 is allllll the other things I’m forgetting! If you are an RN reading this, feel free to comment at the bottom with all the things I forgot! Nursing is so dynamic, and responsibilities vary with each patient, how sick/injured they are, what stage of healing they’re in, and their prognosis.
Covid ain’t no joke. I have not worked in Covid units – but I have heard stories directly from nurses working the front lines. One nurse I worked with at my surgery center after she left Covid ICUs is now on leave because of PTSD, because “every single one of my patients died.” Nurses are leaving the profession because this 4th wave of the virus has beaten down already exhausted nurses, putting them and their families’ health at risk, plus reports of verbal abuse by patients and families and misinformation and denial by the public, contributing to violence in healthcare facilities. We want you to be healthy. Please get vaccinated. (In this photo I was working in the outpatient lab, covid-testing surgery patients.)
Why are some nurses choosing health coaching?
I am honored and grateful to be a nurse. I am grateful for my clinical and scientific knowledge, being of service to my community, supporting people during acute illness/injury, and being an educator, advocate, and coordinator of care.
Nurses do our absolute best for our patients when they are in our care. We also do our best to educate and support before they go home, but of course we are only seeing them in acute-care — when things have gone wrong, due to illness or injury. We want to address our patients’ holistic needs, but if we’re working in acute care, our focus is on stabilizing and safety.
Thank goodness for hospitals and urgent cares in our communities when we have emergencies! Thank goodness for life-saving measures, technology, medicine, and surgeries. But we all know that no one wants to have to rely on acute/emergency care for our health. Where in healthcare can we support our community in helping things go well? How can we support physical and mental well-being so that people need emergency care less?
The answer to that is multi-faceted of course. I have believed from the get-go that to be the kind of nurse I want to be, I must advocate for patients in and out of our hospitals — that includes advocating for equality and justice. Poverty, racism, violence against women, homophobia, and transphobia create stress and trauma that affect one’s health and well-being. And the go-go-go stressful culture that many of us live in can leave us feeling depleted and defeated.
I became a health coach because I want to support women going through transitions in their lives — especially in managing a new illness or injury, while managing everything else that is precious and time-consuming in our lives. We are prone to pushing aside our own health and well-being to take care of our loved ones, perform at our jobs, show up for our communities — so what do we do when our bodies show us that we need to slow down, focus, and show up for ourselves?
My goal is to support you in tuning into what defines “health and wellness” to you at this point in your life — and in showing up for yourself so that you can continue to shine and show up for your loved ones and communities.
Approaching health as a continuum of care
Health coaching is emerging as a possible solution to the lack of health support for individuals in their regular lives, to help people prevent illness, promote their own well-being, and manage their illnesses or injuries for the best possible outcomes. According to Perlman & Abu Dabhr (2020), health coaches can be an integral part of a person’s/patient’s healthcare team, “to create partnerships to empower individuals to take ownership, leadership, and accountability of their well-being, using nondirective, empathic, and mindful conversations that employ motivational-interviewing and evidence-based approaches.” (I couldn’t have summarized it better myself, so there ya go!).
The goal of health coaches is to help you improve your quality of life.
You may not be able to change a diagnosis or heal an injury or illness or reduce stress with an “abracadabra,” but we can support you in making shifts in your life that help you improve your sense of well-being, by helping you tune into your values. Dealing with a chronic illness, whether it be heart disease, cancer, epilepsy, autoimmune diseases, or “Long Covid” can be incredibly challenging and can feel disempowering. Health coaches listen, support, and can provide tools to help you feel more balance.
Even if you are not living with a chronic disease or health condition, focusing on optimal health and well-being is crucial, especially in our high-stress lives. What kinds of shifts do you want to make to contribute to your sense of well-being?
Nurse health coaches can also serve as advocates, educators, and can provide health resources.
Want to read more about what health coaches do? Check out Part 2: What do Nurse Health Coaches do?