Bringing nurses into the boardroom

While involving nurses in executive-level decisions seems like an obvious way to obtain critical input on management issues or quality improvements, this is not always the norm. Boardrooms of hospitals and healthcare organizations across the country are not benefiting from the valuable input of nurses in critical decisions related to administering quality care. In fact, an informal 2007 Robert Wood Johnson Foundation survey of the top 10 healthcare organizations leading the quality improvement agenda in the United States found that < 2% of all board positions were held by nurses. Additionally:

Although nurses are heavily involved in patient care, their lack of participation in strategic decision-making about healthcare delivery is troubling. Input from nurses should be an integral part of decisions about quality of care, patient safety, and implementation of technology used by nurses, as well as staffing, workload, and other decisions that have a significant impact on the ability to recruit and retain highly qualified nurses.

Boards know that healthier patients translate into lower hospital costs. The Institute of Medicine (IOM) found that nurses are the healthcare professionals most likely to intercept medical errors, which cost hospitals $3.5 billion annually. But the connection between adequate nurse staffing levels and improved quality and patient safety is often lost on policymakers and boardroom executives who, according to a recent study published in Nursing Economics, have limited comprehension of salient nursing quality issues. The study showed that board chairs have less familiarity with landmark IOM reports on patient safety and quality of care than Chief Nursing Officers (CNOs).3

The Robert Wood Johnson Foundation (RWJF) has created a new program, “Nurse Leaders in the Boardroom,” to extend nurses' impact beyond the bedside and into the boardrooms of national healthcare and quality-related institutions. The goal is to ensure that nurses are part of the decision-making process at the highest levels so they can help shape policy and guide strategies for improving the quality of health care that patients receive. As part of the project, RWJF will seek to create a training and mentorship program to help nurses learn the skills necessary to succeed in the boardroom.

But a private foundation can only do so much. Nurses need to do their part to prepare themselves for governance roles by gaining the skills and experience that boards seek. In particular, finance, quality improvement, fundraising, and health information technology knowledge are critical.

Patti Brennan, a nurse and professor at the University of Wisconsin, advises nurses to find a niche as they move forward in their careers. If they want to hold leadership positions, they need to advocate for themselves and create a plan for their career. This might include conducting research, writing an article for a peer-reviewed journal, seeking a nomination to an honorific society or nursing academy, or pursuing interdisciplinary skills to broaden their experience.

Nurses seeking practical leadership experience can begin by serving on a local community healthcare board. Starting on a small scale at a local level can be a significant stepping stone and can lead to additional opportunities. Qualified nurses should offer their services as the opportunity arises and not wait to be asked to serve on boards.