Metaphorically speaking

FigureNurse leaders, in particular nurse managers, play a crucial role in building a healthy work environment and driving improved nurse satisfaction and patient outcomes.1 Recent work by the American Organization for Nursing Leadership, in collaboration with Laudio Insights, supports that managers with more consistent, purposeful interactions with their team members are likely to have lower nursing turnover.2 The American Association of Critical-Care Nurses identified authentic leadership as an essential standard for building healthy work environments, and relational leadership styles like transformational, resonant, and authentic leadership have long been associated with improved outcomes for patients, nurses, and organizations.3-8 Conversely, ineffective or toxic leadership results in decreased work effectiveness, lower productivity, job dissatisfaction, and negative patient outcomes.9 Healthcare organizations face many challenges related to inadequate leadership skills, incivility, and workforce pressures.10 As the expectations of the nursing workforce evolve, the focus on leader development, in particular relational leadership and the leader as coach, is increasingly necessary.11 The traditional, directive model of leadership is no longer effective in today's healthcare setting.11 Instead, the nurse leader needs to employ a more collaborative, team-based approach, similar to the way modern athletic teams function. The leader adopts the role of a coach who not only provides guidance but also fosters a culture of shared accountability, open communication, and mutual trust. In many ways, the nursing team functions like a soccer team. The players on the field have individual roles and responsibilities that, collectively, support the team's progress toward a shared goal. The nurse leader as coach facilitates training, provides feedback, and encourages the players to perform at their best. The players hold different positions with different responsibilities on the field, and all are empowered to make split-second decisions to move the ball around the field, from player to player, and ultimately into the goal. During the last several years, I've observed many youth soccer practices and games as my children learned to play. Watching these young players develop their skills, and learn through their wins and losses, I've noted several teamwork and leadership lessons that are easily adapted to the nursing profession and nursing leader development. Among them are the importance of individual skill development as a precursor to team success, the value of collaboration and delegation to move toward a shared goal, and the contribution of a strong coach in guiding the team to success. INDIVIDUAL SKILL DEVELOPMENT When young players are first introduced to soccer, the practice sessions focus on individual skill development. Coaches employ drills and games that help to develop dribbling skills, ball touches, and controlling and turning the ball. These activities are designed to teach basic skills while encouraging players to be engaged in the sport. As players develop the fundamental skills, other activities are added, such as shooting for accuracy, spreading out and moving away from the ball, foot placement, body position, and attacking and defending, which then build to one-on-one drills to introduce the variable of another player. The United States Youth Soccer Association defines these early stages of development as “me and my ball,” “me and my partner,” “the start of us,” and finally, “us,” representing the progression from building individual skills, to one-on-one play, to small-sided games, and finally to larger fields and teams.12 This development takes place during the athlete's first several years in the sport. For novice nurses transitioning into practice, many healthcare organizations have developed structured orientations, preceptorships, and residencies.13 In addition to developing and validating individual clinical skills, these programs help to integrate the new nurses into the culture of the organization; enable nurses to grow professionally and develop the skills necessary to succeed at the bedside; and ensure nurses feel supported by the transition program, leadership, preceptors, and colleagues.13 These programs move the nurse from “me and my ball,” to “me and my partner,” to “the start of us,” and finally, to “us,” the integrated care team. The same holds true for nurse managers, who are often selected for their position based on clinical expertise rather than leadership and management competencies, and many managers assume their role with minimal leadership preparation.14-16 Manager onboarding varies widely among organizations. When there's an orientation plan, it may focus on some individual skills and management tasks, such as payroll, financial reporting, logistics and supply chain, scheduling, and access to computer systems. Building the manager's competencies in relational leadership and other “soft” skills, however, requires more experiential learning and mentorship and is rarely accomplished prior to the manager assuming responsibility for team and unit performance. Just as soccer players begin with a focus on individual skills and ballhandling before they advance to passing and small-sided games, and the onboarding of a novice nurse provides a structured transition with individual skill development and professional socialization, the onboarding of a new nurse manager requires a deliberate and thoughtful approach.12,13 Nurse executives need to assess the quality of manager onboarding programs and invest in a structured orientation, preceptorship, and/or residency, building core competencies to ease the nurse manager's transition into the new role and providing ongoing support, coaching, and mentorship thereafter.14,16 Senior leaders' commitment to continuous professional development at all levels indicates that the managers and team are valued and contributes to performance and retention.17 Nurse executives and managers at all levels can model this commitment to professional development through their own continuing education and development, including by obtaining professional certifications as a reflection of their knowledge and experience. Nurse leaders should seek opportunities in both the tactical aspects of management and the strategic aspects of leadership, building their individual ballhandling skills, so they bring their leadership strengths to the team. COLLABORATION AND DELEGATION Once the youth soccer players have built some competence in individual ballhandling skills, dribbling, passing, shooting, attacking, and defending, they need to develop an understanding of field position and strategy. Early scrimmages and games start with a smaller field and fewer players—for example, four versus four—and grow over time. In these early games, it's common to see the lack of experience manifest as delayed reactions to changes in possession, players not well positioned to defend against an opponent's advances, players clumping together as they all individually try to chase the ball, and players from the same team fighting for the ball. They quickly learn the same person can't recover the ball, move the ball down the field, and score a goal. With time, practice, and coaching, players learn to maintain tactical awareness of their location on the field and the location of the ball, teammates, and opponents.12 They learn to quickly transition from attack to defense or defense to attack. They learn to respond quickly, attacking the ball efficiently, positioning themselves strategically to receive a pass, and anticipating the opponents' movements to intercept the players, defend the goal, and win back the ball. In these later games, the team comes together to move the ball more efficiently down the field, passing from player to player, moving the ball away from the defenders and into a more advantageous scoring position. As one player moves the ball down the field, other players anticipate their trajectory. They move into supportive positions where they can receive the ball, should the ball handler encounter resistance from the opponents. They communicate actively, letting the ball handler know they're available, undefended, and ready to continue toward the goal. When the ball handler passes to another player, now relieved of the ball, they anticipate the movement of the new ball handler and strive to best position themselves to support the next play. Success in the game is no longer driven by one or two strong players and instead relies on the team's ability to communicate, coordinate, and respond to changing situations. In the workplace, think of the soccer ball as the work to be done that needs to be moved toward the goal. As nurse managers function in an environment of increasing patient acuity and workplace complexity, it's harder for one manager, regardless of strengths or experience, to move the ball down the field and score on the goal.16 Instead, managers need support to develop the communication and collaboration skills necessary to share work with peers and delegate effectively to their teams. Teamwork and collaboration are active processes, in which team members coordinate and communicate to move into advantageous positions to support the work to be done. When one team member meets resistance reaching a goal, others look for opportunities to support and contribute to overcome the obstacles. Nurse executives have the opportunity to coach their nurse managers to develop these team skills, encouraging them to collaborate with peers to support the nursing team's goals, while alleviating some of the workload and stress associated with nurse manager burnout and job dissatisfaction.18 This teamwork requires an active effort by all managers on the team to remain engaged and to watch for chances to make meaningful contributions, such as by offering to support colleagues. Moving the ball down the field or working toward a goal also requires delegating and sharing responsibilities with the team. Delegation is a substantial managerial and leadership skill that helps share workload among more people while also promoting personal and professional development and empowering the team to own their practice environment.19,20 When a player passes the ball on the soccer field, that player isn't directing the other player or giving them an order. Rather, they're trusting that their colleague has the intention, motivation, and individual skills and commitment to continue moving toward the goal. Similarly, in the workplace, delegation isn't giving orders and expecting compliance. Delegation is a two-way process that engages the team in decision-making, influence, and action.20 This process relies on relationships and trust, and so relies on the manager's relational leadership, transparency, authenticity, empathy, and communication to be successful.19 COACHING LEADERSHIP In soccer, coaching for player development is an art and a science, with a goal to find the right balance and focus that yield the strongest players with the greatest appreciation for team strategy and alignment. Players have no chance of becoming soccer savvy if they're simply cogs in the team wheel.12 Coaches support the team with individualized training to optimize the players' skills and with team development to build their understanding of formation, position, and strategy. The coach doesn't need to be stronger, faster, or more skilled than the players. Rather, the coach is an expert in coaching, motivating, engaging, and communicating, staying optimistic and encouraging the team to perform at their best. The coach pushes the team to overcome setbacks, acknowledge failures that are inevitable, and embrace those failures as opportunities to learn, grow, and develop. Coaching as a leadership model and style is gaining momentum in healthcare.21 Coaching, in this context, may refer to leadership coaching for the benefit of the nurse manager, or it may refer to performance and leadership coaching by the nurse manager for the benefit of the team. Like coaches in soccer and other sports, nurse leaders don't need to be more skilled or knowledgeable than the team members. Rather, they need the skills to lead and coach the team to perform to their highest potential. They support professional growth, provide frequent feedback, build on the individual's strengths, and ask, “What can we do together?”11 Coaching leadership supports performance through improved confidence and critical thinking, communication, and resilience and is associated with stronger organizational identification, psychological ownership, and workplace well-being, leading to higher job satisfaction and lower intent to leave.8,21 As coaches, nurse leaders need to spend time with individual team members, helping them to reflect on their individual skills, strengths, and weaknesses, and connecting them with professional development opportunities to fill those gaps. Like soccer coaches, nurse leader coaches share a common vision and advocate for their staff, driving success and motivating the team.22 It's important to find or make the time for these face-to-face coaching sessions to build relationships, establish trust, and open the lines of communication needed for coaching to be successful.11 With the foundations of the relationship established, the nurse leader as coach needs to be visible, present, and engaged in the workplace to continue the coaching conversations in real time.22 COLLECTIVE SUCCESS Nurse managers are at the heart of a healthy and productive work environment. The parallels between soccer and nursing leadership emphasize the importance of building individual competencies as the foundation for collective success. Young soccer players progress from building individual skills to thriving as part of a cohesive team. Similarly, nurse managers and their teams need structured onboarding, ongoing professional development, and a culture of shared accountability. The ball (the work) must move fluidly among team members, relying on trust, communication, and strategic delegation to achieve the team's shared goal: high-quality, safe patient care delivered in a healthy work environment.