Karen Avino, the Executive Director of Education for the Integrative Nurse Coach™ Academy and the International Nurse Coach Association providing online and onsite continuing education programs for nurses. As a consultant, Karen helps healthcare organizations create optimal healing environments and integrate holistic nursing into practice. She taught Holistic Nursing and Integrative Health for 20 years in online and on campus classes at the University of Delaware. She received the Faculty Senate Excellence in Academic Advising and Mentoring Award and the Delaware Excellence in Nursing Practice Award as Nurse Educator.
Karen has over 40 years of experience in Maternal-Child Health, Administration, Community Health, Holistic Nursing and Nurse Coach practice. She is board certified as both an Advanced Holistic Nurse and a Health & Wellness Nurse Coach. Karen is a Reiki Master, Stress Management Instructor, HeartMath, and Clinical Meditation and Imagery Practitioner.
Karen served as a Director-At-Large board member of the American Holistic Nurses Association and is a founding leader of the Delaware Chapter (DEAHNA). She is an author and editor of Holistic Nursing: A Handbook for Practice (2016, 2021) and Core Curriculum for Holistic Nursing (2014). She is a Peer Reviewer for the Journal of Nursing Scholarship and Holistic Nursing Practice journals and is an international and national speaker on holistic and integrative topics.
“The way we can re-energize Nurses is by giving them their voice; they need their voice back. And Nurse Coaching does that for us, it gives us language to use, and it gives us an area that we can then center on in health promotion and focus, and that’s what we do, and we do it best.” ~Karen Avino
CPT Codes for Board Certified Nurse Coaches Press Release
Integrative Nurse Coach™ Certificate Program
Nicole Vienneau 00:00
Welcome, everyone, to Integrative Nurse Coaches in ACTION! My name is Nicole Vienneau, and I’m your host and I’m also a board-certified Integrative Nurse Coach. And I am so thrilled that today we have an exciting guest.
We are interviewing Karen Avino, who is the Executive Director of Education for the Integrative Nurse Coach Academy and the International Nurse Coach Association. And why I am so excited to have her on our podcast today is because she is working diligently to move the Nurse Coaching movement forward in so many avenues.
And I know today’s podcast is going to be very exciting because we all want to know what is in the future for Nurse Coaching. So, I welcome Karen as a friend and mentor and all around awesome person. So welcome, Karen.
Karen Avino 00:58
Thank you, Nicole, I’m really happy to be here with you today.
Nicole Vienneau 01:01
Before we get into all of the exciting details of moving Nurse Coaching forward, we have to take a trip back in history and ask you how did you come into Nursing in the first place?
Karen Avino 01:13
Nursing was something that, I think back in the 1970s, my mother said to me, “What do you think it is you want to do? Do you want to be a teacher, a secretary, or a Nurse?” And back then those were probably about the three options that most women had. Because the other options that we have today for women, that are plentiful, were not as well known back then.
And I thought: Nursing, I like that, I’m going to give that a try. And she said, “You’ll always be able to take care of yourself. And you can work at any time of the day if you needed to.” There I am. I’m a Nurse today. I’ve also been a Nurse for about 47 years this year.
And when I thought of that, I thought: my goodness, that’s a really long time. But during that time in Nursing, I’ve really taken the journey in many, many different areas, which is also one of the very positive things about Nursing, is that there’s so many opportunities and avenues that Nurses can go into.
When I first started out in maternal child health, I started working with mothers in labor and delivery, I started working with mothers in postpartum. I also was part of the team that opened the first NICU in New Jersey.
And when that happened, I just really started to understand a little bit more about the body-mind connection with women and how women could use that to their benefit, whether it was to help their lactation with you know, feeding a baby or whether it was in childbirth.
Because at that time, Lamaze was really in vogue, if you will. And so Lamaze, unlike today’s typical childbirth education class, really focused on preparation of relaxation, guided imagery, and using that, you know, to have natural deliveries.
I was 20 years old when I took my NCLEX, and I then continued on to just learn more about Nursing. I did a small stint in med surge and knew that probably wasn’t quite right for me. I had the birth of my first child when I was 23. I was happily married, still am, to the same man.
What I learned there was the power of the mind and the spirit and the body, and I just was hooked right away on holistic Nursing way back then. So, I could just continue to grow in that area in discovery for myself, my family, but also, as a lactation consultant, began to use things like herbs and music therapy and different relaxation, you know, with women.
So, I knew that that was the avenue that I wanted to take, but I didn’t quite fit into the traditional medical system, you know, at that time. So, I had to do a lot of entrepreneurial kinds of things myself, where I started my own business as a lactation consultant, breast pump rental station, I offered parenting classes, Lamaze classes and different things in my own home.
And that just kind of continued to grow. I moved into some pediatric work. I also then went into community health and worked in maternal child health at first. And that’s really where I think I discovered the power of Nursing, because you’re out there alone, you needed to be creative, you needed to establish relationships with clients that were long-term.
And I knew that that was also something that I was very interested in, was the relationship part of caring for people. From there, I also then was very interested in education, I loved to teach other Nurses. So, I went and I finished my bachelor, my masters and my doctoral degree.
Got a job at the university teaching. And I was, of course, interested in the holistic aspect, so I did teach holistic Nursing, integrative health and taught in a health coaching program for 20 years at the University of Delaware.
So, when it came time to really feel like – not that that wasn’t fulfilling – but I knew that there was more I wanted to do, and I was unable to in that structure, you know, that that provided. I knew that INCA was the place for me because we could develop and design and help Nurses continue to grow and learn about these topics. And so, that’s where I am today.
Nicole Vienneau 05:57
What an incredible journey you have had. I imagine you as a young Nurse, 20 years old, at the bedside, in more of a traditional Nursing role. But then, discovering that you had this distinct connection with mind-body-spirit, and moving your personal journey towards something that really spoke to you.
It’s fascinating to me, because a lot of the conversations that we have on this podcast, we do hear that theme that we just didn’t quite fit into the traditional medical model. And a lot of our Nurses are seeking something a little bit different and where they can really feel that they can thrive.
I heard you talking mind-body-spirit, holistic Nursing, working with moms, babies, entrepreneurial spirit from a young age as a lactation consultant, using herbs, music, relaxation, and I know there are so many more things that you could have contributed to explaining your history as a Nurse.
And then, you know, advancing your degree: BSN, MSN, doctoral Nursing, being an educator, I mean, so many things that brought you to the space you are in today. And I know you mentioned, you know, working at the University of Delaware, and those many years doing Nurse Coaching and education combined.
And so now you’re in the role of Director of Education at Integrative Nurse Coach Academy, so tell us a little bit about what you do. What’s a day in the life of Karen Avino in this role?
Karen Avino 07:33
Well, it’s quite busier than I thought it was going to be. But it’s a good busy. I’m able to live my passion now. That’s how I feel. You know, you should do your work; you have to do the work of a Nurse to understand it. But when you get to the point where you’re able to then say: I’m going to take this fork in the road, because now I can live my passion and I can design my own destiny, It’s an amazing thing.
So, every day is like a journey of discovery. You know, what’s going to come up today? What else can we develop? What else are people saying that they need in order to be able to continue to grow, either in Nurse Coaching or holistic Nursing or, you know, for their own self-development.
And so, it’s about designing, it’s about meeting the needs of Nurses today. And certainly, we’re seeing a lot of requests from organizations, because we find that Nurse Coaching is not just about the skills of a Nurse Coach, and the different types of strategies that you can use in working with somebody. But it’s also about self-development of the Nurse themselves.
And we know that our Nurses today have really gone through a period of suffering, if you will, and pain. Knowing that our Nurses are really injured, we need to be able to help them to go through a process of self-development, which includes self-assessment, self-reflection, self-care, in order then to be able to sit with the suffering of others and be able to help to transform that person the same way that they’ve been transformed themselves through that process.
So, it sounds complicated, but it’s actually quite interesting. It’s not something that is linear, that we say step-by-step you must accomplish, you know, X, Y and Z in order for you to actually come to this outcome. It’s an interesting thing, how it evolves on its own and in its own time, but with the support of a community.
And that’s one of the things that INCA is, I think, well known for – is the community of people who come together, who are like-minded, and who have helped to support each other in all kinds of struggles or things that come up throughout your life. You know you can always call on an INCA.
So, organizations call us because they say, “Our Nurses need to be resilient, can you come do a one-day for them?” And I say, “We’d be happy to do a one-day, but that’s not going to create resilience.” Resilience is a process. And it’s a journey. And it’s something that the Nurse has to be willing to take and wanting to take. And it has to be delivered in a healing environment in order for that to occur.
Now, we’re working with organizations who want to be able to integrate Nurse Coaching into their practice and make it really a professional model for practice in their hospital, from teaching Nurses about Nurse Coaching right in orientation, to taking the champions who are really interested in this, and having them become board-certified Nurse Coaches.
And placing them on the floor, either in manager or preceptor type positions, and working with the new orientees to implement Nurse Coaching into patient care. But also, that mentee or that board-certified Nurse Coach is working with a new Nurse on her own self-development.
Because we know at 24 months, that’s a critical time for a new Nurse to perhaps make the decision: this is not quite right for me. And she may leave Nursing altogether. So, having Nurse Coaches who can walk the talk, have taken the journey themselves, can help others to achieve satisfaction in their lives and in their jobs. It’s an interesting thing that we’re seeing now.
Nicole Vienneau 12:01
It really is. And I often have the conversation with fellow Nurses and with consumers and with family, thinking about our Nursing shortage, thinking about how our Nurses are stressed, overworked, and often doing multiple jobs that are not really their own job.
But in order to take care of the patient and work in the system that they’re working in, they have to be able to do multiple things and wear multiple hats. However, that takes a toll. And what I discovered 10 years ago in taking the Integrative Nurse Coach Academy program, and became a board-certified Integrative Nurse Coach, is that you’re right, it isn’t linear.
It’s a journey that takes continuous self-discovery, self-awareness, building a strong network of friendships, of people who understand what it is you’re doing, that you can feel comfortable speaking with and connecting with and feeling reinforced by the work that we do, as well. So, I really appreciated hearing your perspective on that.
Because it isn’t a step-by-step-by-step. Yeah, it is step-by-step when you’re learning something, but when you really become immersed in it, and it becomes part of who you are, as it has for myself, it is a continuous learning process and relearning and rediscovery and a journey to say: okay, I feel comfortable in this space, and now I’d like to advance my awareness and learn different things.
Which is another thing that I really appreciate about Integrative Nurse Coach Academy, is the opportunity for some of the specialty programs that you have, and advanced programs that you have. So, I’m hoping that you can share a little bit about some of that work that you’re doing in helping our graduates become more comfortable in other areas of practice.
Karen Avino 14:03
Yeah, when we first started getting into Nurse Coaching years ago, we thought: Oh, I’m going to be my own business owner. I’m going to open my own practice and I’m going to work solo with clients. Today, that concept has really broadened to not only some who do do that and, you know, perhaps even do it on the side but learn to bring the Integrative Nurse Coaching into their present place of employment.
Because we certainly have an opportunity as Nurses, which we should be taking full advantage of. Our organizations that we are employed by are now listening a little bit more carefully to Nurses and saying: what is it that you need? And what is it that you want?
So, Nurses are able to help bring a new culture of healthcare with more of a focus on lifestyle, health and wellness and well-being and the importance of all of those dynamics in not only for the Nurse themselves, but working with patients.
So, now we’re talking about changing patient outcomes to one that is more encompassing as we look at the whole person. And so, I think the Integrative Nurse Coach philosophy is one that re-energizes Nursing practice. And that’s what our Nurses need today; is they say: this is not why I went into Nursing.
I’m not practicing the core of Nursing practice, which is really health promotion. But as a Nurse Coach, I now have the opportunity to do that. We have Nurses who have taken the program and if you’d like to hear, I can give you some examples of things that they’re doing.
One Nurse in particular, in Brooklyn – it was one of the hospitals where COVID kind of first hit in that area, and they were bringing in patients… very, very sick patients, and we didn’t even know what it was at first. And a lot of the Nurses were contracting COVID themselves, and some were hospitalized, some in ICU and ventilators, some lived and some died.
And so, one of our Nurse Coaches, who became a wellness Nurse in this hospital, is now working with Nurses who are COVID survivors, helping them on their health and wellness and their journey towards, you know, not only increasing their pulmonary function and things like that, but you know, their overall health and well-being.
We have other Nurses who have approached their employee health department, and they are seeing Nurses who show up with what they call burnout or anxiety or stress, and helping them doing stress management on a one-on-one basis with them. They’re running group coaching classes for self-care for Nurses within the hospital setting, or they’re working with specific patient populations to try to improve patient outcomes.
One Hospital in particular has a very high Medicare population, and so we know that if patients are readmitted within 30 days after being in the hospital, that the hospital doesn’t get paid again. So, it’s really an economic kind of look at what kind of patient populations can we use Integrative Nurse Coaching to improve those outcomes.
So, we’re implementing Nurse Coaching, not only the coaches – the Nurses on the floor with patients – but in the home health that goes to see the patients after they’re discharged. And talking with the physician’s offices even about coaching, you know, of clients and how we can try to reduce the readmission rate of patients who go home.
And in particular, the population of women with heart interventions that are frequent readmission patients in this area. So, there’s so many different ways that we can use this and it’s finding that niche that really gives you that passion and that drive, but showing what Nursing can do and the power that Nursing has to be able to help influence the healthcare system in the right way.
Nicole Vienneau 18:30
I always call what you’re speaking to: blooming where you’re planted. You know, and using the skills that we learn in Integrative Nurse Coach Academy as a Nurse Coach, and using them where you work on a daily basis and help supporting the roles in which we see so many Nurses are struggling.
And for our listeners, just a reminder to listen to past episodes of the Integrative Nurse Coaches in ACTION podcast, because there are so many ways that we’re seeing our INCA graduates combine the skills and tools and strategies of Nurse Coaching with the things that they’re so passionate about, and creating niches or niches, however you say that, where they are, in their communities.
And it’s such a beautiful and creative space to be in, to be able to choose how you would like to bring alive the skills and tools that you learn as a Nurse Coach and combining it, which you so eloquently spoke about, with the self-development and self-awareness that is taught within our programs, as well.
Karen Avino 19:39
And you did ask me about growing in Nurse Coaching skills and we do recognize, because this was a need from Nurse Coaches, to be able to continue to grow, or for specialty programs – things like… we have cannabis Nursing now, which is certainly a trend where we’re not selling cannabis, what we’re doing is advising clients on the use of cannabis and, you know, what cannabis can do for them or not do for them.
We have a Functional Medicine for Nurses™ program that is extremely popular. And that’s not only for advanced practice Nurses, but it’s taught in a way where the Registered Nurse can use this in their practice, because there’s a lot of things that Registered Nurses can do in functional medicine with clients.
We have a program related to reimagining the end of life. And it’s about living for today and, you know, learning how to work with clients near end of life. So, perhaps end-of-life coaching. Or we have, of course, a new one that’s coming out is stillness practice for Nurses.
So, it’s about meditation and how to use that in your daily living, of course, but it helps you then be able to transfer that into patient care. And the business of Nurse Coaching, which is going to be extremely popular because Nurses have not been educated in business concepts.
And a lot of us either we have an entrepreneurial spirit, we have the go and the willpower, but we don’t have the know-how. So, this is going to take people step-by-step on creating their own business and not only how to set it up and deliver their services, but also to market it and grow within that.
Nicole Vienneau 21:37
How exciting! So many things that we can choose to help us move forward within our practice as Nurse Coaches, or even if we’re interested in aspects, because some of those programs, you don’t have to be an actual Nurse Coach to take.
So, I will definitely be including all of the links to each of those programs within the show notes. So, if our listeners want to take a look at some of these amazing programs, they will have an easy way to access them.
I wanted to shift gears a little bit, because we did talk a little bit about the future of Nursing. And I know, within the past six months or so, the American Medical Association approved a modification to the Current Procedural Terminology (CPT code) for health and well-being coaching.
So, it’s now going to include board-certified Nurse Coaches, and I know that you were a key spearheader, if that’s a word, you were the spearheader of making this known that Nurses, and board-certified Nurse Coaches in particularly, needed to have a seat at the table to be able to contribute to this important way of helping move Nurse Coaching forward.
So, I definitely want to hear more about that; about how you came to understand this and knew that it was something that needed to be advanced further.
Karen Avino 23:07
Well, certainly there was an announcement by another certification body that they had received a CPT category three code. And they were actually named in the descriptor, which is an unusual thing to be in a CPT code. Because CPT code descriptor really just describes the service and what it is.
When you look at the service, it’s exactly what a Nurse Coach can do, but of course, she can do more than that. So, we wanted to be included in that, also. A CPT three code actually means that it is put in place for tracking so that you can now begin to collect data on it by many different people who are using those codes. And perhaps, you know, do research and be able to produce patient outcomes on that.
Because you have three years from the time the CPT code was approved to go back and ask them for a category one code, which means now it is reimbursable by insurance companies. So, at present, insurance companies do not have to reimburse, but the category three code allows us to then be able to track and pull data.
So, there’s some processes that are being put in place now that will help us. And we’ll be sending out probably more information on that and, you know, how you can use it and where you should use it and how then we can collect data, because it’s a really important piece that we’ll be able to also provide to the AMA – the research on Nurse Coaching and the effectiveness of it.
So, I worked in conjunction with the American Holistic Nurse Association and the American Holistic Nurse Credentialing Corporation. I was chair of the committee under AHNA, and actually completed the application and presented to the AMA CPT editorial board. So, that was an interesting process to go through.
But it really helped to create awareness, I think, to the physician group about Nursing and what Nurses can do as Nurse Coaches, and that we need to be included at the table, that we could not just be able to say only one group could do this kind of service, no. Nurses are actually the most educated and trained and experienced people to be able to truly provide health coaching.
But we can also provide well-being coaching along with that. So, that’s one of the things that are in the works now. But what that means is that there’s a lot of processes that we’re going to have to set up, we’re going to be setting up many different research projects in order to then be able to publish them, and have that data in the literature, you know, to be able to support our claims.
So, that’s something that’s actually quite exciting to me, because that not only means Nurse Coaches can use that, but it’d be the first time that, really, Registered Nurse services would be reimbursable under insurance without being an advanced practice Nurse. So, I think it might actually help to open up some doors from some other opportunities, and show what Nursing can do for healthcare.
So, that’s one of the, you know, the big things, the most exciting thing I guess that’s happened this year. INCA also has an Integrative Health and Wellness Assessment Tool that measures eight dimensions of the whole person. And we just recently did factor analysis on it; we’re completing using content experts to look at and do a review of that.
And we’ll be releasing a new version two of the IHWA tool that would be updated, but still certainly follow the same dimensions as originally developed by Barbara Dossey and Susan Luck and those back then. So, there’s lots of new things happening.
We’ll also be working on the release of a new textbook on Nurse Coaching. Yeah, so the advancing of Nurse Coaching is actually creating a lot more opportunities for publications and work to be done in this field.
Nicole Vienneau 27:41
I think back to the very beginning – I was in cohort number four – and please remind me how many cohorts we have now.
Karen Avino 27:50
Well, we’re up to 38.
Nicole Vienneau 27:54
Right, and I remember back then, there was no textbook, there was a manual that we used, and of course theories to support the work that we’re doing – Nursing theories. But I think of how much detail and how much dedication and how much work goes on behind the scenes to advance this new way of being for Nursing.
I mean, Nurse Coaching started as a thought in someone’s mind, and has grown to now include multiple textbooks, multiple programs, and 1000s of graduates, and 1000s of Nurses who are doing this kind of work.
And, of course, sometimes it feels like things are going slow, but the research is so important for us to really prove the outcomes that Nurses are contributing to in helping patients, supporting clients, supporting communities, and helping people discover that well-being… health and well-being are very important factors within life and creating stability for our communities moving forward.
So, is there anything else that you would like to share with us about, you know, moving Nurse Coaching forward, or even words of wisdom from Karen Avino?
Karen Avino 29:25
Oh, my goodness. Put me on the spot with that. I just think one of the things we need to remember as Nurses is that a lot of us want to, you know… because we are a little dismayed with the healthcare system and, you know, really the health of our populations and know that we can impact it, we should remember that we are part of the healthcare system in the United States and that what we do, we should be able to impact change within that, rather than turning away and moving away from Nursing.
Always remember, Nursing is really the core of who we are, and the majority of us, I would say, you know, we say we have that calling, and we did have the calling, we were caring, helping people. So, I really think we need to try to impact healthcare to improve it, because we are in a system that does not, at this point, really value wellness.
And wellness is really going to be the key to try to drive down those chronic diseases that, you know, are really what we’re dealing with now. We no longer… well, we shouldn’t say that, we are with COVID, but the communicable diseases are more under control than the chronic diseases are.
It’s something that we need to think about, is… you know, what is your passion, and how can you impact exactly where you are today? And that’s the thing that’s going to help keep you re-energized and driven based on what your mission is.
So, learn to articulate your thoughts and speak out where you can to help Nurses that are coming after us. After all, who’s going to care for us when we’re old? We need our Nurses. But we need to redesign the way that Nursing is practiced, and we need to redesign the tasks that the Nurses are being asked to do in the hospital system.
We have to be able to be at the table to say: this is what Nursing can do, and this is what Nursing will do. And Nurses will no longer clean the rooms, do the laundry, do the garbage, and do the dietary needs of patients, because those are things that other people can help with, while Nurses do the more important tasks.
Nicole Vienneau 31:58
Very well said. One thing that I really appreciated about being involved in the community of the Integrative Nurse Coach Academy is that our like minds come together to discuss these important topics, and to feel connected with like-minded people, which then helps reinforce the work that we are really doing in our communities.
Whether it be a hospital system, or actually in the community as a Nurse who’s practicing either public health or bringing alive the wellness and the well-being aspects, which is something that I really went into Nursing for, because that is a passion of mine. And being able to use my skills on a daily basis in that avenue has really helped me to support my community, which is hospital systems, as well.
So, I appreciate you bringing that to life, to recognize that we are Nurses, most of us were called to this profession, and we feel a deep sense of loss and suffering right now. And it has been even before COVID.
And for our listeners, if you haven’t listened to the podcast that’s previous to this, it’s about burnout in Nursing school and some ideas and tips on how we can help support our new graduates into the Nursing profession. Please have a listen to that, because there are so many things that we can do to support our colleagues as we all journey through this system, as well.
Karen Avino 33:38
And it’s interesting, about burnout, we have this word for it: burnout, right? That we use. But is it really grief and loss that we’re experiencing? And it comes out as anxiety and stress and burnout and discouragement. And that’s something that I hear over and over that they’re so… Nurses are so discouraged.
The way that we can re-energize Nurses is by giving them their voice; they need their voice back. And Nurse Coaching does that for us in a way that it gives us language to use, and it gives us an area that we can then center on in health promotion and focus, and that’s what it is that we do and we do best.
And not that we can’t give medications and we can’t do treatments, but we don’t need to be cleaning the bedpans and cleaning the floors and doing all of those things that somebody else can do. We need to be doing the more important tasks that are more equal to our education and training that we do have.
Yeah, so I really, you know, encourage Nurses who are feeling discouraged to begin to look at new avenues for themselves and how they can grow themselves as a person and as a human being.
Nicole Vienneau 35:03
Yes. Alright, Karen, as we tie things up here today, is there anything that you would like to share from your heart?
Karen Avino 35:14
Well, I just would like to say to all Nurses out there, I think it’s time. And our time is now. And we have the opportunity to make change. And so you need to think about where you are and what you can do. I hear a lot of Nurses call their Nursing their job, and when I hear a job, I think that’s because they’re in a robot-like mode, you know, doing tasks.
It’s a career, and it’s an opportunity to grow your career in the way that you want to see it grow and focus on the things that you want to see in life and the impact that you can make, not only on the Nursing profession, but on the world.
INCA is now in 13 different countries. And I can only envision, or I would love to envision, seeing this grow so that we have this large community of people who continue to support and grow in Nurse Coaching because they’re using the skills of communication, the skills of perhaps integrative therapies.
And Nurse Coaching has really become a framework to deliver holistic philosophy of care, the integrative therapies, and the communication skills. So, it’s become an umbrella and a model of practice. So, join us. The INCA family would love to have you with us and on board. And together we work together to continue this charge forward.
Nicole Vienneau 36:50
Thank you so much, Karen, for spending some time with us today to talk about so many things. And I’m going to share how people can get in touch with the Integrative Nurse Coach Academy and all the different programs that we have, of course.
I love that: charge forward. Charge forward! Thanks so much, Karen.
Karen Avino 37:13
Thank you, Nicole.
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