NR 529 Week 4 Coaching Conversation Plan Example

Coaching Conversation Plan: Seven Missing Morning Weights, One Opening Sentence, and What I Say Next to Each of the Three Answers an Experienced Nurse Is Likely to Give

Student Name

College of Nursing, Chamberlain University

NR 529: Leadership and Management within the Clinical Healthcare Environment

Instructor Name

Month Day, Year

Coaching Conversation Plan: Seven Missing Morning Weights, One Opening Sentence, and What I Say Next to Each of the Three Answers an Experienced Nurse Is Likely to Give

The Situation

Gwen has worked on our renal and urology unit for nineteen years and is one of the nurses new graduates ask for help. She is also, on one measure, the nurse whose patients most often have no morning weight recorded. Over the last two weeks, 22 of her patient-days carried an order for a daily weight. Seven had no weight in the record. On the unit as a whole the figure was 11 missing of 61, or 18%; for Gwen it was 32%. On two of those mornings the nephrologist set the amount of fluid to remove during dialysis without a current weight and wrote "no weight today, estimated" in the note.

Weights matter on this unit more than on most. For patients on dialysis or with heart failure and kidney disease, the morning weight guides how much fluid is removed, whether diuretics change and whether a patient can go home. A missing weight is a small omission that forces someone else to guess.

What I Want From the Conversation

I want Gwen to weigh every patient with a weight order before 0700, or to tell the charge nurse by 0700 which weights could not be done and why. I do not want an apology or a promise to try harder. I also want to learn whether something on the unit makes weights harder for her than for others, because a nurse with nineteen years of good practice who misses one task repeatedly is more likely to be running into an obstacle than to have stopped caring.

Feedback research supports this approach. In a large meta-analysis, feedback raised performance overall yet lowered it in roughly one study result in three, especially when it drew attention to the person rather than to the task (Kluger & DeNisi, 1996). The conversation therefore stays on the weights, the record and the mornings, not on Gwen's reliability or attitude. I will not use the word inconsistent. It describes her, and she can do nothing with it.

The Opening

We will meet in my office at 1430 on a Tuesday, after her shift's busiest hours and with the door closed. I will open with this:

"Gwen, I want to talk about morning weights. Over the last two weeks, seven of your patients with a weight order had no weight recorded, and on two of those days the nephrologist had to estimate fluid removal for dialysis. That is more than the rest of the unit, and it is unlike you, so I want to understand what is happening on your mornings before I decide anything."

The opening gives the number, the consequence and the reason I am asking, in that order. It says that the pattern is unusual for her, which is true, and that I have not decided anything yet, which is also true.

Branch A: "The Scales Are the Problem"

This is the most likely answer, and part of it may be true. The unit has one standing scale and two bed scales, and the bed scale for rooms 20 through 24, where Gwen is often assigned, has been reading high.

"That is useful, and I did not know the 20 to 24 scale was still off. Let us check it against the standing scale this afternoon and get a work order in. While it is being fixed, what would let you get those weights done? Could the night nurse weigh those rooms at 0500 with the standing scale, or could the technician bring the standing scale to you first?"

If the scale explains all seven missing weights, the problem is the equipment and the conversation becomes a work order and a temporary plan. If it explains two of them, I will say so: "The scale explains the two in room 22. What happened with the other five?" The aim is not to catch her out but to find every obstacle, and some may be ones I can remove.

Branch B: "Why Me? Everybody Misses Them"

This answer is also partly true. The unit misses almost one weight in five, which is too many.

"You are right that it is not only you, and I am raising it with the whole unit at next week's huddles. I am talking to you first and separately because your number is the highest this month and because new nurses copy what you do. If you set the standard for weights, they will follow it."

The last sentence is honest and matters. It tells Gwen that her influence is the reason for the conversation, not an accusation. If she remains upset, I will not argue: "I understand this feels unfair. I would still like us to agree on what happens at 0700."

Branch C: "Fine, I Will Do It"

Quick agreement is the hardest answer to handle, because it can end the conversation without changing anything.

"Thank you. Before we finish, tell me what a morning looks like when a weight does not get done. Where does the time go?" If she describes a morning with two early dialysis departures and a transfusion, we have found the real obstacle. If she says it will not happen again, I will ask for the specific step: "What will you do at 0700 if a weight is not done?" The answer I am looking for is that she will tell the charge nurse, which turns a missed task into a known one.

Closing and Follow-Up

Whichever branch the conversation takes, I will close with one agreed action, in words we both say: every weight done by 0700 or reported to the charge nurse by 0700. I will write a two-line summary and send it to her, not to her file. We will meet again in two weeks to look at the numbers together.

People speak up about obstacles when they believe it is safe to do so, and teams in which that belief is shared learn faster from problems (Edmondson, 1999). That is why the plan asks before it tells. It is also why the follow-up is a review of numbers, not a test. If the missing weights continue after the obstacles are removed, a just culture approach treats a repeated choice to skip a required step differently from an error or a system problem (Marx, 2001). The second conversation would then be firmer. I do not expect to need it.

References

Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999

Kluger, A. N., & DeNisi, A. (1996). The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin, 119(2), 254-284. https://doi.org/10.1037/0033-2909.119.2.254

Marx, D. (2001). Patient safety and the "just culture": A primer for health care executives. Trustees of Columbia University.