The nurse as coach – why the Wellness Corporation's wellness programs work so well

A nurse's perspective is the key to helping clients succeed at making healthy choices in their life.

Joyce Pratt, RN, BS, Wellness Rewards Program Coordinator. (Photo by David Stone for On Call )

Before he founded the Wellness Corporation in 1984, James Carbone, RN, MPH, was a nurse, working on emergency, intensive care, and burn units in Minnesota and Massachusetts. He was also an insurance executive, but it's his nursing background that has given the Shrewsbury firm's innovative wellness programming a competitive edge. Perhaps best known for its Employee Assistance Program (EAP) Counseling Services, the Wellness Corporation offers client companies an array of services they can make available to their employees, including wellness programs that stress the importance of preventive healthcare and behavioral change.

One such program is the Wellness Rewards Program. Coordinated by Joyce Pratt, RN, BS, the Wellness Rewards Program pairs an individual who wants to change unhealthy behaviors with a nurse who serves as a health coach. Working one on one, the nurse walks the client step by step through the process of making healthy choices and healthy lifestyle changes.

A nurse's perspective can make the difference in wellness
There are currently five nurses on staff at the Wellness Corporation. They are there to help clients make behavioral changes that can significantly improve the quality of their life. "All of the nurses have worked in hospitals and understand the disease process," Carbone says. "So it is much easier for them to educate people."

Carbone points out that a lot of companies have disease-management programs. But, he adds, they do not have a nurse working so directly with clients to help them understand and get through the process of making change. The fact that clients know they are working with nurses is important. "Many people will call," Carbone says, "and if it is a nurse they're talking with, they will ask about or tell us about medical things."

Pratt agrees, saying that clients understand the benefits of having a nurse as a wellness coach. "People place a lot of stock, faith, and value in a nurse," she says. "They feel a nurse has the [necessary health] information. If, for example, someone comes to me and says, 'I am taking this medication and I want to stop taking it. Do you think I can?' I refer them back to primary care. But I also give them the pros and cons of what they're considering. Because I am a registered nurse, they have added confidence in me."

Health-risk assessment as the first step
In her role as coordinator and health coach, Pratt works directly with employers and their employees. "If a company decides they want wellness programming," Pratt says, "the first thing we consider is having a health-fair kickoff. It helps people understand what we want them to do, which is a health-risk assessment."

The assessment, Pratt explains, gives the company a picture of what the overall health situation within the company is. At the same time, it also gives individual employees an opportunity to speak with Pratt about their results.

The assessment analyzes all aspects of an individual's life - both the positive and negative behaviors regarding exercise and diet; family, work, and social issues; and medical conditions and concerns. It generally takes one month, Pratt says, to conduct all the assessments. At the end of that period, the Wellness Corporation provides the client company with a group analysis.

"Once they get the group analysis," Pratt says, it is up to them to determine what type of wellness program they want. We can set up whatever they want to do - seminar, webinar, [or help put] programs like Weight Watchers on-site. Or we can do the coaching piece. "

If a company chooses to put the Wellness Rewards Program in place, Pratt works individually with each employee who is interested in having a plan set up. "I tailor everyone's program to their own needs," she says. Many companies, she adds, offer incentives for their employees to use the service.

Stages of Change: Starting where the client is
Pratt uses the Prochaska Change Model - also known as the Stages of Change Model - to help coach her clients along the sometimes bumpy road to self-improvement and ultimately better health. "We use it to determine where someone is as far as being ready to change," she says. Each stage in the model - precontemplation, contemplation, preparation, action, and maintenance - corresponds to a particular state of readiness to change, which may vary for an individual over time.

"We look at all the factors," says Pratt about her clients' needs and possible changes. "A lot of times, we have people who need to make more than one change. But we look at whatever change they are willing to make and are willing to work on. If someone needs to lose weight and needs to exercise, and they are not willing to diet at this point, I will work with him on whatever he is willing to do." Usually what starts to happen, she says, is that once people see they have problems and can make a change to move forward, they are willing to add other challenges to their plan.

To help people who are well stay well, the coaches provide educational materials to their clients. "Even though we are not a nurse line," Pratt says, "I tell people, 'Any time you need info on any topic, I can look it up and research it for you.'"

The Wellness Corporation usually has three-year contracts with the companies that offer the Wellness Rewards Program to their employees. "For individuals," Pratt explains, "each change plan takes three to six months. But I am available beyond that. I follow up to make sure things are going okay. It is almost like adding a bit of life coach with the health piece."

What nurses bring
In any given week, between email and phone calls, Pratt deals with approximately 100 people. "I spend most of my days doing research and talking," she says. "Some [contacts] are quick while others are not. Because you have built a rapport with people, they have trust in you."

One of the major strengths of the program is that it is run by a clinical professional. "Not that someone else doesn't have the knowledge," Pratt says, "but the Wellness Corporation's program adds the nursing piece along with other background. With nursing, you have a better picture of [how things] interconnect - how certain things affect people if they are exercising or if their diet changes." A nurse, Pratt says, looks at the whole person - mind and body as well as the social and economic pieces. "You are looking at all the barriers that may arise," she says.

Nurses also have a working knowledge of how certain conditions can be affected by changes in behavior. "For example, if someone is overweight and has sleep apnea, I know that once they lose weight it is possible they may no longer have sleep apnea. Someone without the medical background may not be able to see that far ahead," she explains. "I have a lot of people who have been on Lipitor who are now on no medications. Exercising has changed things completely for them. That is something that a medical professional can fully appreciate."

Like Pratt, Carbone knows that a nurse can see the impact and correlation between behavior and disease management. "A nurse will know if someone is 100 pounds overweight and diabetic what the consequences of that can be." Carbone admits he is partial to having nurses on staff. "I am a nurse," he says, "and it has worked out beautifully."

For more information, contact

The Wellness Corporation
Corporate Headquarters
512 West Main Street
Shrewsbury, MA, 01545
(800) 828-6025
(508) 842-2780
Website: http://www.wellnesscorp.com/contacts.html
Email: info@wellnesscorp.com

Susan Wessling is a freelance writer and editor in chief of International Figure Skating. She is a longtime contributor to On Call.