The Role of a Health Coach - How We Fit In
So if it’s not obvious to anyone here yet, I have a nursing background. I’ve worked public health when I first started which I was passionate about because I centered on helping adolescents make positive changes in their lives which is what made me want to become a Certified Health Coach in the first place. So I can see why quite a few people who I speak to are confused when I introduce myself primarily as an Emotional Wellness Coach and as a nurse second. Or even what the difference actually is. And of course the line blurs when you see a lot of nurse
For me personally it’s hard sometimes for me to call myself a nurse because working in many different fields (home health, long term care, primary care, health IT, etc) I would be party to see how admin, billing, coding, and insurance companies were consistently putting themselves in between patients and their provider by deciding what they will and won’t cover. Treatments such as life saving inhalers or telling diabetics they’ve reached their limits on their insulin and will need to pay hundreds of dollars each month just to stay alive. As you can probably imagine, it makes me appalled and disgusted. Most healthcare professionals did not get into their field to be on the phone for 10+ hours per week with insurance companies to battle for them to cover medications and diagnostic tests that are needed for their patients. I’m no exception.
And while many healthcare providers, clinics, and other facilities are shifting that paradigm in their own groundbreaking ways, I separate myself from that process as a Wellness Coach by not being tied to having to use diagnosis or procedure codes, not working directly under a healthcare provider, or following the guidelines set by insurance companies. Because what’s been proven to work for people is giving them time to ask them questions, discuss the issues that are either internally or externally blocking them from making the lifestyle changes they are seeking. And because it’s not as quick or easy as ordering tests or prescribing medication, there’s a lot of providers who feel like they just can’t spare the time in this way for their patients.
Nurses are in this same boat as providers in this when they work directly for a primary doctor because they still must keep up with all of their patients’ needs and the increasing administrative burden thrust upon them by Medicare, Medicaid, and commercial insurance companies to justify the care that is being ordered and send supporting documentation to all of them while also serving as the go-between for families, home health, specialists, laboratories, imaging centers, etc. So unfortunately for many nurses patient teaching is either very rushed or gets put on the back burned to accommodate the growing workload.
This is where I believe the Health and/or Wellness Coach role will manifest and show that this is a true need. Someone who isn’t obligated to see as many patients as possible, but have a caseload of patients who they see regularly either weekly or bi-weekly and help facilitate clients making their own sustainable changes to their lives and overall well-being. Instead of what patient teaching has unfortunately become which is just telling people “you have to follow a low-salt diet and walk 10,000 steps per day” without giving them a solid HOW to integrate this into their daily routine in a way that feels authentic for them. Instead of thrust externally upon them which means they’ll be labeled non-compliant or just won’t keep to it for the long term.
Insurance companies are jumping on this bandwagon already have some of their own. Companies dedicated to health (such as Cerner Corporation here in Kansas City where I live) also employ nurse health coaches in their employee health clinic. And still other clinics are adding this role to their health care team to measure progress and keep patient’s accountable to their health goals. This trend is exciting, but it’s still a ways to go until it enters the general Health Care system.
What some of the more ‘alternative’ Health Coaches without the benefit of a solid healthcare background tend to forget or may even have been portrayed to them from other sources is that people with chronic conditions such as heart disease, diabetes, sleep apnea, and serious behavioral health disorders still need the overall health care team behind them including a primary care physician, specialists, a dietitian, and a therapist if indicated. I have read on various health care forums ask ‘how do I help treat this patient’s indigestion’ or ‘patient has started experiencing headaches after changing their diet, how do i adjust their diet.’ That is NOT the role of a Wellness and Health Coach. You have to know where your role ends.
Health and Wellness Coaches do not diagnose, treat, or cure any medical or psychological conditions. We do not prescribe or adjust clients’ diets, no matter how many dietary theories your Institute has taught you about unless you have the Registered Dietitian credential (at least in my state of Missouri, I know that some others are less restrictive). We can only be truly taken seriously in Western medicine when we firmly establish our role and freely refer when we are faced with issues outside our scope. And that scope is one of an educator, a professional encourager, a loving kick in the pants for clients, someone who may be like them but just a few steps farther, one who asks the right questions to get clients thinking of their own mental blocks on their mindset towards changing their behavior. This is something that should be directed by the educational institution as well as given to the client when outlining what the coach-client relationship will look like for them.
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