Innovations in coaching and mentoring: implications for nurse leadership development

Abstract

This longitudinal study sought to examine ways in which coaching and mentoring relationships impact on the professional development of nurses in terms of career and leadership behaviours, and evaluating the differences and similarities between those coaching and mentoring relationships.

According to the UK government, leadership in nursing is essential to the improvement of service delivery, and the development and training of all nurses is vital in achieving effective change. A coaching and mentoring programme was used to explore the comparative advantages of these two approaches for the leadership development of nurses in acute, primary care and mental health settings.

A longitudinal in-depth study was conducted to measure differences and similarities between the mentoring and coaching process as a result of a six-month coaching/mentoring programme. Five nurses from six UK Health Care Trusts were allocated to a coaching group (n = 15) or a mentoring group (n = 15), these were coached or mentored by a member of the senior directorate from their own Trust. Qualitative and quantitative data were collected at three time points (T1 = baseline, T2 = 4 months and T3 = 9 months) using semi-structured interviews and questionnaires.

While mentoring was perceived to be ‘support’ and coaching was described as ‘action’, descriptions of the actual process and content were quite similar. However, while both groups reported significant development in terms of career development, leadership skills and capabilities, mentees reported the highest level of development with significantly higher scores in eight areas of leadership and management and in three areas of career impact. Implications for nurses and health services are discussed.

Introduction

In UK health services, people, not capital, are the business' most vital assets.¹ To meet demand and the accelerated pace of change, health services must innovate and, as its key workers, nurses need to develop the skills that serve as the basis of innovation. It is acknowledged that career development and the development of leadership skills and qualities are essential to the delivery of change in health services and the improvement of patient care.² According to the Modernisation Board's Annual Report (2000–2001),³ leadership in nursing is essential to the improvement of service delivery and the development and training of all nurses is vital in achieving effective change. It also acknowledges that senior management in the health services must increase their contact with front-line staff as part of this process.

Coaching and mentoring have been identified as the keys to developing the leaders of tomorrow.⁴ Such tools could meet the acknowledged training and development needs of nurses, while expanding the role of senior management and their links with those who deliver patient service. According to the Chartered Institute of Personnel and Development (CIPD),⁵ the difference between coaching and mentoring is that mentoring gives advice and teaches, whereas coaching facilitates learning. However, a review of the literature indicates that there is a lack of clarity and understanding surrounding these concepts and a CIPD survey (2004)⁶ reported that 81% of respondents agreed that there is a great deal of confusion around what is meant by the term coaching, and the fact that Europe and the USA interpret the words differently adds to the confusion. Furthermore, the majority of research is cross-sectional in design and there is a growing need to investigate the efficacy of coaching and mentoring programmes over time.^7–9

The aim of this longitudinal study is address this gap by assessing the impact of coaching and mentoring delivered through a development programme within the UK National Health Service Nurse Leadership, ‘Innovations in Coaching and Mentoring’, to evaluate the differences and similarities between those coaching and mentoring relationships, and to evaluate the impact of the programme on the career and professional development of coachees and mentees.

Background

Coaching

Coaching has been defined as the provision of support and guidance for people to use their existing knowledge and skills more effectively¹⁰ and is concerned with the immediate improvement of performance and development of skills by a form of tutoring or instruction.^11,12 Traditionally, coaching has been undertaken in a business context as a remedial process, now usually referred to as performance coaching and is an acknowledged approach to the development of human capital resources. Much is written to extol the virtues of coaching, but rarely is the business effectiveness of this concept clearly demonstrated as a tool for the development of leaders.^13,14 Buck¹⁵ provides research evidence to suggest that a coaching training programme for managers can be successful in changing behaviour and improving employee perceptions about how they are managed. Empirical evidence is lacking about the role and effectiveness of coaching for excellence in the development of potential leaders, yet this information is essential if we are to identify and promote an optimal model of coaching.

It is also suggested by Kopelman¹⁶ that coaching may be used to overcome the problems associated with the transfer of the learning process. That is, coaches can provide problem-focused training and encouragement for coachees to be proactive. It is a goal-focused process wherein action is required so the coachee can move forward.¹⁷ A coachee can be helped to focus on personal skills (e.g. goal setting, planning and initiation), interpersonal skills (e.g. communication, conflict resolution and team development), and needed system changes necessary for leadership development. Essentially, it is about providing a structure and time for reflection to help the individual gain awareness, with the aim of continuous improvement.¹⁸ Coaching provides the opportunity to reflect upon what works well, to identify the ways to sustain excellence, and to be creative and embrace change in a positive and innovative manner.¹³ Coaching activities can be used for people at all experience levels, but there must be shared commitment and enthusiasm and it is vital that the coachee takes responsibility for actions and is motivated to learn. The purposes of coaching may be diverse, but can include: (1) transitions from one role or state to another; shifts in role or career; (2) dealing with organizational changes; (3) resolution of issues and problems; and (4) skills development.¹⁴

Coaching aims at organizational excellence through the effective use of abilities and potential in a way that allows growth in knowledge and experience.^19–21 This wide breadth of description is the essence of what we mean by transformational coaching. The coaching process involves the development of rapport, relationship building, gathering of information through assessment and review, negotiation of carefully defined goals and implementing problem solving. However, coaching is not simply telling people what you think they should do or how to do it. It is not interfering or occasionally overseeing what a coachee is doing and advising them how to do it better,^22,23 neither is it a parental approach to the passing on of hard gained experienced. Through an effective coaching process, an individual should be able to identify an action plan and implement it. Indeed, research evidence indicates that learning gained through coaching is far more effective than that of learning gained from telling or showing.²⁴

Mentoring

The mentoring relationship is also regarded as a valuable development tool and can play a crucial role in early career and business success. According to Clutterbuck and Ragins,²⁵ it is ‘support, assistance, advocacy or guidance given by one person to another in order to achieve an objective or several objectives over a period of time’. It is also viewed as an integrated approach to advising, coaching and nurturing, focused on creating a viable relationship to enhance individual career, personal, professional growth and development.²⁶ These definitions illustrate the apparent confusion that exists in distinguishing differences between the concepts of mentoring and coaching. Some writers appear to use the terms interchangeably, whereas others embrace coaching as a category of mentoring.²⁷ We suggest that coaching is defined as directly concerned with the immediate improvement of performance and skills by a form of tutoring or instruction.¹² Mentoring is one step removed and is concerned with the longer-term acquisition of skills in a developing career.²⁸

Although many writers describe a good mentor as counsellor and coach, mentoring should not be confused with counselling or coaching per se. Counselling and coaching are focused on emotions and behaviours whereas mentoring focuses on thinking. Effective mentoring enhances the link between thinking, feeling and action.²⁹ Change in behaviour comes through focused dialogue. Furthermore, mentoring is a developmental, empowering and nurturing relationship extending over time in which mutual sharing, learning and growth occur. In this sense, it is a two-way process with learning for both parties.³⁰ Thus, it is acknowledged that mentoring is likely to be reciprocal in that wisdom is not handed down in a one-way transaction, rather both mentor and mentee share knowledge, insight and skills.^31,32

To be successful, it is suggested that mentoring must progress through four distinct stages of evolution: initiation, cultivation, separation and redefinition,²⁷ and the period of time required to develop a fully effective mentoring relationship can be lengthy.³³ The behaviour and expectations of both mentor and mentee is likely to change at each of these stages. Mentoring may not be beneficial if offered as a short-term option in a leadership development programme. However, unlike informal mentoring relationships, this constraint might not be evident in a formal mentoring relationship where both mentor and mentee understand that the programme has a relatively short and defined time-span, and so will accelerate through these stages. Due to organizational restraints within health services, protracted mentoring relationships may not be viable.

Mentoring is not about telling, giving solutions, criticizing mistakes, giving advice or jumping in to handle solutions without being asked; a mentor is the person who guides another to success.³⁴ Murray³⁵ suggests that mentors can act as both role model and sponsor but their main involvement in the career development of the mentee is the most crucial feature of the relationship. Mentoring offers many benefits to the organization directly or indirectly,^25,36,37 including: increased productivity, improved recruitment, induction and training, staff retention and increased motivation, better communication, enhanced succession planning and leadership development, the strengthening of the nursing profession, a smoother transfer of company culture, and ultimately a more stable corporate climate.

The study

Innovations in coaching and mentoring – programme evaluation

A longitudinal study was conducted to measure differences and similarities between the mentoring and coaching process as a result of a six-month coaching/mentoring programme. Qualitative and quantitative data were collected from coachees (n = 15) and mentees (n = 15) at three time points (T1 = baseline, T2 = 4 months; T3 = 9 months). This study was not intended to measure the direct benefits of coaching or mentoring, but to assess the relative benefits over time of each method of professional and personal development.

Six UK Health Care Trusts took part in the programme: two Acute Trusts, two Primary Trusts and two Mental Health Trusts. The Trusts were recruited by the Department of Health based on the level of commitment expressed by the senior management teams, as a high level of by-in from senior management is essential for any development programme of this kind. Final selection of Trusts was through a matching process based on function, size and location. These participating Trusts were split into two groups, a coaching group and a mentoring group, each comprising of one Acute Trust, one Primary Trust and one Mental Health Trust. Coaches and mentors were recruited from each Trust based on a range of matched criteria, including experience of coaching/mentoring, seniority in Trust, professional background and responsibilities. Five nurses from each of the three Trusts in the coaching group (n = 15) were coached or mentored by a member of the senior directorate from their own Trust. Similarly, five nurses from each of the three Trusts in the mentoring group (n = 15) were mentored by a member of the senior directorate from their own Trust. All participants involved in the programme were volunteers. Ethical approval was not required as this study was considered to be an audit rather than primary research.

In total 22 women (coachees = 10; mentees = 12) and eight men (coachees = 5; mentees = 3) took part in the programme. The majority were married (coachees = 13; mentees = 13) and ranged in age from 31–51 years. On average, participants had been in nursing for 20 years and had been employed in their current organization for approximately 12 years (range 1–25 years). A similar pattern was seen for the coaches/mentors, with 23 women (coaches = 12; mentors = 11) and six men (coaches = 3; mentors = 3) taking part in the programme. Again the majority were married (coaches = 13; mentors = 11) and ranged in age from 34–56 years. Both senior managers and directors accounted for eight coaches and seven mentors, respectively.

The overall aim of the ‘Innovations in Coaching and Mentoring’ programme was to provide leadership and career development for nurses in health services. The programme consisted of two separate three-day professional development workshop for coaches and mentees. A half-day workshop was undertaken separately by coaches and mentors, this was designed to ensure that all coaches and mentors had the same knowledge of models, techniques and process. Finally, coaches/coachees and mentors/mentees attended separate joint half-day workshop to establish the goals of their relationships, format of meeting, boundaries and process. Formal coaching and mentoring relationships lasted for a period of eight months. In this programme, coaching dealt with specific developmental issues, the immediate improvement of performance and skill development, whereas mentoring revolved around the long-term organization of skills in career development.³⁸ Sessions took a formal, structured approach that included the undertaking and assessment of tasks such as shadowing (of coach/mentor and line-manager) and a patient walk-through (i.e. an investigation into an area of service delivery). The coaching process involved the development of rapport, relationship building, gathering of information through assessment and review, negotiation of carefully defined goals and implementing problem solving. In contrast, a mentors role was to provide career-related behaviours that included protecting, providing challenging work assignments, enhancing visibility, sharing information and wisdom, coaching, making suggestions without imposing decisions or solutions, and challenging the protégé to think. Plus psychosocial support behaviours include activities such as counselling, acceptance and role modelling.³⁵

Participants were also supported through action learning sets, which is based on the ‘relationship between reflection and action … where the focus is on the issues and problems that individuals bring and planning future action with the structured attention and support of the group’.³⁹ A final event was held at the six-month stage to formally complete the programme and terminate coaching/mentoring relationships. The programme was hosted by a UK University and ran from January 2004 to November 2004.

Evaluation is a concept about differences over time, i.e. a difference in the before and after situations associated with a programme.^40,41 It is important to evaluate by monitoring progress against stated aims and objectives by eliciting feedback from participants and tracking the careers and personal and professional development of those involved.^25,28,42 Specifically, the aims of the evaluation were:

To identify how coaching and mentoring relationships impacted on careers, leadership and management, and service delivery/patient care for coachees and mentees;

To assess the impact of coaching and mentoring on coaches and mentors;

To evaluate the differences and similarities between coaching and mentoring relationships.

The evaluation process employed a longitudinal design, using face-to-face or telephone interview with coachees and mentees and questionnaire methods, with repeat measures at three time points (T1 = baseline, T2 = 4 months and T3 = 9 months). In-depth one hour interviews used a semi-structured format of open-ended questions to explore participant's expectations and experiences of the coaching/mentoring relationship;⁴³ the impact of that relationship on their career and professional development; the impact of their development on patient care and service delivery; and the implications for the organization in terms of working relationships and organizational commitment. Questionnaires were formulated based on the content analysis of the interviews,⁴⁴ adapting themes in conjunction with the literature review, and employed a five-point Likert scale for questions investigating the impact of the programme on:

Career progression (23 questions) – exploring career prospects, goals, ambition, career development strategies and networking skills;

Leadership and management development (20 questions) – investigating political skills, negotiation skills, leadership ability, problem solving, management style and self-perception;

Organizational impact (6 questions) – in terms of organizational understanding, patient care and service delivery.

A four-point bi-polar scale was used for questions investigating:

Career support (6 questions) – exploring the impact of guidance, feedback and information;

Career assets (8 questions) – investigating perceptions of skills/abilities, opportunities and control;

Organizational support (6 questions) – looking at perceptions of support, relationships and role models.

Questionnaires were administered by the researcher in order to gain a natural response, rather than a considered one. Results are based on the content analysis of qualitative interview data at the baseline and final measure points;⁴⁴ and on the statistical analysis of quantitative data utilizing t-tests from questionnaires.⁴⁵

Results

The data were analysed using mean comparisons (t-tests) even though the sample numbers are small. Due to the tendency for the occurrence of type errors, trends are reported up to the 10% probability level.⁴⁵ Qualitative data, analysed using a thematic approach, are provided where appropriate to provide additional insight into the qualitative data.

Coachees/mentees

Career progression

About 27% (n = 4) of coachees and 40% (n = 6) of mentees experienced positive impact on their career progression. Twenty percent (n = 7) of both cohorts were promoted by the end of the programme. Table 1 gives a summary of the key findings.

Table 1

Career progression

	Mean T1	Mean T2	df	t	P
More ambitious
Coaches	3.71	4.36	13	−2.5	0.02
Mentees	3.75	4.08	10		NS
Career prospects
Coaches	3.29	3.93	13	−2.09	0.057
Mentees	3.18	4.09	10	−2.32	0.043
More able to achieve career goals
Coaches	3.83	4.33	13		NS
Mentees	3.64	4.46	10	−2.32	0.043
Perceived career planning ability
Coaches	3.07	4.14	13	−3.51	0.004
Mentees	2.80	3.80	10	−3.00	0.015
Political awareness
Coaches	4.57	4.93	13	−2.11	0.055
Mentees	4.50	5.00	11	−3.32	0.007
Individual political awareness
Coaches	3.36	4.07	13	−2.91	0.012
Mentees	3.08	3.58	11	−2.17	0.053
Networking skills as a career development strategy
Coaches	3.07	3.79	13	−2.69	0.019
Mentees	3.00	3.93	13	−2.74	0.017
Motivation to fulfil career potential
Coaches	3.86	4.07	13		NS
Mentees	3.79	4.29	13	−2.46	0.029
More empowered to achieve career goals
Coaches	3.43	4.07	13	2.33	0.045
Mentees	3.57	3.86	13		NS
Knowledge/use of career development strategies
Coaches	2.86	3.79	13	−7.32	0.0004
Mentees	2.77	4.29	12	−6.06	0.0004
Visibility/credibility in organization
Coaches	3.86	3.79	13		NS
Mentees	2.54	3.46	12	−3.86	0.002
Understanding working of organization
Coaches	3.36	3.93	13	−2.51	0.026
Mentees	3.31	3.85	12		NS

There was a trend for both cohorts to be more ambitious by the end of the programme. In addition, satisfaction with ‘career prospects’ increased significantly for both cohorts. There was also a trend for both cohorts to feel more able to achieve career goals. This effect was stronger among the mentee group and a very strong improvement in perceived career planning ability for both groups.

Both mentee and coachee perceived political awareness as very important for career advancement in the UK Heath Care organizations, and this perception increased significantly over the duration of the programme. Furthermore, perceptions of individual political awareness increased during the programme for both groups. There was also a significant improvement in the perception of, ‘networking skills as a career development strategy’ for both cohorts. Plus, levels of motivation to fulfil career potential increased for both cohorts, but the difference was significant only for the mentees. Coachees also reported a significant improvement in feeling more empowered to achieve career goals.

Both cohorts reported a significant increase in ‘knowledge and use of career development strategies’. However, perceptions of visibility and credibility in the organization increased more for the mentees. While this did not appear to be the situation for the coachees, it should be noted that they reported feeling highly visible and credible at the baseline measure point (significantly more than the mentee group, P = 0.008) and thus reported only minor improvements during the programme. Further, coachees reported a significantly greater level of understanding of the working of the organization, but levels did not improve significantly for the mentees. Finally, while both mentees and coachees reported a wide variety of improvements to aspects of career and organizational factors, the results indicate that this improvement did not extend to perceptions of personal/life satisfaction.

Leadership and management development

Both coaches and mentees reported opportunities for leadership and management skills from the coaching and mentoring process. Table 2 gives a summary of the key findings.

Table 2

Leadership and management development

	Mean T1	Mean T2	df	t	P
Effectiveness of management style
Coaches	2.71	3.93	13	−6.50	0.0004
Mentees	2.85	3.62	12	−3.83	0.002
Negotiation skills
Coaches	3.64	3.93	13		NS
Mentees	3.14	3.71	13	−2.51	0.026
Network of professional contacts
Coaches	3.29	3.71	13		NS
Mentees	3.29	3.86	13	−2.83	0.014
Insight on performance effectiveness
Coaches	3.29	3.71	13		NS
Mentees	3.29	3.86	13	−2.83	0.014
Self-esteem
Coaches	3.50	3.93	13		NS
Mentees	2.71	3.57	13	−4.6	0.001
Self-confidence
Coaches	3.43	3.86	13		NS
Mentees	3.29	3.86	13	−2.28	0.04
Leadership skills and capabilities
Coaches	3.54	3.85	13		NS
Mentees	3.54	4.15	13	−3.41	0.005
Ability to open and direct
Coaches	3.71	4.14	13		NS
Mentees	3.50	4.07	13	−2.83	0.014
Insight and ability to problem solve
Coaches	3.64	3.93	13		NS
Mentees	3.69	4.08	12	−2.74	0.018
Perceived leadership ability
Coaches	3.57	3.93	13		NS
Mentees	3.58	4.00	11	−2.80	0.017
Ability to negotiate
Coaches	3.43	4.43	13	−3.89	0.002
Mentees	3.08	4.33	11	−5.75	0.0004

Both cohorts perceived a significant improvement with respect to ‘insight on the effectiveness of my management style’. It should be note this trend was also observed at the Time 1 measure for both cohorts, meaning that this improvement was a rapid change. Although there was a trend for perceived improvement in negotiation skills, this result was significant for only the mentee group. Again there was a trend in the perceived improvement of ‘network of professional contacts’; this was significant for the mentee group only.

Both cohorts perceived a greater insight on performance effectiveness. However, while levels of self-esteem increased for both cohorts, but significantly so for only the mentees. The same was observed for reported levels of self-confidence, which increased for both cohorts, but significantly so for only the mentees. There was also a trend for improvement in the perception of leadership skills and capabilities, but the difference reaches significance for only the mentees. Again a trend for improvement was observed in the ability to be open and direct in discussion with others but this change was also significant for mentees only. Perceptions of ‘insight and ability to problem solve’ improved for both cohorts, but significantly so for mentees only. A trend was also found for improvement in perceived leadership ability for both cohorts, but again it was significant for mentees only. In contrast, the ability to negotiate was perceived to have greatly improved for both mentees and coachees.

Organizational impact

In terms of service delivery, 47% (n = 7) of coachees and 87% (n = 13) of mentees reported that their participation in the programme had had a direct impact on patient care. In addition, 53% (n = 8) of coachees and 40% (n = 6) of mentees reported job or role enrichment resulting from participation in the programme; for example, invitation to lead on high-profile projects or restructuring initiatives.

One-third of coachees and just over half of the mentees were actively engaged in the training and development of staff. Increased motivation and the vigour required to do this was a reported outcome of participation in the programme. The desire and motivation to cascade their new skills and abilities down through the business and empower others was evident:

I have put forward a pilot for a course to make practice safer and improve care. (Coachee)

I'm training nurses on this new programme … and I'm empowering them to deliver (Mentee)

Engaging and enrolling in further study and the subsequent personal and professional development of staff, and potential for impact on patient care, were also acknowledged as organizational outcomes of participation in the programme. Further, 40% (n = 6) of coachees and 53% (n = 8) of mentees had registered or were in the process of registering for further study. This included higher degree qualifications (e.g. Masters and MBA); RMN Higher, ECP-Masters, plus a variety of leadership and management specialist courses.

Career support, career assets and organizational support

Perceptions of ‘career support’ increased significantly for both groups during the programme (coachee: x = 3.24 and 3.93; 13 df; t = −4.00; P = 0.002 and mentee: x = 2.85 and 3.68; 12 df; t = −3.618; P = 0.004). That is, the participants perceive positive changes with respect to:

Having someone to guide career aspirations and provide effective career guidance; the provision of regular, constructive feedback and good communication at work to guide career development and prospects; feeling informed about career opportunities; and having informal communication networks to help career development.

Perceptions about ‘career assets’ also increased significantly for both groups (coaches: x = 3.35 and 3.88; 12 df; t = −3.40; P = 0.005 and mentees: x = 3.07 and 3.68; 11 df; t = −3.64; P = 0.004). They felt that they had:

The skills required for the next career move; satisfaction with opportunities to use my skills/abilities, and development opportunities; satisfaction with opportunities for continuous performance assessment; setting realistic performance targets and working to achieve them is part of the routine; feeling in control of career development; my management and leadership style is an asset to career advancement; and active career planning is part of a development strategy.

It should be noted that no significant differences were observed between coachees and mentees on the measures of ‘career support’ or ‘career assets’, at baseline, time 1 or Final measure points.

Measures of organizational support showed a slight, but not significant increase, although levels of organizational support were higher among coachees. This was associated with:

Social support; good relationships with line manager, colleagues and coach; ability to identify with a good role model, and feeling informed about organizational changes.

Perception of help received from a line manager increased during the programme for both cohorts, although this was significant for the mentee group only. The coachee group reported high levels of help from a line manager at all three measures point. Perceptions of help received from ‘Trust Management’ were very low at the baseline measure point for the mentee cohort, but improved over the duration of the programme. Coachee measures remained stable.

Coachees/mentees – careers impact

Thirteen percent (n = 2) of coaches and 20% (n = 3) of mentors experienced positive impact on their career progression. Both mentors and coaches described learning experiences associated with competences in their role of mentor or coach. Many common themes emerged with respect to initial anxieties, finding that competence existed beyond expectations, and that the structured process worked. Ultimately, the experiences of coaching and mentoring seem to have been beneficial, although the greatest impact of the programme appears to be on mentors' approach to service delivery and patient (note: no coaches commented on this aspect):

I am much more aware what is happening on units and how patients feel. I am planning to make changes.

I'm using the same skills on my staff; the mentoring structure has helped me do this; it has made me think differently; I have gained as a Manager from the process.

Being grounded back in clinical practice again and seeing reality and the implications.

We are currently developing a strategy for the Trust. It has been useful to realize how this programme fits our strategy.

It has had an effect on the way I engage with different services – the patient walk-through will lead to changes and benefits for service delivery.

I'm seeing gaps in nurse development and asking if we are training Ward Managers to be good mentors and supervisors.

Increased job and personal satisfaction from seeing the mentees achievement is a career achievement for me. Ultimately this will have positive impact for our clients and the delivery of care.

Difference and similarities in coaching and mentoring

The importance of the quality of the relationship in mentoring appeared to be much more significant than for the coaching process. Half of the mentees were described as the ‘drivers’ of the process compared with 33% (n = 5) of coachees. Indeed, two-thirds of the coaching cohort was more likely to describe the process as ‘jointly driven’. There was also less agreement within the mentee cohort about what makes it potent as a tool of development, plus the coaching cohort focused far more on expectations and less on barriers.

While mentoring was perceived to be ‘support’ and coaching was described as ‘action’, descriptions of the actual process and content were quite similar. In fact, 66% (n = 20) of both the coaches and mentors reported some overlap between mentoring and coaching concepts. It should not be a surprise that a positive impact from both coaching and mentoring was observed in all aspects of development, although overall opportunities appeared to be greater for the mentees. This is further reflected in the achievement of objectives, with 80% (n = 12) of coaches and 66% (n = 10) of coaches compared with 87% (n = 13) of mentees and 80% (n = 12) of mentors reporting that that had met their goals.

Discussion

The results demonstrated that, when it comes to the leadership development of nurses, coaching and mentoring undertaken in a structured programme can have significant benefits in terms of professional and personal development. The findings show that both coaching and mentoring are useful and effective techniques for the development of nurses, in terms of leadership and management, career and service delivery, which concurs with previous literature in both of these areas.^24,29 However, although coachees made significant progress in many aspects of these elements of development, mentees progressed much further. Indeed, this was most evident in relation to the positive impact for the mentees in terms of Leadership Management skills compared with the coaches. Of the 11 Leadership and Management skills, mentees scored significantly higher ratings compared with the coachee cohort on eight items, i.e. ‘improvement in negotiations skills’, ‘network of professional contacts’, ‘levels of self-esteem’, ‘levels of self-confidence’, ‘leadership skills and capabilities’, ‘the ability to be open and direct in discussion with others', ‘insight and ability to problem solve', ‘improvement in perceived ability’, and ‘ability to negotiate’. There may be several reasons for these differences. Firstly, coaching has traditionally been used in a business context,¹⁵ which may explain why the three areas in which coachees improved in significantly more than mentees were more business orientated than leadership orientated, i.e. being more ambitious, feeling more empowered to achieve and understanding the organization. Secondly, coaching is a goal-focused process¹⁷ which may be more compatible with certain elements of the ‘Innovations in Coaching and Mentoring’ programme, such as the patient walk-through, which are task focused. General leadership development may not be action orientated enough for this form of intervention, especially if the nurses involved do not have access to leadership opportunities in their current job role. Thus, for nurses coaching may be most effective at the beginning of a cycle of career progression (e.g. promotion), rather than as means to further career progression.

Further, while the overlap between coaching and mentoring in practice is probably responsible for the high degree of similarity found in many areas of development, it appears that mentoring may include aspects of coaching more than coaching incorporates aspects of mentoring.^12,26 This would explain why mentees increased significantly more than coachees in three aspects of career impact, including motivation to fulfil career potential, more able to achieve career goals, and increased visibility/credibility in the organization. It may also offer some explanation as to why more mentees achieved their objectives than coachees and why mentees reported a higher positive impact on their career than coachees. The fact that mentoring combines facets of both approaches more than coaching²⁸ may mean that mentoring of early career nurses is a much more effective form of leadership development than coaching. This combination also makes the approach more flexible in meeting the individual needs of each nurse. By enhancing the links between thinking, feeling and action,²⁹ mentoring can deal with specific issues from a variety of standpoints.

Limitations and future research

To date, most programme evaluation has been limited and certainly no comparative work has been undertaken. Thus, while the study is based on a small sample size, which inevitably restricts the generalizability of its findings, it does provide a unique insight into the comparative benefits of mentoring and coaching. This is an area that clearly requires further research in order to establish exactly which elements of the coaching and mentoring process are responsible for individual development. For example, these findings may be an artefact of organizations in which the participants are employed, rather than a reflection on coaching or mentoring. Further, it was not possible to analyse the effects of gender on the coaching/mentoring relationship due to the sample size. The literature around this particular variable has produced mixed results²⁵ and future research is required to understand the influence of demographic variables on coaching and mentoring relationships. The impact of other variables, such as ethnicity, sexuality and disability should also be fully explored.

Conclusions

Nurses are essential in the delivery of change in health services,² yet their development in terms of leadership skills and capabilities has largely been down to ‘stand alone’ training courses, rather than on-going, one-to-one support and advice. The formalized nature of the programme meant that coaches/mentors and coachees/mentees could progress through all of the four distinct stages of mentoring evolution that are essential to a successful relationship²⁷ in a relatively short time period. This means that health services can develop the leadership skills and capabilities of their nursing staff in a fixed, manageable time frame, with tangible positive outcomes for service provision and patient care.

Although mentoring appears to have the greatest impact across all relevant aspects this may be a reflection of the relatively junior level of the nurses (i.e. early career) in their respective organizations, a lack of opportunities to exercise leadership skills in their current position or a lack of previously effective leadership development. Indeed, for higher level nurses who are working in leadership roles, coaching may be more appropriate than mentoring, especially at the start of those career roles where a focus on problem-solving behaviours may be more appropriate.

Coaching and mentoring offer a real opportunity to health service organizations to develop their key workers by increasing the interaction between nurses and senior management. Senior management, acting as coaches and mentors, also benefit substantially from a greater exposure to the practical issues around service delivery and patient care from a nursing perspective. Indeed the greatest impact on coaches and mentors appears to be their increased understanding of front-line issues and their reassessment of organizational policy and strategy to reflect that knowledge.

The programmes use of a multi-method approach to the process of coaching and mentoring does mean that it can provide nurses with problem and emotional focused approaches to leadership development, meeting the needs of the individual rather than trying to be a ‘one-size-fits-all’ approach. Although this programme has been evaluated using a relatively small sample, it does illustrate the power of coaching and mentoring in the development of leadership skills and capacities for nurses. Further work is required to establish at which specific career stages nurses would gain most from each approach, but what is important is that both approaches do benefit nurses, health service organizations and, perhaps most importantly, patients.

Footnotes

Acknowledgement

This study was funded by the NHS Leadership Centre.

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