May 01, 2014

The Importance of Nurse Leadership: Increasing Nurses in the Boardroom

The Future of Nursing: Campaign for Action is proud to celebrate National Nurses Week, May 6–12, 2014. In honor of this year’s theme, “Nurses Leading the Way,” the Campaign is publishing two articles on the importance of nurse leadership. This is the first article in that series. 

When hospital boards want to save money, an easy step is to negotiate a better deal for supplies. But without the perspective of someone who has worked on the front lines of patient care, they could make a costly mistake that could result in increased patient injury, or even death.

Unexpected Consequences from Cost-Saving Measures

The Importance of Nurse Leadership, nurses in the boardroomFran Roberts, RN, PhD, a nurse who has served on a number of boards, said that she once heard of a hospital’s plan to save money by purchasing a new type of IV needle for infants. A nurse working in the neonatal unit pointed out that it took time to learn to how to properly use any type of IV needle on infants, because their vessels are so tiny. But once the nurses became accustomed to using one type of needle, the hospital often switched to another one to save money without asking nurses for their input or offering in-service training. By not consulting with nurses on this decision, Roberts said, the hospital risked spending more money because of bad needle sticks that could lead to higher infection rates.

“Nurses are translators to the board,” said Roberts, a consultant and former executive director of the Arizona State Board of Nursing. “We can point out the potential implications of a seemingly cost-saving decision and bring the perspective of someone who has worked on the front lines of patient care.”

Only six percent of hospital board members are nurses, according to a 2011 American Hospital Association survey of more than 1,000 boards. That means the vast majority of hospital boards are missing one of the most crucial voices and viewpoints they need to improve patient safety, quality of care, and satisfaction. It is nurses who work most closely with patients and see up close the needs of those patients and families, and the system-wide challenges of meeting those needs, from the inpatient to the ambulatory setting.

Today, improving patient safety and quality of care and preventing unnecessary hospital re-admissions are among the most pressing issues facing hospital and health system boards. Having nurses on a board helps to bring the patient and family perspective into the boardroom.

Improving Health through Patient-Centered Care

“In order to improve health, there has to be a major change in the delivery of health care in this country,” said Susan Reinhard, RN, PhD, FAAN, senior vice president and director, AARP Public Policy Institute and chief strategist, Center to Champion Nursing in America, which coordinates the Future of Nursing: Campaign for Action. “Nurses are so often the ones who understand how to make that happen because they work in all aspects of health care and have the most intimate experience of patient and family care. We believe that having more nurses on hospital and health system boards is critical, as those boards make decisions that are fundamental to changing the way that care is delivered.”

Reinhard has served on several hospital and health system boards. While serving on one system that included nursing homes, she introduced her fellow board members to the concept of “person-centered care,” which focuses on meeting the person’s needs, rather than the institution’s. For example, rather than waking everyone up at 7:00 a.m. to eat breakfast, a provider using a person-centered approach would consider individual needs. So a person who hadn’t slept well the night before would not be awakened simply because it seemed more efficient for staff to serve everyone breakfast at the same time, for example. There can be other options for those who need to sleep more than they need to eat at 7:00 a.m.

“Rest is such an important part of healing,” Reinhard pointed out. “I introduced this topic to the board, showed them the evidence that it improved care and that this approach made it easier on the staff—not harder, organized staff retreats, and the health system made important changes to make each nursing home more person-centered. These are the kinds of decisions boards can make that really make an impact on the quality of care and quality of life.”

Action Coalitions Working to Increase Nurses in the Boardroom

To help get more nurses on hospital and health system boards, the Future of Nursing: Campaign for Action, an initiative of AARP and the Robert Wood Johnson Foundation, is taking a number of actions. Among them, theCampaign convened more than 35 Action Coalitions in late 2013 and early 2014 to develop a national strategy to increase the number of nurse leaders serving on hospital system, state, and national boards. Many Action Coalitions are already working to increase the number of nurses on boards, including the Virginia, Rhode Island, and New Jersey Action Coalitions, all of whom have seen increases in the number of nurses on boards in their states.

Increasing the number of nurses in positions of leadership is a key recommendation of the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health. The report calls for nurses to be involved in decision-making bodies to help lead change to transform health care, and for “public, private, and governmental health care decision makers at every level” to “include representation from nursing on boards, on executive management teams, and in other key leadership positions.”

Among the accomplishments of New Jersey’s efforts: the creation of a database of New Jersey nurses that is housed at the New Jersey Health Association (NJHA). The database provides easy access for governmental offices and organizations to identify and select nurses for their boards. The NJHA is also providing ongoing educational programs for nurses in how to be a board member.

Such educational opportunities may be crucial for many nurses, who have the patient care and management experience to bring to a board, but may have never thought of taking on such a leadership position. To help build a critical mass of such nurses, Texas Healthcare Trustees, working in partnership with the Texas Team Advancing Health through Nursing, the state’s Action Coalition, has developed a Nurses on Board initiative. Texas Healthcare Trustees represents nearly 500 Texas hospitals.

“Nurses connect with people, they are good listeners, and they are relentless in getting things done,” said Stacy G. Cantu, president and CEO of Texas Healthcare Trustees and a member of the Texas Team. “Being a good listener is extremely important in the board room, as well as being relentless in finding out how to solve the pressing issues that face hospitals and health systems.”

Initially, the Nurses on Board project will provide 25–50 nurses who already have substantial professional experience with training in board roles and responsibilities, strategic planning, reading financials, acting as an advocate for the community, and problem solving. In the next phase, the organization hopes to provide up to 400 more nurses in Texas with training for leadership positions, including political office.

In addition to the important role that nurses can play on boards, their “connector” role with the community is equally important for hospitals and health systems.

“Nurses are the most trusted health professional,” Reinhard noted. “People ask nurses what hospitals, doctors, and advanced practice nurses they recommend. Nurses are viewed by the public as honest and trustworthy, and that’s a very good thing for a board.”

To learn more about how to the Campaign is working to get more nurses on hospital and health system boards, subscribe to our Advancing Health newsletter.