Digital Repository Masters Projects Spring 2023 Career Coaching Utilization to Improve Intention to Stay in Bedside Nurses Amber Pisk Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Pisk, A. 2023. Career coaching utilization to improve intention to stay in bedside nurses. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 4/5/23 05/24/2023 2 Career Coaching Utilization to Improve Intention to Stay in Bedside Nurses Amber Pisk, BAN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 3 Abstract Bedside nurses are leaving healthcare organizations quicker and at higher rates than in previous years. Evidence indicates that one of the reasons nurses leave their organizations is because of a perceived lack of professional growth opportunities. To meet the needs of the nursing workforce and improve nurse retention, organizations must offer growth opportunities for nurses. This MSN project aims to provide bedside nurses with intraorganization growth opportunities by developing an 18-month nurse career coaching program. The program will include resources for the career coach and participating nurses to help educate them on the program. Additional resources will help to guide the participating nurse's professional growth through education, shadowing, and coaching. The program will also offer resources and support for those nurses who want to attain their specialty certification. This project will meet bedside nurses' desire for professional growth opportunities, possibly improving nursing satisfaction and retention, ultimately benefitting the participating nurse, the healthcare organization, and the patient. Keywords: career coaching, professional growth, nurse retention, career advancement, nursing certification 4 Career Coaching Utilization to Improve Intention to Stay in Bedside Nurses According to a Bureau of Labor Statistics (2022) report, in 2021, 3.98 million workers, or approximately 2.9% of the working population, left their jobs each month. Although this increase in resignations peaked in late 2021, the trend has not reversed in the following months. Unfortunately, the nursing profession has not been immune from the increase in resignations. NSI Nursing Solutions (2022) found that a quarter of the registered nurse (RN) workforce left their jobs in 2021, increasing RN turnover by 8.4% from the previous year. Further, RNs are becoming more difficult to recruit as the RN position vacancy rate increased by 7%, almost doubling in one year (NSI Nursing Solutions, 2022). Additionally, the millennial nurse, the newest generation in nursing, will soon be 75% of the nursing workforce. This generation is much more likely to leave their jobs in the first years than previous generations (Keith et al., 2021). The average tenure for the millennial nurse is 2.8 years, which is drastically different from the 10.1-year tenure of the previous generation (Wise & Church, 2022). Further illustrating the abbreviated tenure, recent research has found that 25% of new graduate RNs will leave their initial positions within the first year, and another 18% will leave in their second year of employment (Wise & Church, 2022). The increased RN turnover and shorter tenure present a financial concern for healthcare organizations. On average, the cost to turnover one RN is $46,100 (NSI Nursing Solutions, 2022). Moreover, every 1% increase in RN turnover costs $262,300 annually. Therefore, as the average healthcare organization's RN turnover increased by 8.4% in 2021, the one-year increase accounted for $2.2 million in unbudgeted spending (NSI nursing solutions, 2022). Statement of the Problem 5 A contributor to millennial nurse turnover is a perceived lack of intraorganization professional growth opportunities (Keith et al., 2021; NSI Nursing Solutions, 2022). Research indicates that millennial nurses who lack a defined path for professional growth will likely become bored with their current positions and look for external opportunities for professional growth (McClain et al., 2022; Wise & Church, 2022). In addition, millennial nurses expect management to provide a career advancement track and professional development opportunities (Keith et al., 2021). Compared to past generations who were content to wait for advancement, most millennial nurses believe they should not have to wait for career growth opportunities (Wise & Church, 2022). However, despite these expectations, employers have been slow to provide bedside nurses with a defined path to potential growth opportunities (Koppel et al., 2017). Therefore, this project aims to develop a career coaching program to guide bedside nurses in finding intraorganizational opportunities for professional growth. The overarching goal of creating a career coaching program is to improve nurse job satisfaction and retention. Project Contributions This project has the potential to benefit nurses, healthcare organizations, and patients. Bedside nurses will benefit as they are provided a charted path for intraorganizational growth through professional development and career opportunities with guidance from a designated coach. As bedside nurses achieve their professional goals, they are more likely to be satisfied with their job and retained within the organization, benefitting the organization financially (Keith et al., 2021; McClain et al., 2022; Webb et al., 2017; Wise & Church, 2022). Additionally, organizations with a high rate of nursing retention and job satisfaction see improved nursingsensitive quality indicators and patient satisfaction, with fewer adverse patient events (Perry et al., 2018). 6 Rationale for Importance of Project This MSN project is beneficial because a career coaching program addresses bedside nurses' desire for professional development and career growth, ultimately improving nurse retention and decreasing organizational costs (Keith et al., 2021; McClain et al., 2022). Bedside nurses want opportunities to grow as professionals and expect leaders to define their track to growth (Keith et al., 2021; Wise & Church, 2022). Considering this expectation, the implementation of career coaching can assist nurses in establishing goals for professional growth and defining a path for achievement (Webb et al., 2017). In addition, when nurses are provided with opportunities for advancement, they are more satisfied with their job and develop a sense of commitment to the organization, which can decrease turnover (Webb et al., 2017; Wise & Church, 2022). Nurse turnover significantly impacts a hospital's financial status and can impact the quality of care. For instance, a high rate of RN turnover corresponds to a higher rate of patient falls, central line infections, and catheter-associated urinary tract infections (Perry et al., 2018). These adverse events impact patient outcomes, length of stay, and have negative financial implications (Perry et al., 2018). The average central line infection costs a healthcare organization $48,108 and, more significantly, can lead to patient death (Drenkard, 2022). In addition, high turnover rates leave facilities with fewer experienced RNs, which can further impact care quality and patient outcomes (Wise and Church, 2022). Nurses, both experienced and inexperienced, have become more challenging to recruit. On average, a healthcare organization will wait 87 days to find a suitable RN candidate for an open position (NSI Nursing Solutions, 2022). The long wait leaves organizations paying added fees for agency nurses or overtime incentives to ensure adequate staffing (NSI Nursing 7 Solutions, 2022). Furthermore, in 2021 the average hospital saw a 2.4% reduction in its RN workforce as they could not fill vacancies (NSI Nursing Solutions, 2022). As nurses become challenging to recruit, a nurse career coaching program would meet the expectations of the new generation of nurses bringing organizations improved nurse retention rates and job satisfaction, advancing quality care and financial stability. Literature Review and Framework A literature review was completed to obtain recent and historical evidence related to bedside nurse career coaching. The results assisted in understanding the need for and the development of a career coaching program that provides nurses with a guided path to achieve professional goals within their current organization. Further, evidence-based practice (EBP) change frameworks were reviewed for project fit to ensure thoughtful implementation and outcome evaluation. Each framework was evaluated for pertinence with a high-priority, nursingfocused evidence-based change. Framework For this MSN project, the Iowa model revised (IMR) is used as the framework for change evaluation and implementation. The IMR framework is a pragmatic, multi-phased model that assembles questions, critically evaluates evidence, and implements change (Melnyk & FineoutOverholt, 2019). Additionally, the framework offers a multi-level decision-point procedure that either moves the team forward through change implementation or allows them to loop back to evaluate a previous step (Cullen et al., 2017). The IMR framework begins with identifying opportunities for improvement (Melnyk & Fineout-Overholt, 2019). Nursing curiosity, the basis for EBP and IMR, is required to identify opportunities for change in clinical nursing. Nursing curiosity also helps to develop the next step 8 in the IMR framework: asking a well-developed question or defining a purpose (Melnyk & Fineout-Overholt, 2019). The development of the question leads to a critical decision point in the IMR framework that determines if the identified question topic is a priority. A topic that is a low priority to the organization or the community is not likely to secure the resources needed for the project's success (Buckwalter et al., 2017). Conversely, a high-priority topic that addresses an organization or community aim is likely to gather resources and, thus, is crucial to continuing forward in the IMR framework. Identifying a high-priority topic helps to assemble an engaged stakeholder team (Melnyk & Fineout-Overholt, 2019). Further, a diversified, committed team will be crucial in the next steps of the IMR framework and the project's ultimate success (Cullen et al., 2017). Together the team will gather and evaluate the body of evidence related to the project to reach the next decision point in the IMR framework (Melnyk & Fineout-Overholt, 2019). If enough evidence exists in the literature, the project may continue, but the project should be considered for further research if applicable literature is lacking. For projects with sufficient literature, the team will develop an in-depth pilot implementation plan utilizing the gathered evidence (Melnyk & Fineout-Overholt, 2019). After the pilot, the final IMR decision point allows the project to be evaluated for full-scale implementation or redesigned for a repeat pilot. The IMR framework assists the team in hardwiring the change and communicating the results (Melnyk & FineoutOverholt, 2019). As nursing EBP updates are continuous, the model loops back to identify another nursing question to continue the IMR framework. Nursing career coaching fits into the IMR framework as nurse retention is a high priority for healthcare organizations, with stakeholders in finance, human resources, education, leadership, and nursing. As the project affects multiple disciplines within the organization, the 9 IMR team approach is essential. The various viewpoints will assist in the program's design, especially considering available resources and barriers to implementation. Nursing stakeholders' participation will also help define the program's design needs. As bedside nurses are the focus of this MSN project, their preferences will take the place of the patients' to guide the program's design. Additionally, the multiple decision points utilized in the IMR framework allow the team to evaluate how to move forward after each step. For nurse career coaching implementation, these decision points will allow the team a natural pause to evaluate progress. Further, the decision point after the development and implementation of the pilot project will be crucial to the program's ultimate success. Gathering nurse, leader, and team feedback along with retention data will allow for an accurate program evaluation. A neutral or negative response to the program could help the team to redesign or move back to the literature for continued review before a costly global implementation. Strengths and Limitations The IMR framework presents various strengths. Most importantly, the IMR framework was recently revised and validated as a practical tool for EBP implementation (Buckwalter et al., 2017). It is generally viewed as a streamlined, user-friendly model that adapts to many EBP changes (Buckwalter et al., 2017). As this MSN project evaluates and implements nursingfocused interventions, the IMR framework easily adapts to the project's unique implementation needs. Another benefit to the IMR framework is the recommendations for sustaining the EBP change (Buckwalter et al., 2017). Sustaining a practice change is a complex process and can not be achieved with a one-time intervention (Buckwalter et al., 2017). Change hardwiring requires a 10 committed team continually scrutinizing pertinent data and re-training as needed (Buckwalter et al., 2017). In this MSN project, change hardwiring must address nurses' continued interest in the program, requiring repeated interventions. If nurses are uninterested or unaware of the program, they will not participate. Additionally, the recommended data collection would be beneficial in evaluating the need for program re-enculturation. For example, the career coaching team could review nurse retention rates, program participation, and evaluations to gauge the program's success. One pitfall of the IMR framework is the vague description of result dissemination. During the revision and validation of the IMR framework, users identified the need for further recommendations to disseminate EBP (Cullen et al., 2017). As a result, due to the varying organizational needs and communication channels, Cullen et al. (2017) recommended that organizations identify a customized process that fits staff and professional governance needs. Therefore, the nurse career coaching team must evaluate the organization for consistent, effective nursing communication and advertisement modes to outline a unique strategy. Analysis of Literature Following the EBP change structure outlined in the IMR framework, a literature review was conducted to evaluate the established body of evidence for nurse career coaching. The literature was reviewed to understand if career coaching was a realistic and effective nurse retention strategy. Additionally, the review sought career coaching program frameworks, implementation strategies, and subsequent outcomes. Search Strategies A literature search was conducted using Google Scholar, Medline, Ovid, and CINAHL databases to identify current, relevant evidence related to nurse career coaching. Database filters 11 assisted in limiting literature search results to those published from 2017 to 2022 and were later adjusted to include 1997 to 2017 for historical studies. As the concept of nurse career coaching can have several derivations in the literature, search keywords initially included nurse career coaching but expanded to include nurse career mentor, nurse career mapping, nurse career, nurse career planning, and nurse career development. To identify nurse career coaching in nurse retention literature, search terms were expanded to include nurse retention, nurse turnover, and nurse intention to stay. The utilization of Boolean modifiers allowed for slight variations of key terms. Additionally, articles were excluded from the search if they appeared to focus on the clinical ladder, an alternative career development process. The relevant nurse career coaching literature highlighted five recurring themes. The themes of (a) millennial nurse expectations, (b) organizational loyalty and retention, (c) the role of the coach, (d) program framework, and (e) the nurse as an individual are each discussed below. Millennial Nurse Expectations Millennial nurses, born between 1980 and 2000, will soon make up the majority of the nursing workforce (Keith et al., 2021; Price et al., 2018). Unlike previous generations, studies have found that millennial nurses expect organizations to provide individualized professional development and abbreviated paths to career advancement (Keith et al., 2021; McClain et al., 2022). Researchers conclude that to engage and retain the new nursing majority, organizations should work to meet the expectations of millennial nurses and develop professional growth and career advancement pathways (Brook et al., 2019; Keith et al., 2021; McClain et al., 2022; Price et al., 2018; Walden et al., 2022; Wise and Church, 2022). Healthcare organizations that provide 12 opportunities for guided professional growth and career advancement are proposed to be the ideal milieu for the millennial nurse (McClain et al., 2022). For professional growth opportunities, researchers suggest millennial nurses want organizational programs for professional development, leadership development, and preceptorships/mentorships (Keith et al., 2021). Additionally, millennial nurses want opportunities to advance quickly within the organizational structure while feeling supported by the organization. Brook et al. (2019) and Keith et al. (2021) state that millennial nurses want a mentor or coach committed to their growth to feel supported. Nurses feel a relationship with a capable preceptor or mentor indicates that the organization is supportive and committed to the nurse's long-term success, improving millennial nurse retention (Brook et al., 2019; Keith et al., 2021). Millennial nurses also differ from previous generations as they are quick to leave an organization if career growth expectations are unmet (Keith et al., 2021; Price et al., 2018). The average nursing tenure has dropped from 10.1 to 2.8 years, highlighting the movement between organizations to meet career expectations (Wise & Church, 2022). Further, Walden et al. (2022) found that nurses who want to advance their education are most likely to leave an organization if their career and professional growth expectations are unmet. This finding is concerning as, in the same study, 70% of millennial nurses planned to advance their education in the next three years (Walden et al., 2022). Hence, researchers reiterated that organizations must provide a path for nurses to achieve their educational and career goals, or newly licensed nurses will go elsewhere (Walden et al., 2022). Ultimately, millennial nurses want to feel supported by their organization and be given opportunities for professional development and career growth. Millennial nurses can be retained if their desire for supported growth is met within the organization. 13 Organizational Loyalty and Retention Organizational loyalty is a predictive form of retention, measuring if a nurse is satisfied and plans to stay at an organization in the coming months and years (Koppel et al., 2017). Researchers recommended nursing-targeted engagement strategies to develop organizational loyalty, such as career coaching (Koppel et al., 2017; Yang et al., 2015). Career coaching programs offer the opportunities for professional growth and career advancement that the nursing workforce expects (Keith et al., 2021; McClain et al., 2022). Further, nurses whose expectations for professional growth within an organization are met are proven to feel supported by their employers and develop loyalty to the organization (Yang et al., 2015). Implemented career coaching programs have demonstrated positive but varying rates of improved organizational loyalty and nursing retention (Brook et al., 2019; McGillis-Hall et al., 2004; Tucker et al., 2019). McGillis-Hall et al. (2004) found that nurses who participated in an intraorganizational career development program had a higher rate of organizational loyalty. Similarly, Tucker et al. (2019) and Brook et al. (2019) identified increases in the retention of new hires after implementing career development planning. These studies indicate that career coaching programs can improve nurse retention and organizational loyalty, which is consistent with the recommendations from Koppel et al. (2017) and Yang et al. (2015) (Brook et al., 2019; McGillis-Hall et al., 2004; Tucker et al., 2019). Career coaching programs offer professional growth and career advancement in a supportive intraorganizational structure, leading to organizational loyalty and retention. The Role of the Coach The role of a coach differs from that of a mentor in that coaches do not share much about their own life experiences (Thompson et al., 2012). Instead, coaches ask thought-provoking 14 questions and provide feedback to help participants reflect on their behaviors, evoking change (Thompson et al., 2012). In a career coaching program, the coach's role is pivotal to developing a supportive structure, but many within an organization may not be suited for the job. Managers playing the role of career coaches are common in the literature; however, they may not be the ideal coach. Two studies found that nurse managers often feel ill-prepared to help nurses advance their careers (Sandehang et al., 2019; Sonmez & Yildirim, 2009). Even with formalized career coach training, managers felt they lacked the knowledge, support, and time to help their nurses grow professionally within the organization (Sandehang et al., 2019). Furthermore, Donner et al. (1997) contend that bedside nurses rarely feel comfortable asking their managers for career advice making managers a less-than-ideal choice for the role of career coach. In addition, ethically, managers with direct supervisory authority may not be the ideal candidate to function as career coaches to their nurses. Thompson et al. (2012) state that if a nurse reports directly to a coach, it could be considered a conflict of interest, as they may try to sway the nurse to opportunities that benefit the nurse manager. To avoid an ethical conflict, researchers discussed the opportunity for an advisor outside the organization, such as local education faculty (Donner & Wheller, 2001; Thompson et al., 2012). However, coaches outside the facility may not understand the organization's functional needs nor be committed to the nurse's growth within the organization, leaving intraorganization coaches as a better option (Donner & Wheller, 2001; Thompson et al., 2012). To fill the role of an internal career coach, several frameworks designated and trained nurse educators, senior leaders, or nursing peers as career coaches (Donner et al., 1997; Fusilero et al., 2008; Thompson et al., 2012; Webb et al., 2017). Further, other frameworks implemented coaching teams so that nurses had the support of multiple coaches, with some of the teams even 15 including the manager (Shermont et al., 2009; Tucker et al., 2019; Webb et al., 2017). If part of the coaching team, the nurse manager met with the nurse and helped to track the ongoing professional progress mapped out by the coach (Fusilero et al., 2008; Tucker et al., 2019; Webb et al., 2017). Many different people and teams within the organization can fulfill the role of coach with the proper framework and training. Of note, the training nurse educators, senior leaders, nursing peers, or even managers received to become a designated career coach was not outlined in any of the reviewed career coaching programs (Donner & Wheller, 2001; Fusilero et al., 2008; Shermont et al., 2009; Sonmez & Yildirim, 2009; Sandehang et al., 2019; Thompson et al., 2012; Tucker et al., 2019; Webb et al., 2017). In fact, none of the programs defined the role expectations of the career coach (Donner & Wheller, 2001; Fusilero et al., 2008; Shermont et al., 2009; Sonmez & Yildirim, 2009; Sandehang et al., 2019; Thompson et al., 2012; Tucker et al., 2019; Webb et al., 2017). Although the literature can define who in an organization could make the best career coaches, it does not define how to train the coaches or how they function to be effective coaches within the program framework. Program Framework In the literature, various nurse career coaching frameworks were suggested. Although the frameworks differed, they tended to show positive outcomes. Several career coaching programs were based on a track system that designed organizational paths to achieve identified nurses' career goals (Fusilero et al., 2008; Shermont et al., 2009). The programs' offered multiple preestablished tracks for advancement based on the nurses' ultimate career goals. Another coaching program implemented a process where nurses identified short and long-term goals with a timeline based on Benner's model (Webb et al., 2017). An additional career framework had 16 nurses review specific questions to identify their strengths and weaknesses. The nurses were then coached to utilize their strengths effectively to grow within the organization (Dooner & Wheeler, 2001; McGillis-Hall et al., 2004). The frameworks were similar in that they utilized an initial goal-setting session combined with continued coaching. As for the cadence of coaching in the career coaching framework, the literature was vague. One framework suggested that coaching continue over 18 months but did not specify how often coaching should occur (Shermont et al., 2009). Others did not identify the frequency of meetings or duration of time career coaching would continue after the goal-setting session (Dooner & Wheeler, 2001; Fusilero et al., 2008; McGillis-Hall et al., 2004; Tucker et al., 2019; Webb et al., 2017). A career coaching framework needs both a goal-setting session and ongoing coaching, but both steps lack a standard best practice. The Nurse as an Individual Although published career coaching frameworks have inconsistent practices, the literature is consistent that pathways for professional growth need to be individualized and ongoing to meet the unique needs of each nurse. Each career coaching framework recommended or implemented individualized goals and recurrent career coaching sessions in order to make a plan specific to the nurse (Donner & Wheeler, 2001; Fusilero et al., 2008; McGillis-Hall et al., 2004; Niesen et al., 2018; Shermont et al., 2009; Thompson et al., 2012; Tucker et al., 2019; Webb et al., 2017). The individual focus allowed nurses to identify resources and be coached over organizational barriers to progress toward their career goals (Tucker et al., 2019; Webb et al., 2017). A generalized intraorganizational career map would not meet nurses' expectations for individualized professional development and, therefore, would not retain them. Summary of Literature Review Findings and Application to the Project 17 The literature consistently recommends career coaching as a tactic to improve nursing retention. Multiple millennial retention sources indicated that a perceived lack of professional growth opportunities was linked to nursing turnover and recommended a career coaching program to combat the perception (Donner et al., 1997; Donner & Wheeler, 2001; Keith et al., 2021; McClain et al., 2022; McGillis-Hall et al., 2004; Thompson et al., 2012; Walden et al., 2022; Wise & Church, 2022; Yang et al., 2015). The literature also showed that when implemented, nurse career coaching programs improved nursing retention and organizational loyalty (Brook et al., 2019; Koppel et al., 2017; McGillis-Hall et al., 2004; Tucker et al., 2019; Webb et al., 2017; Yang et al., 2015). Improved nursing retention and organizational loyalty could, in turn, benefit organizations financially. (Brook et al., 2019; Koppel et al., 2017; McGillis-Hall et al., 2004; Tucker et al., 2019; Webb et al., 2017; Yang et al., 2015). Career coaching programs provide benefits for both nurses and healthcare organizations. However, a career coaching program may be challenging to implement because a single career coaching framework is not established as a best practice. Therefore, the framework will need to be adopted from one of the previously published frameworks or a combination of successful frameworks to fit the organization's structure and available resources. Additionally, there is no outlined training for career coaches or timeline for coaching; thus, a training process and timeline will need to be developed. Tailoring the framework, coach training, and coaching timeline to the organization's resources will help to provide a program that addresses the organization's unique structure. Ultimately, implementing an organization-specific career coaching program that outlines an individualized path for nursing professional growth and career advancement may improve nursing retention and satisfaction. Project Methodology 18 This MSN project works to improve bedside nursing satisfaction and retention by designing a coaching program to provide nurses with a charted path for professional growth and career advancement. To meet the outcome goals of the project, an organizational team will be engaged to plan and implement the nurse career coaching program. As part of the implementation, deliverables have been developed to establish the coach's role, define pathways, and educate the teams and individuals. Description and Development of Project Deliverables Seven project elements were created to assist the healthcare organization in implementing nurse career coaching. These items include a leadership education pathway, an educator education pathway, a certification pathway, a career coach job description, a career coaches' training module, a nurse career coaching application, and a participating nurse education module. Each item and its purpose in the nurse career coaching program are described below. Leadership Pathway The first deliverable for this MSN project is the leadership pathway (see Appendix A). The pathway plays a crucial role in nurse career coaching. A coach and participating nurse will utilize the leadership pathway to guide the nurse's professional growth over the 18-month-long nurse career coaching program. The electronic pathway form will be used to record coaching conversations, identify the participating nurse's goals, and select education specific to the nurse's goals from a curated list of shadowing opportunities, education offerings, and activities during the once-per-quarter coaching sessions. The growth opportunities listed on the pathway are designed to help develop the nurse's fundamental leadership skills and prepare them for future leadership roles. Further, the growth opportunities on the pathway do not need to be done in a particular order but can be selected to fit the nurse's quarterly goals and previous experience. As 19 the pathway is an electronic form, comments and previous assignments are saved for later review. Additionally, a QR code provides direct access to the electronic form from a smartphone should a coaching session occur outside the organization's campus. Educator Pathway The educator pathway is similar to the leadership pathway but designed for those interested in future educator roles (see Appendix B). As with the leadership pathway, the coach and participating nurse will use the educator pathway to guide the nurse's professional growth over the 18-month-long nurse career coaching program. The pathway will be used to record coaching conversations, identify the participating nurse's goals, and select education specific to the nurse's goals from a curated list of shadowing opportunities, education offerings, and activities during their once-per-quarter coaching sessions. The growth opportunities listed on the pathway are designed to help develop the nurse's skills as an educator and prepare them for future in-hospital educator roles. The pathway assignments can also be individualized with the coach's assistance to complement the nurse's quarterly goals and experience. As with the leadership pathway, responses and previous assignments are saved on the electronic pathway form with an available QR code for easy access to the form when not on the organization's campus. Certification Pathway The certification pathway differs slightly from the leadership and educator pathway as this program's ideal outcome is certification, not career advancement preparation. With the assistance of a certification coach, the pathway helps the participating nurse identify an applicable specialty certification. The coach will assist the nurse with identifying certification requirements, costs, testing resources, and a timeline to test for the certification. The information 20 is saved on the electronic pathway when the certification coach and nurse meet and can be reviewed at the next session. The provided QR code allows easy access to the form from a smartphone or other device (see Appendix C). Nurse Career Coach Job Description An additional deliverable is a formal job description document for the career coaches (see Appendix D). As the role of a nurse career coach adds additional responsibilities to the coach's current leader or education position, a job description helps coaches to understand the expectations of career coaching before accepting the designation of coach. The job description outlines a nurse career coach's essential duties and responsibilities in the nurse career coaching program. Career Coaches' Training Module The career coach training module is a PowerPoint created to educate coaches on the nurse career coaching program, coaching and participant expectations, and the educator or leader electronic pathway (see Appendix E). The module includes an explanation of the program, pictures of the pathways, and an example of using the pathway for an inexperienced nurse interested in leadership. QR codes are also embedded in the slide deck so coaches can access the pathways before their first coaching sessions. Nurse Career Coaching Applications The nursing career coaching applications outline what the nurse can expect if accepted into the nurse career coaching program (see Appendix F). One application is for educator and leadership coaching, while the other is for certification coaching. Both applications include a short explanation of the program, the nurse and coach's roles, and the criteria for participation. The nurse signs the application to acknowledge the program expectations and participation 21 criteria, and the manager signs to acknowledge that the potential participant meets the listed criteria. Participating Nurse Education Module The participating nurse education module for nurse career coaching is an interactive PowerPoint reviewing the program (see Appendix G). The module includes an explanation of the program, an example pathway, and the nurse's responsibilities as a participant. A QR code is also embedded in the slide deck so nurses can access an example pathway before their first coaching sessions. Plan and Implementation Process As alluded to above, the program planning and implementation phase of this project will require the participation of individuals throughout the organization. The organization's chief nursing officer (CNO), Human Resources (HR) leaders, and nursing directors will need to approve the nurse career coaching program before its implementation. After approval, the CNO, nursing directors, nurse leaders, educators, and human resources (HR) will meet to review the deliverables and understand the desired outcomes. The meeting will ideally gain the support from the entire team for implementation and the commitment from leaders for participation. The team would also develop an elevator speech to encourage support from other leaders (Webb et al., 2017). As one medical-surgical unit will be selected as the pilot, the team will brainstorm an ideal unit and identify potential coaches. After this initial meeting, the individual directors will invite possible career coaches to participate. Shermont et al.(2009) saw success with career coaches taking up to 10 participants; therefore, only four leadership and four education career coaches will be needed in the initial implementation. Coaches will take personality tests to ensure coaches are an equal spread of 22 personality types to fit the personality of the participating nurses. Matching compatible personalities in a mentoring situation is ideal for optimal outcomes (Crew, 2016). After coach identification, education will also be provided to other organization nursing managers so that they will be aware of the trial program can speak to any concerns or questions from their associates. After identifying the trial unit, education will be provided to the unit nurses. Unit nurses who volunteer to participate will be personality tested and matched with their pathway coaches and then will complete a pre-program satisfaction survey. Pre, midway, and two post-program satisfaction surveys will be collected from the participants as the program progresses, including a post-program coach evaluation. Coaches will meet monthly during the pilot to collaborate and provide feedback on the program. Along with the coaches, a program steering team will evaluate the program's success at the end of the initial nursing cohort to identify if the desired outcomes were achieved. Interdisciplinary Teamwork Collaboration between multiple team members is crucial to facilitate a tailored learning experience (Perregrini, 2019). Leaders, educators, HR personnel, and nurses will need to collaborate to ensure the career coaching program's success. Each discipline's required contribution is outlined below to ensure the program's success. Leaders and educators designated as career coaches. Leaders and educators designated as career coaches must understand the pathway's purpose and help bedside nurses navigate it (Webb et al., 2017). While helping to navigate the pathway, career coaches will need to develop a trusting working relationship with the participating nurse to provide constructive feedback to aid the nurse in advancement. The career coaches will also need to communicate 23 with HR to match open positions to potential applicants within the program. Ultimately, coaching will focus on developing a supportive and trusting relationship to provide career guidance and opportunities. Certification coach. The certification coach has a similar role to the career coach. The coach will assist the nurse in identifying an applicable nursing certification and evaluating the criteria they would need to meet to take and pass the associated test. A nursing certification specialist already exists in the education department. The coach will not need additional training to perform the role as they know the organization's nurse certification resources, such as certification preparation courses or preparation handbooks. Nurses will follow up with the certification coach quarterly to track their progress. Nursing leaders. Nursing leaders, including nurse directors and nurse managers, will be influential advocates for the nurse career coaching program. Although only one unit within the organization will begin trialing the program, nurse leaders must communicate with other units about the program. Nurse leaders will utilize an elevator speech to discuss the program and spark interest outside the trial unit. They will also need to be able to answer questions such as why a trial was necessary before implementing the program throughout the organization. Additionally, while direct leaders will not be assigned as career coaches to their nurses, the direct leader for the individual trial unit will need to touch base on the nurse's progress in the program during the quarterly check-ins completed for all staff. HR personnel. HR personnel will need to approve the program and provide a noguarantee disclosure document (referred to in the ethical considerations). Also, HR will provide position vacancy information and reimbursement guidance as needed. For example, policies on certification reimbursement are owned by HR. Hence, questions on the reimbursement of an 24 obscure certification would need to involve HR for policy review. Further, as HR has a grasp on organizational vacancies, career coaches will work with HR to identify potential future positions for the participants. CNO. The CNO plays a vital role in program oversight. Initially, the CNO must approve the program. Nurse career coaching is optional for participating nurses, meaning that the hours associated with program education may not be compensated. To define the hours that are eligible for compensation, a cost analysis will need to be presented to the CNO for review and approval. The CNO will need to understand the rationale behind the program so they can be persuaded, and persuade c-suite leadership, to support the associated costs. For example, the organization could see a significant return on investment if, as predicted, nurse satisfaction and retention improve. In addition, the added training would provide the organization with a group of nurses prepared to step into leadership and education positions. For current leaders and educators, the CNO must also be committed to supporting program participation, as they may need to delegate some responsibilities to others to make time for coaching. Participating nurses. The career coaching program is optional, meaning nurses who participate must be self-motivated. The participating nurses will be responsible for tracking their progress on the pathway and scheduling their own education and growth opportunities. Although the coach will help guide the nurse, the nurse's success in the program depends on their ability to translate the provided education and feedback into professional growth. Timeline Thoughtful nurse career coaching program implementation can lead to continued program success (Titler et al., 2013). When initial approval of the program from the CNO, nursing directors, and HR is obtained, implementation can begin. The next step is to identify 25 career coaches. Within one month of selection, the career coaches will be designated and educated on their role as a coach and the career coaching process (utilizing Appendix G ). During that same month, education on career coaching will be provided to nurse leaders within the organization, and marketing material will be developed for eventual distribution. After educating nurse leaders, marketing materials will be distributed to nurses utilizing email, posters, and the unit newsletter. Since the initial implementation will be limited to one unit, advertisement of the program will be limited to the designated unit. Applications will be open to nurses within two months of the CNO's program approval. Applicants employed in the trial unit who meet all criteria described in Appendix F will be accepted into the program. Upon acceptance, nurses will identify their desired pathway, complete personality testing, and take the pre-program survey. Nurses who identify their desired path as leadership or educator will be matched with their coach based on their personality type and desired pathway. Nurses who identify certification as their desired pathway will be paired with the hospital certification coach. Participants will be paired with their coaches and begin quarterly meetings four months after initial program approval. Coaches will also begin monthly meetings to support each other and provide pathway feedback. To evaluate the program's effect on nurse satisfaction and retention, data will be compared to organizational data at enrollment into the program, midprogram checkpoint, program completion, and one year after program completion. As initial implementation takes four months and the coaching pathway takes 18 months to complete, evaluation of the program will take place 22 months after CNO's program approval (see Appendix G). Plan for Evaluation of Project 26 Several data points will be evaluated to quantify the success of the nurse career coaching program. To assess the satisfaction of the nurse participants, nursing satisfaction surveys will be completed at the start of the program, midway through, at the completion, and one year after program completion utilizing an existing nurse satisfaction survey. The survey will measure the participant's satisfaction with their current positions, offered education, organizational support, and the likelihood of recommending the organization to other nurses for employment. As this pulse survey is used quarterly throughout the organization to measure nursing satisfaction, program participants' survey results can be compared pre- and post-coaching, and with nurses who are not participating in the program. Additional post-coaching surveys will include an evaluation of the career coach so that the coaches may also receive feedback. Along with nurse satisfaction, improved nurse retention would indicate program success. Data on nurse turnover throughout the organization is currently tracked and graphed for a monthly snapshot of nursing retention. Turnover data for nurses in the program will be gathered and compared to the organizational data to identify if nurse career coaching improves retention within the organization. However, as the program takes 18 months to complete, program effects may not be seen in the initial six quarters of turnover data. In order to have valuable data sooner than six quarters, on the satisfaction surveys, nurses will be asked if they intend to stay employed with the organization if offered a similar job elsewhere. This question provides predictive retention data that can be compared to the organization, as nurses not participating in the program are asked the same question on the quarterly pulse surveys. Ultimately, should nurse career coaching be effective, participant nurses will feel satisfied in their employment and be retained at a higher rate within the organization. Ethical Considerations 27 Nurse career coaching has the potential to help nurses advance as professionals within the organization. However, coaching does not guarantee the nurse's promotion to a leadership or educator position. Participants must understand that although they will be given education, encouragement, and the opportunity to apply for a promotion, hiring for a position depends on the individual's fit for the role. Roles are limited within the organization, and a vacancy may not occur during the nurse's desired time period. To avoid the assumption of guaranteed intraorganizational promotion, participating nurses and career coaches will be educated on the program's objectives, including a definitive statement that promotion is not guaranteed. The career coach education will include a statement that the participating nurses are not guaranteed promotion to their desired position within the organization. Further, the nursing program application will include a statement that the organization does not guarantee a promotion because of program participation. Additionally, as the nurse career coaching program is optional, nurses can participate or elect not to participate without repercussions. Nurses who choose to participate and do not meet the program behavior expectations may be asked to leave the program. Any unprofessional behavior, as defined by the organizational code of conduct, program disengagement, or corrective action while participating in the nurse career coaching program will lead to removal from the program. Further, as each nurse comes into the program with a different experience level, satisfactory professional growth in the program will differ for each nurse. If a nurse fails to grasp educational concepts, the coach will adapt the next quarter's goals to reinforce the education. A nurse may be asked to leave the program if the coach continues to observe a lack of growth after feedback and reinforcement education. Discussion 28 Nurses desire career and professional growth opportunities (Wise & Church, 2022). If nurses perceive a lack of growth opportunities within their current organization, they will go elsewhere to find them (Keith et al., 2021; NSI Nursing Solutions, 2022). In addition, nurses do not want a list of education available within the organization; nurses want the organization to define a pathway for intraorganizational professional growth and provide support for those who wish to participate. The nurse career coaching program developed for this MSN project addresses the desires of the current nursing workforce and the healthcare organization's needs (Brook et al., 2019; Keith et al., 2021). This section of the paper includes a discussion of the dissemination of project results, along with a description of the significance, implications, and recommendations for future research related to this project. Evidence-based Solutions for Dissemination After the initial 18-month program cohort, the CNO, nurse directors, HR personnel, and the organization data specialist will meet to discuss the comparative survey findings, coach feedback, nurse turnover data, and program costs based on paid participant nurse and coach hours. Data evaluation and cost calculation results will be compiled into a program outcome report. The team will utilize the program report to evaluate if the nurse career coaching program offers a return on investment for the nurses and the organization. After evaluation, the report will be finalized to include the team's recommendation for continuation, renovation, or discontinuation. The report will then be shared with the organization's senior leadership team, participants, and frontline nurses for review. Further, the team will discuss the outcome and recommendations at a Nursing Grand Rounds presentation, ending with a question and answer session. In addition, as this project was initiated as part of Weber State's MSN-Excutive 29 program, the project will be presented to WSU faculty and peers through a written paper and poster presentation. Significance to Advance Nursing Practice This project can benefit participating nurses, nurse leaders, nurse educators, and bedside nurses. Participating nurses are provided with education to grow their professional skills as a nurse (Keith et al., 2021). As discussed, the growth opportunities can improve nurse satisfaction and retention but also can advance the individual nurse's ability to communicate and develop professional relationships with others in the organization. Further, as the career coaching pathway offers education on EBP, nurses participating in career coaching can partner with nurse educators and leaders to help advocate for evidence-based changes to improve the quality of patient care (Mulkey, 2021). Participating nurses will also be better prepared to assume the role of educator and leader should a suitable position become available. Replacing a nurse leader or educator can often be an extended process leaving a unit without the role for weeks to months. As the organization proactively prepares nurses for leadership and education roles, those prepared nurses can quickly step into a vacated role. This new system can provide frontline nurses with continuous and capable leader or educator support during a role transition as nursing peers are prepared to assume the role (Hedenstrom et al., 2023). Implications Nurse career coaching offers multiple benefits for nurses, providing them with the guided career and professional growth they want. As discussed above, the project prepares nurses for future roles and assists them in attaining their specialty certifications, improving their communication and relational skills while continuing to work at the bedside. Further, the 30 participating nurses can be more engaged in the organization, which can lead to improvements in the delivery of quality patient care. However, there are also multiple limitations to this project. First, only one unit will be involved in the implementation trial. Further, nurses will not be required to participate, so the initial cohort may be limited in size and exclude others from different units who wish to participate. Nurse managers will need to be able to discuss with their nurses why the trial unit is needed for the initial implementation. Second, the program timeline of 18 months will not produce immediate results. Hence, this may be frustrating for both the participating nurses and the organization, who may be looking for a quick change in retention results or careers. Again, communication with the organization and nurses about the necessity of the 18-month timeframe to incorporate the pertinent education, and have time for coaching and growth, is crucial. Recommendations The literature review recommended the implementation of guided intraorganization career and professional growth opportunities to decrease nursing turnover. However, few publications discuss guided career and professional growth opportunities, such as nurse career coaching. When examples of this type of program are published, the programs are not described in detail and are, therefore, difficult for interested organizations to replicate. Thus, further research on nurse career coaching is needed to confirm the program's effect on nursing retention and satisfaction, to identify an optimal, reproducible framework. Conclusion Healthcare organizations are having an increasingly difficult time recruiting nurses (Wise & Church, 2022). When organizations can recruit new nurses, the newly hired nurses stay employed at the organization for drastically fewer years compared to previous generations (Wise 31 & Church, 2022). Now more than ever, nurses are willing to leave their employers to find professional growth opportunities (Keith et al., 2021). To retain nurses, organizations must provide guided intraorganizational professional growth opportunities (Brook et al., 2019; Keith et al., 2021). Establishing a nurse career coaching program provides guided education with support from an experienced coach. By implementing a career coaching program, healthcare organizations meet the expectations of the nursing workforce, which may lead to improved nursing satisfaction, nursing retention, quality, and financial gains (Brook et al., 2019; Keith et al., 2021; McClain et al., 2022; Price et al., 2018; Walden et al., 2022; Wise and Church, 2022). 32 References Association for Nursing Professional Development. (n.d). NPD expertise in your pocket. Retrieved January 28, 2023, from https://www.anpd.org/Resources/Podcasts Brook, J., Aitken, L., Webb, R., MacLaren, J., & Salmon, D. (2019). 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Journal for Nurses in Professional Development, 33(1), 25-32. https://doi.org/10.1097/NND.0000000000000317 Wise, T., & Church, C. (2022). Insights into the millennial generation of nurses. Nursing Management, 53(5), 28-33. https://doi.org/10.1097/01.NUMA.0000829284.89318.27 Yang, Y., Liu, Y. H., Liu, J. Y., & Zhang, H. F. (2015). The impact of work support and organizational career growth on nurse turnover intention in China. International Journal of Nursing Sciences, 2(2), 134-139. https://doi.org/10.1016/j.ijnss.2015.04.006 37 Appendix A Leadership Pathway 38 39 40 Appendix B Education Pathway y 41 42 43 Appendix C Certification Pathway 44 45 Appendix D Nurse Career Coach Job Description Title: Job Summary : Essential duties and responsibilities Scope Educaton Certification, registration, and license Experience Nurse Career Coach Provide guidance and feedback to support bedside nurses' professional growth in their desired nursing field. Meet with participating nurse advisee once per quarter as scheduled by the nurse.  Utilize designated growth opportunities to assist participating nurses in developing a personalized professional growth plan.  Use motivational interviewing techniques to assist participating nurses in identifying personal goals.  Discuss nurse-completed development assignments to provide alternative viewpoints or advice.  Deliver constructive, thoughtful feedback.  Assist participating nurses in self-identifying personal strengths and weaknesses.  Introduce participating nurses to key contacts within the organization.  Strategize tactics to help participating nurses overcome organizational barriers. Coach bedside nurses  Required: Bachelor's level degree in nursing or higher Required: Montana registered nurse license Preferred: Certification in nursing management, nursing leadership, nursing executive leadership, or nursing professional development. Required: Three years in nursing leadership or nursing education Preferred: Previous nurse coaching or mentorship experience 46 Appendix E Career Coaches' Training Module 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 Appendix F Nurse Career Coaching Applications Nurse Career Coaching Program Application: Nurse Leader or Educator The nurse career coaching program is an exciting new option for nurses wanting to grow as professionals. The nurse career coaching program is 18 months long and will require a time commitment of 10-20 hours each quarter. During that time, participants will complete development activities, job shadowing, educational courses, and meetings with an assigned coach. Your commitment to the program is key to your professional growth; therefore, you must be aware of you and your coach's roles in the program. Nurse's role:  You will need to schedule meetings with the coach once every quarter  Actively participate in coaching sessions  Be willing to accept and grow from constructive feedback  Complete assignments before coming to a coaching session  Come to each coaching session prepared to discuss what you have learned  Commit to learning from the program. Coach's role:  Meet with the nurse every quarter to review their progress, discuss what they have learned, and identify new learning objectives for the next quarter  Assist in developing an individualized growth pathway based on experience, goals, and organizational standards  Provide constructive feedback to optimize professional growth By applying for this program, I affirm:  I have not been in corrective action in the last 6 months of my employment.  I have worked for the organization for at least 6 months.  I understand there is a 10-20 hours per quarter time commitment.  I understand that I can be asked to leave the program at any time due to unprofessional behavior, lack of engagement, or corrective action.  I understand that completing the program does not guarantee career advancement within the organization. 63 Your signature below indicates you wish to participate in the nurse career coaching program and agree to be held accountable for the above requirements. Desired Career Path (circle one): Leader or Educator Associate Name (Print) _______________________________________ Associate Signature____________________________________ Date________________________ Manager Name (Print) _______________________________________ Manager Signature____________________________________ Date_______________________ 64 Nurse Career Coaching Program Application: Certification Nurse career coaching for certification is a program to help nurses attain a specialty certification. The program will require nurses to make a commitment to take the test for their chosen certification within 18 months. As an interested nurse, your commitment to the program is key to attaining your certification; therefore, we want to inform you of your role and the coach's role in the program. Nurse's role:  Schedule meetings with the coach to discuss progress  Actively participate in coaching sessions  Complete testing preparation courses and materials  Complete pre-testing requirements such as CEs requirements and transcript transmission  Commit to testing for an applicable nursing certification in 18 months Coach's role:  Assist nurse in identifying appropriate certification  Meet with the nurse every quarter to review progress toward certification  Provide possible resources to assist in testing preparation  Assist in identifying cost-reduction or reimbursement opportunities By applying for this program, I affirm the following:  I have not been in corrective action in the last 6 months of my employment.  I have worked for the organization for at least 6 months.  I will complete all the required practice and education elements associated with my desired certification before taking the certification exam.  I will take the identified certification exam within the next 18 months.  I understand that I can be asked to leave the program at any time due to unprofessional behavior, lack of engagement, or corrective action.  I understand that if I do not take a certification test within 18 months, I may be asked to reimburse the organization for any preparation material or courses. Your signature below indicates you wish to participate in the nurse certification program and agree to be held accountable for the above requirements. Associate Name (Print) ___________________________________ Associate Signature_______________________________________ Date________________________ Manager Name (Print) ____________________________________ Manager Signature_______________________________________ Date________________________ 65 Appendix G Participating Nurse Education Module 66 67 68 69 70 71 72 73 74 Appendix H Timeline Project Implementation Timeline Preimplementation First Month Second month Third month Forth month Thirteenth month Twenty-Second month Nurse career coaching program proposal to CNO for approval Career coaches designated Career coaches educated on role Career coaching application opens to nurses Initial quarterly meeting between coach and nurse Nurse to complete midprogram satisfaction survey Nurse to complete post program satisfaction survey Nursing Directors and HR program approval Marketing materials developed Nurse leaders educated on the program Nurses accepted into program and complete the preprogram satisfaction survey and personality testing. Initial monthly coaches' meeting Trial unit designated Marketing materials distributed to the trial unit Nurse paired with a coach Gather data from surveys and turnover reports for review and organization comparison.