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Taking the first steps to serving on a board


Nurses have a singular perspective on patient care and community health. With our training and experience, we can inform and improve healthcare decisions in ways that complement those of other professionals but are uniquely our own.

As a nurse, there are many ways you can be a leader—in your job, in your community, and in government. Some of the most important decisions shaping health care take place in the boardrooms of hospitals, health systems, and nonprofit organizations. Boards of directors and trustees set the goals, direction, and policies for their organizations. They are responsible for the organization’s financial health and guide its senior-level decisions. The leadership they exert is critical to the heart of their organizations and their missions.

Too few nurses on boards

Nurses are chronically underrepresented on boards. In many cases, they’re not perceived as playing a substantial leadership role in health care. A 2010 survey of more than 1,000 hospitals by the American Hospital Association found that nurses made up only 6% of board members, while physicians held 20% of board seats. A 2010 Gallup poll funded by the Robert Wood Johnson Foundation (RWJF) asked 1,500 thought leaders from corporations, insurance companies, health services, government, industry, and higher education which professions and groups will have the greatest influence in healthcare reform over the next 5 to 10 years; nurses ranked lowest. But signs suggest the status quo is about to change. In the survey, thought leaders overwhelmingly said nurses should have more influence in healthcare planning, policy, and management.

IOM leadership recommendations

The 2011 landmark report from Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health, recommended nurses be represented on boards, in executive management teams, and in other key leadership positions as public, private, and governmental healthcare decision makers at every level. The report committee included Michael Bleich, the Maxine Clark and Bob Fox Dean and Professor at the Goldfarb School of Nursing in St. Louis, Missouri. A nurse who has served numerous boards at the community and national levels, Bleich challenges nurses to consider board service. “As the largest population of health workers in the country, we must be at the leadership tables.”

Stewardship and governance

If you’re considering board service, know that your role will be one of stewardship—which means you must place the organization’s best interests above your career advancement, special interests, or personal agendas. Board members don’t represent or advocate for a specific profession or group of employees. Instead, they must act in accordance with the organization’s values and mission and advocate for its constituents and stakeholders, including those it serves, its funders, employees, and the community at large. A board member’s job is to help secure the organization’s present and future.

While stewardship focuses on the greater good, governance is the pro­cess by which the greater good is served and realized. Governance includes providing strategic planning and direction—establishing what the organization wants to achieve and how it will measure success. Boards also make policy, expressing their values and beliefs as a basis for action. They advocate on behalf of the communities they serve and identify and understand the stakeholders who can be affected by the board’s action. Governance includes fiduciary responsibility—monitoring the organization’s financial health, ensuring financial controls are in place, and raising funds to ensure its viability.

What nurses bring to board service

As a nurse, your experience gives you an essential viewpoint on the critical issues our healthcare system faces. Nurses are involved in almost every aspect of patient-care delivery, and many also provide care in the community. Their connection between care and community and their understanding of healthcare organizations’ impact on the broader communities is particularly valuable to boards. Nurses have firsthand insight into the views and concerns of patients, families, and communities, as well as expert knowledge of how best to achieve high-quality care. They can offer innovative solutions to improve safety and quality, and they understand the need for collaboration across health professions and care settings.

What’s more, the personal characteristics of the best nurses are important for boards. These nurses are good at listening to others and asking questions to help them understand problems. They understand and respect the wide range of professional roles and skills required for patient care and can work as effective team members. They understand the need for honesty, transparency, and integrity. And they’re effective, articulate patient advocates.

What board service brings to nurses

Board service can be rewarding to nurses both personally and professionally. It not only requires them to exercise leadership; it expands those skills and advances their capabilities and knowledge. It gives nurses the chance to meet people and enhance their professional networks. And it can be inspirational and empowering.

“Being a nurse leader on a board connects you to the world,” states Catherine Dodd, director of the San Francisco Health Service System. Dr. Dodd has served on nonprofit boards, including her current position on the Glide Foundation board of trustees. “It gives you a new perspective and makes you really proud to be a nurse. It makes you realize how perfectly prepared you are to change the world.”

Becoming “board ready”

Of course, not every nurse is ready to serve on a board. Before considering board service, reflect on whether you’ve gained leadership skills through increasing levels of responsibility at work or in volunteer roles. Also, know that nurse leaders should attain broader operational knowledge and experience so they can understand how the many elements of an organization function together. While this knowledge can come from work-related experience, you also can acquire it by serving in increasingly responsible volunteer roles within a community or nonprofit organization.

In Nurse Leaders in the Boardroom: The Skills You Need to Be Successful on a Board, an educational presentation developed by the Center to Champion Nursing in America and the RWJF, nurse leaders who’ve served on boards provide additional insights on preparing for board service. These insights are summarized in the five action steps below.

Create a personal strategic plan

Think about and articulate what you want to achieve, and develop specific action steps to achieve it. What do you need to learn? To whom do you need to talk? What’s your timeline? Creating your strategic plan will give you direction on the path to board service. Find out what boards look for in prospective members. What can you contribute? What are your special skills?

Be passionate

What issues are you most passionate about and have some knowledge or skill of? Find a community organization with a mission you can support and to which you’re willing to commit time and energy through active participation.

Start locally

The best way to grow leadership and board skills is to start in your community and look for opportunities to serve. Think first about a local nonprofit or community organization; join and volunteer to serve on a committee or project. Committee work is the first rung on the leadership ladder. Volunteer service in a smaller community organization also helps you learn how the various parts of an organization function in tandem; this builds your operational understanding and skills.

Build connections

Begin to build connections outside your profession and more broadly within your community. Again, volunteer with an organization and fully embrace its issues. Find a mentor, and ask her or him for concrete advice. Begin to develop a network of relationships as you serve in the community, especially those outside nursing.

Seek ongoing education

Invest in yourself through continuing education on leadership and board skills. Sigma Theta Tau offers an outstanding online education program for nurses. Most graduate business schools offer board training programs, as do other organizations. (See Useful tools and resources by clicking the PDf icon above.)

The time is now

As a nurse, you already have a tremendous advantage because of your clinical knowledge. Now you need to develop the governance skills and knowledge required for board service by gaining at least a basic understanding of financial management, organizational operations, strategic planning, and fundraising. With activities taking place across the nation to make the IOM recommendations a reality, this may be one of the most exciting times in the history of nursing. Make the effort to do the work required to prepare for leadership and to step onto the first rungs of community board service—and beyond.

Visit www.AmericanNurseToday.com for a complete list of references.

Susan Hassmiller is a senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action.

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