Use the skills you have—and learn new ones—to advance health care and your career.
You’re educated and prepared to lead in safety and quality. You’re at the bedside caring for patients and working to improve care. However, decisions about the allocation of resources for caregiving are made at the board level, and there’s a dearth of nurses in board positions. Why?
A nurse’s insights
The late nurse leader Connie Curran told the story of a nurse on a hospital board asking significant questions when financial cuts were needed. The proposed solution was to discontinue pharmacy services in remote parts of the facility during off shifts. The nurse board member asked, “Who would go to the central pharmacy when patients need medications in the middle of the night?” The answer: “The nurses.” Her next question: “Who will do the nursing care while the nurse is transporting the medicines?” By the end of the conversation, the board realized that the proposed budget solution would actually increase costs.
Because of her intimate knowledge of bedside care delivery and her understanding of the relevant systems, this nurse board member prevented her hospital from making a costly mistake. Clearly, the nursing voice is critical at the board level to help hospitals make effective, financially viable and sustainable healthcare decisions.
What’s stopping you?
So why don’t nurses serve on hospital boards? Do policymakers not appreciate the value nurses can bring, or are nurses not stepping forward to join? If they’re not stepping forward, is it because nursing culture is built on serving in the background? Or do nurses think they don’t have the competencies needed for board service?
In The Atlantic, authors Kay and Shipman state, “Evidence shows that women are less self-assured than men—and that to succeed, confidence matters as much as competence.” Most nurses are women, so Kay and Shipman’s conclusions could easily apply to nurses who don’t seek board positions.
However, findings of a recent study of board effectiveness showed that a greater number of women on a board results in better, more well-rounded decisions. One investment firm tracks the number of women on companies’ boards and offers to invest funds in those that have more women and thus greater returns on investments. According to Joy and colleagues, “The correlation between gender diversity on boards and corporate performance can also be found across most industries—from consumer discretionary to information technology.”
In the video Sentimental Women Need Not Apply: A History of the American Nurse, producers Garey and Hott suggest that the first trained nurses were chosen because they were hard workers, stayed in the background, didn’t call attention to themselves, and were subservient—hardly characteristics for board service. This history may have set the stage for nurses not seeking positions where their insights are needed.
Skills, skills, skills
For the benefit of patients and the financial health of hospitals and other healthcare organizations, boards need to harness the safety, quality, and evidence-based practice knowledge of nurses; nurses need to join healthcare agency boards. To achieve this national goal, nurses also need to become more aware of the skills they already possess that translate well into board service. For example, nurses are experts at communication and reading nonverbal cues. They’re good at establishing relationships, making others feel comfortable, using data for decision making, and, as we’re often reminded by the yearly Gallup Poll, perceived as honest and ethical.
Walton and Mullinix developed a list of board-readiness skills that can help you assess your ability to work successfully on a board. A single individual can’t be expected to have all the skills, but you can check yourself against this list of overall competencies.
• Understand the difference between management and governance.
• Comprehend financial statements presented to board members each time they meet.
• Possess social etiquette proficiency for business conducted in social settings.
• Know Robert’s Rules of Order so you can contribute to accomplishing the board’s work.
• Bring influence and work to gain power.
• Possess negotiating skills.
• Speak comfortably in public.
Where are you strong and where do you need more refinement? If you’re deficient in any area, don’t let that stop you from serving; take the time to hone your skills. (See Get ready to serve.) Patients and healthcare organizations deserve your expertise at the bedside and in the boardroom.
Count and be counted
Ready to be counted as someone who wants to serve? Visit the national Nurses on Boards Coalition website (www.nursesonboardscoalition.org) and let boards know you want to serve. If you’re already serving, you can help the Future of Nursing: Campaign for Action reach its goal of 10,000 nurses on boards by 2020 by visiting www.nursesonboardscoalition.org to make sure you’re counted. Ultimately, nurses serving on boards provide a voice for and improve the health of their communities across the country.
Connie Mullinix is an associate professor in the department of nursing at the University of North Carolina–Pembroke. AnnMarie Lee Walton is a postdoctoral fellow at the University of North Carolina Chapel Hill, School of Nursing. Diana Ruiz is the director of population & community health in the Medical Center Health System in Odessa, Texas.
American Hospital Association. Spenser Stuart/AHA Healthcare Leadership Team Survey. April 1, 2014.
Garey D, Hott LR (producers). Sentimental Women Need Not Apply: A History of the American Nurse [DVD]. Los Angeles: Florentine Films; 1988.
Hassmiller S. Taking the first steps to serving on a board. American Nurse Today. 2012;7(11):18-20.
Hassmiller S. The top five issues for nursing in 2015. December 3, 2014. Robert Wood Johnson Foundation.
Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011.
Joy L, Carter NM, Wagner HM, Narayanan S. The bottom line: Corporate performance and women’s representation on boards. Catalyst®. 2007.
Kay K, Shipman C. The confidence gap. The Atlantic. 2014.
Mason DJ, Keepnews D, Holmberg J, Murray E. The representation of health professionals on governing boards of health care organizations in New York City. J Urban Health. 2013;90(5):888-901.
Norman J. Social issues: Americans rate healthcare providers high on honesty, ethics. Gallup®. December 19, 2016.
Walton A, Mullinix C. Increasing the number of oncology nurses serving on boards. Clin J Oncol Nurs. 2016;20(4):440-2.