NC-BC cheat sheet

Nurse coaching is a client-centered, structured, purposeful process that blends nursing knowledge and skill with coaching principles to promote health, wellness, and the client's self-directed goals.

The American Holistic Nurses Credentialing Corporation (AHNCC) administers the NC-BC (Nurse Coach, Board Certified) examination; eligibility requires an active unencumbered RN license, completion of an endorsed nurse coach education program, nursing practice experience, and passing the exam.

Nurse coaching draws on three inputs: nursing knowledge and clinical judgment, coaching competencies, and a holistic whole-person/whole-system perspective.

The client, not the coach, is the expert on the client's life and sets the session agenda; the coach holds and manages the process.

Coaching is present- and future-focused work with functional clients and excludes diagnosing or treating mental illness, which belongs to psychotherapy and lies outside nurse coach scope.

Decision rule: if assessment reveals depression, trauma, active withdrawal, or suicidal ideation, the nurse coach refers rather than continuing coaching as the sole intervention.

Role differentiators: consulting supplies expertise and answers; mentoring shares experience-based guidance; teaching transmits content; coaching elicits the client's own answers, strengths, and capacities.

Core nurse coach competencies: relationship building, therapeutic communication and presence, self-awareness and self-development, facilitating learning and behavior change, accountability partnership, and ethical/professional practice.

Nurse coach scope is the intersection of the state Nurse Practice Act, the RN license, certification standards, employer policy, and the individual coach's documented competence.

OARS = Open-ended questions, Affirmations, Reflections, Summaries - the four core motivational interviewing microskills used to build alliance and evoke client talk.

Reflection types: simple (restates content), complex (adds inferred meaning or feeling), double-sided (names both sustain and change talk), amplified (mild exaggeration that invites correction).

The righting reflex - the urge to advise, fix, or reassure - reliably raises client resistance; decision rule: when resistance rises, shift from informing to reflecting and asking.

Rogers' three relationship conditions: congruence/genuineness, unconditional positive regard, and accurate empathic understanding.

Empathy communicates understanding from within the client's frame of reference; sympathy expresses pity from outside that frame and tends to create distance.

Powerful questions are open-ended, brief, free of embedded advice, and asked one at a time with silence allowed for processing.

Change talk (desire, ability, reasons, need, commitment, activation, taking steps) predicts behavior change; sustain talk predicts maintenance of the status quo.

Motivational interviewing spirit = partnership, acceptance, compassion, evocation; the coach's stance is collaborative rather than expert-driven.

Nonverbal attending (open posture, steady eye contact, relaxed stance) and deliberate silence regulate pacing; cultural humility plus plain-language teach-back adapts communication to culture and low health literacy.

Coaching process arc: establish agreement and rapport → assess and explore → identify readiness → set goals → co-create an action plan → implement with accountability → evaluate and adjust → close or graduate the relationship.

GROW = Goal, Reality, Options, Will (commitment to action); it structures a single coaching conversation from desired outcome to a committed next step.

SMART goals = Specific, Measurable, Achievable, Relevant, Time-bound; goals are generated by the client, not assigned by the coach.

Transtheoretical stages: precontemplation → contemplation → preparation → action → maintenance → termination; relapse recycles the client to an earlier stage and is an expected part of the cycle.

Stage-matched rules: precontemplation - raise awareness, no action plan; contemplation - explore decisional balance (pros and cons of changing versus staying the same); preparation - concrete plan with a start date; action - reinforce and problem-solve barriers; maintenance - relapse-prevention planning.

Self-determination theory: satisfaction of autonomy, competence, and relatedness supports intrinsic motivation and durable change, while controlling language and pressure undermine it.

Bandura's self-efficacy sources, strongest first: mastery experiences, vicarious experience, social/verbal persuasion, and physiological or affective states.

Scaling or confidence ruler (0–10): a rating below 7 signals the action step is too large or an unaddressed barrier remains.

Accountability is built by specifying what, when, where, and with whom, plus a defined check-in; vague intentions do not predict follow-through.

Holistic nursing is all nursing practice that has healing the whole person as its goal, addressing body-mind-spirit within the person's environment, culture, and relationships.

Wellness is a multidimensional continuum rather than the absence of disease; common dimensions are physical, emotional, social, spiritual, intellectual, occupational, environmental, and financial.

Prevention levels: primary (reduce risk before disease occurs), secondary (screening and early treatment), tertiary (limit disability and support rehabilitation and function).

Watson's Theory of Human Caring centers on ten Caritas processes and the transpersonal caring moment; caring is framed as the moral ideal of nursing.

Theorists used in holistic coaching: Nightingale (environment and sanitation), Rogers (unitary human energy fields), Newman (health as expanding consciousness), Parse (human becoming).

Salutogenesis (Antonovsky): a strong sense of coherence - comprehensibility, manageability, and meaningfulness - predicts movement toward health under stress.

Integrative health combines conventional care with evidence-informed complementary approaches and emphasizes the whole person, self-care, and practitioner-client partnership.

Lifestyle pillars: nutrition, physical activity, sleep, stress management, social connection, and avoidance of risky substances.

Coach self-care is a professional obligation: unmanaged compassion fatigue and burnout impair presence, judgment, and ethical practice.

The ANA Code of Ethics has nine provisions: 1–3 address direct duties to patients, 4–6 the boundaries of duty and self-preservation, and 7–9 duties beyond individual encounters.

Nurse coaching scope = state Nurse Practice Act + RN licensure + certification standards + employer policy + documented individual competence; the most restrictive applicable limit governs.

Informed consent for coaching discloses the nature and limits of coaching, session structure, fees and cancellation policy, confidentiality and its limits, and the client's right to terminate.

Coaching is typically not reimbursed by third-party payers; common revenue models are per-session fees, prepaid packages, group programs, employer or wellness contracts, and consulting.

HIPAA binds covered entities and their business associates; a coach in private practice outside those entities still owes confidentiality through the coaching agreement, professional ethics, and state law.

Confidentiality limits: imminent risk of harm to self or others, suspected abuse or neglect under mandatory reporting law, court orders, and written client authorization.

Dual or multiple relationships (employer, friend, family, treating clinician) risk impaired objectivity and power imbalance; decision rule: avoid, or disclose and manage with supervision.

Ethical decision rule: when a client's need exceeds the coach's competence or license, the coach refers and documents the referral.

Documentation and business safeguards: notes record goals, plans, progress, referrals, and significant events, retained per policy and discoverable in litigation; a written coaching agreement and professional liability coverage are standard safeguards.