By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
“I want to be a servant leader, but where do you draw the line between coaching your staff and doing therapy?” Frontline nurse leaders have asked me this question many times recently as they work with younger staff with very high anxiety levels and clinical depression who often overshare their personal situations with leaders. There can be a fine line between leader coaching and therapy, but leaders must avoid crossing it when possible. The International Coaching Federation has issued a whitepaper for coaches that provides helpful guidance.
Part of the ICF guidance is to ask yourself this question about conversations you have with nurses – “Do the issues we discuss interfere with their ability to manage their daily activities and perform their work responsibilities?” If they have recurrent panic attacks and emotional meltdowns – the staff member probably needs a referral to a mental health referral if they are not already under treatment. There is a difference between coaching and therapy.
When coaching, you do the following:
- Help the staff member envision success.
- Help the staff member plan for their professional future.
- Help the staff member maximize their personal and professional potential.
- Help the staff member develop skills to manage their personal and professional growth.
When therapists work with clients, they do the following:
- Help the client explore reasons for emotions.
- Help clients examine their past and the impact it has on current behaviors.
- Help clients to work on emotional healing and trauma recovery.
- Help clients to develop skills to manage their emotions.
As nurses, most of us have at least some behavioral health education. We learn to have conversations with emotionally distraught staff and patients. This is helpful in our leadership but can also make the boundaries less clear about coaching versus therapy. From a dimensional mental health perspective, healthy functioning can be seen on a spectrum instead of present or absent. Leaders need to take action and make a referral when a staff member displays signs of loss in their mental health and functioning.
Many nurse leaders tell me they know when they have crossed the line, but it can be hard to pull back without looking like you are rejecting the person. If interactions with a staff member cause concern or discomfort, you are probably past a point where coaching will be of value. If the emotional problems keep resurfacing and the staff member is not progressing after a reasonable time, you need to refer the staff member to therapy.
Once you have determined that the staff member might benefit from seeing a mental health professional, you should bring up the subject in a supportive way. Your role is to provide support, offer options, and identify resources. Become knowledgeable about your organization’s employee assistance program before you make the referral. You want to normalize mental health issues and treatment, but be firm about the need by telling the staff member – that your well-being is my primary concern, and you need more help than I can professionally provide. The choice to seek help must be the nurse’s decision, so keep the lines of communication open.
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