Impact of ontological coaching on well-being, job outcomes, and retention intentions in nurses: A multi-centre randomised controlled trial

BACKGROUND: Nurses are at risk for poor psychological outcomes due to work-related burnout and stress. Since supportive interventions such as coaching have been found to improve nurses' overall well-being, an ontological coaching intervention was developed to improve nurses' well-being. OBJECTIVE: To investigate the effects of an Ontological Coaching among Nurses intervention on nurses' psychological well-being (primary outcome), occupational stressors, social support, goal-setting proficiency, intention to leave nursing, and job satisfaction (secondary outcomes). DESIGN: Multi-centre, two-group parallel-armed randomised controlled trial with baseline, intermediate, and post-intervention measurements. SETTING(S): Data were collected from public tertiary hospitals and primary care public outpatient clinics (polyclinics) under the National University Health System Cluster in the Central and Western region of Singapore between December 2023 and October 2024. PARTICIPANTS: Four hundred nurses, aged 21 and above, working in the NUHS, were recruited and randomly assigned to either an intervention group (n = 200) or a control group (n = 200). METHODS: The intervention group received the Ontological Coaching among Nurses intervention, comprising one group coaching session followed by four individual coaching sessions, in addition to the standard support available to nurses. The control group received only the standard support provided by their respective hospitals or organisations. At baseline, all participants completed a sociodemographic questionnaire. Outcome data were collected at three time points: baseline (during recruitment), intermediate intervention (after two individual coaching sessions), and post-intervention (after four individual coaching sessions). Between-group differences were analysed using general linear models. RESULTS: After adjusting for baseline, recruitment site and intervention, participants in the intervention group also reported higher psychological well-being (mean difference (MD) = 8.70, 95% CI: 5.38 to 12.02, p < 0.001), goal-setting proficiency (MD = 1.88, 95% CI: 0.28 to 3.49, p = 0.02), job satisfaction (MD = 11.22, 95% CI: 2.59 to 19.85, p = 0.01), and lower intention to leave nursing (MD = 1.05, 95% CI: 1.74 to 0.37, p = 0.003) at post-intervention. At the intermediate timepoint, nurses in the intervention group reported a statistically significantly higher psychological well-being (MD = 2.93, CI 95%: 0.17 to 5.68, p = 0.04) and job satisfaction (MD = 8.24, 95% CI: 0.82 to 15.66, p = 0.03), and lower intention to leave nursing (MD = 0.76, 95% CI: 1.39 to 0.13, p = 0.02). CONCLUSIONS: The Ontological Coaching among Nurses is a feasible and promising intervention to enhance nurses' psychological well-being, goal-setting skills, job satisfaction, and retention intentions. It could be integrated into workplace well-being programmes, with refinement to address occupational stressors and social support. Future research should adopt cluster randomisation, use shorter validated tools to reduce survey fatigue, include objective retention measures, and assess long-term outcomes. REGISTRATION: https://clinicaltrials.gov/ (NCT06878157).