A Story About Nurse Peer Coaching Part 4: Putting skills to the test.

Posted on April 8, 2024 by VITAL WorkLife

Updated April 8, 2024

Kelsey Smith’s first nine months at Wildwood Hospital brought her opportunity, struggle, achievement, frustration and insight.

The experienced obstetric nurse had to adjust to a larger hospital than she had worked in prior while handling the unavoidable challenges of a thousand-mile move with her husband Kyle and their two kids. She found a mentor, built a record of excellent patient care, handled difficult deliveries with consummate professionalism—but also found some colleagues hard to work with. Her successes in fact, made the interpersonal problems that came up for her particularly frustrating—it was clear she knew what she was doing, so why were certain colleagues—like anesthesiologist Dr. Luke Ward and traveling nurse Karine Collins—second-guessing her, or even “instructing” her as if she were a nursing student? And what could she do about it?


Luckily, Wildwood had not only state-of-the art obstetric equipment and facilities, but a forward-looking philosophy that prioritized the well-being of its staff. The hospital made peer coaching available to its people and on the urging of her mentor, Dr. Amelia Morton, Kelsey made an appointment with Greta Holmberg, certified coach—and nurse.

The coaching process wasn’t a therapy session, but rather focused on addressing concrete problems rather than probing wounds. Greta helped Kelsey draw on her own understanding of herself and of the problems she had with these colleagues to come up with her own solutions. She helped Kelsey focus on standing up for herself peacefully and with respect, communicate her needs and be willing to listen to the other person—all of this rather than losing herself in the heat of her initial, internal, resentful response.

A change of attitude and approach isn’t easy however and Kelsey had a few moments with Dr. Ward during which she “froze” and fell back into silence and a slow burn.

But then came the day when she was attending a second-time mom. The delivery time had come, and Karine was nearby, which made Kelsey uncomfortable. Trying to push her feelings aside, Kelsey went forward to attend her patient.

“LeeAnne, are you ready to start pushing?” Kelsey asked.

“One second,” said Karine. “LeeAnne, I want to confer with Kelsey for a second.”

Kelsey felt the blood draining from her face. But she turned to face Karine, and the two nurses stepped away from their patient.

“Do you really want her to start pushing now?” Karine asked.

There it was again, one of Karine’s favorite gambits. Do you really want to do this? Translation: You shouldn’t do this.

What Kelsey wanted to say was, I obviously want her to because I just asked her if she was ready to! Followed—again only mentally—by an impolite one-syllable characterization of Karine.

Instead, Kelsey paused, took a breath and said:

“Yes. But what do you think?”

“She’s somewhat frail and pretty tired already. If we were to let her wait and then labor down, she’d need to do less pushing.”

“There are downsides to a longer labor overall, Karine.”

Karine frowned—but not because she was angry, it seemed like a frown of consideration.

“I just hate seeing them get so exhausted,” she said. “It wears on me to see how it wears on them.”

“I hear you, I’m wanting to avoid a sepsis case here,” said Kelsey.

“She’s your patient,” said Karine. “You have to do what you think best. Just putting my two cents in.”

She’s your patient. Karine had said that. My two cents. The words came to Kelsey as a type of revelation.

She had always reacted to Karine’s suggestions so immediately, so defensively, certain that they were criticisms. She’d done her best to ignore them and go on wordlessly, meanwhile cultivating her resentment overtime.

This time she had received them and there had been…a conversation.

Karine, although she liked to talk at length about her experience, and offered advice when she wasn’t asked for it, was willing to have a give and take—and willing to say, She’s your patient. My two cents. Kelsey discovered she was willing to say those things because she had actually given Karine a chance to be something other than an opponent.

When Kelsey related the conversation to Greta a few days later, Greta smiled, nodded and said, “Sounds like you came out of that defensive fog that you told me you get into and had a meaningful exchange. Nice, right?”

“Sure is,” said Kelsey. “I think I was so self-conscious and anxious to prove myself that I was walking on eggshells and ready to snap at anybody who questioned me, or even seemed to be questioning me. Except I didn’t snap at them. I closed my mouth, got mad and stewed about it.”

“You know that you can keep approaching Karine this way, right? You can even approach your Doctor—is it Warren?”

“Oh! Ward. Luke Ward,” said Kelsey with a laugh.

“You can deal with Ward in the same way, right? Recognizing his knowledge, being open to it, politely letting him know when you feel he’s encroached on you, but not accusing him of encroachment. He might surprise you like Karine did.”

Kelsey made a wry face, then smiled.

“Yeah, maybe,” she said. “Worth a try.”

“And then you can try it when Kyle gets on your nerves,” said Greta.

“Funny you should say that,” said Kelsey. “Just last night we were doing the dinner dishes, and out of the blue he said, ‘You know, Kelsey, it seems like I’m not getting on your nerves as much these days. You seem…happier.’ All I could think of to say was, ‘Yeah, honey, I think I am.’

“And then he said, and I’m not kidding: ‘I don’t mean to criticize or anything. Just an observation. Just my two cents.’”

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