Getting nurses on board

Trustee talking points

The vast majority of the nation's hospitals and health systems do not have a nurse on their board.
Adding nurses to boards adds diversity and a broader range of perspectives.
Nurses' experience and skills lead to boards making more effective operational, financial and strategic decisions.
There are a number of organizations and resources that can help health care organizations considering recruiting nurses to serve as trustees.

As a nurse and a trustee for many years, I know that a nurse on the board can add new dimensions to discussions, fresh angles that lead to smarter actions. But while America has 3.6 million nurses, the surprising truth is that only 5 percent of the nation’s hospitals have a nurse as a trustee.

As the largest segment of the country's health care workforce, nurses individually and as a profession see it all, in hospitals as well as in communities, schools and businesses. Nurses are on the front lines of making sure care is delivered safely, effectively and compassionately in all settings.

Nurses not only tend to patients’ physical health needs but also respond to their social, mental and spiritual needs. What’s more, many registered nurses are public health nurses, collaborating with agencies and local residents, and promoting wellness through education and advocacy.

And the contributions nurses make as board members in hospitals are quantifiable: a University HealthSystem Consortium analysis found a correlation between the number of nurse trustees at hospitals and better performance in both quality and safety. Having a nurse on the board also creates a work environment that leads to higher retention rates for staff nurses.

Smarter boards

I see two intertwining issues at play in why more boards don’t include a nurse. First, nurses are not perceived as influencers, according to a 2010 Gallup Poll. And second, the nursing field is largely made up of women, who also are underrepresented on boards.

Interestingly, the same opinion leaders who told Gallup in 2010 that they did not perceive nurses to be influencers also said they view nurses as "having a great deal of influence on key elements of a quality health care system.” Further, a majority "say nurses have a great deal of influence in reducing medical errors and improving patient safety, and 50 percent say nurses exert a great deal of influence on improving the quality of patient care.”

If gender is a factor, the health field is not alone: In 2014, women held 19.2 percent of board seats for Fortune 500 companies. And the gender gap is self-perpetuating when one considers that boards are seeking those who have already served on boards.

These are issues the nursing field can take on, and has. Indeed, nursing as a profession has expanded its own gender diversity. Men comprised 3.9 percent of the nursing workforce in 1970. That figure has grown to 12 percent, and the number of male nursing graduates is growing.

But it also takes someone on each board to understand that expanding its depth of knowledge and diversity by adding a nurse can lead to smarter operational, financial and quality strategies.

Systemic change

There are many examples of how a nurse’s expertise in health care and policy has furthered the cause of organizations. Here is one to start with: mine.

My path to the boardroom started in the community as a visiting nurse. My daily work back then made me want to better understand the policies that drove what I could and could not offer patients and their families, options that were based on whether they had insurance or what their coverage allowed. I went from wondering, 'How can I get what this person needs?' to realizing that what I sought was change — and change happens at the systemic level.

Today, I sit on a number of boards, including that of RWJBarnabas Health — New Jersey’s largest integrated health care delivery system and one of the largest systems in the nation, with multiple medical centers, children’s hospitals, outpatient care facilities and home care programs. I serve on the strategic planning committee and chair the committee that oversees quality of care. As a board member, I also focus on the role of the family caregiver, whose actions after a person leaves a hospital are critically important to keeping him or her healthy.

I learned after I joined the board of RWJBarnabas Health, when it was still the Robert Wood Johnson Health System, that RWJ University Hospital New Brunswick — where I also served on the board— had a higher-than-average rate of catheter-associated urinary tract infections. This was a practical health matter that concerned me as a board member and a nurse: CAUTIs can lead to bladder and kidney infections, illnesses that require longer time in the hospital or even nursing home stays, and higher hospital costs.

The hospital had done away with its policy that had allowed only physicians to order the removal of a catheter, but nurses still functioned as if they needed permission. Collaborating with the chief nursing officer, I suggested we bring in a national expert on CAUTIs who could address the nursing staff. That presentation was well-received, and nurses are helping lower the CAUTI rate at the hospital because they feel encouraged and empowered to act.

This example also lends detail to the statistic showing that retention rates are higher at hospitals with a nurse on the board. I worked with the chief nursing officer for practical reasons, but that action emphasized to nurses on staff that they are heard, and that their experiences are being considered and incorporated into the decisions made at the highest levels.

Nursing wisdom

Many other nurses on boards have examples of how their viewpoint has improved the organization's health and financial strength:

Gerry Lewis-Jenkins, R.N., pushed harder in looking at quality indicators during board meetings. It’s important to remember that hospital boards include many leaders who are not clinicians. In this case, as reported in a recent American Hospital Association Great Boards newsletter, fellow trustees at Platte Valley Medical Center in Brighton, Colo., did not all know what to look for in the data or what to ask. Lewis-Jenkins spoke up, leading to comprehensive discussions and a better understanding by all of the issues important to the hospital.
Fran Roberts, R.N., served on a quality committee of a hospital board that sought to improve mortality rates. As committee members looked at the numbers, deciding which percentile to aim for, Roberts translated their ideas into the number of lives to be saved (or lost). Setting its target goals that way shifted the board from considering goals on a spreadsheet to understanding its work in human terms, as Roberts explained in a Great Boards newsletter.
The late Connie Curran, R.N., told the story of listening as her 100-bed community hospital proposed saving money by eliminating weekend hours at its in-house pharmacy. Medication orders could be filled Friday evenings, the thinking went. The other board members, she noted, were not being negligent. But she was the only person whose experience working nights and weekends led to a few unasked questions, such as, “What about newly admitted patients?” The pharmacy stayed open.
Overseeing the governing council at Advocate Good Samaritan Hospital in Downers Grove, Ill., Therese Fitzpatrick, R.N., told Trustee in 2014 that she alone among board members asked architects presenting expansion plans about safety and ergonomics for those providing care. Her questions led to conversations about workflow and how design could be improved by considering the needs of all caregivers, including nurses who had practiced for decades.

High impact

As both a nurse and a trustee, it is easy for me to see that nurse leaders have a distinctive perspective and should be among those deciding an organization’s vision, strategies and goals.

I now head the Public Policy Institute at AARP. I’m also the chief strategist at the Center to Champion Nursing in America, which coordinates the Future of Nursing: Campaign for Action, a national campaign working to transform health and health care through nursing. Both the center and the campaign are initiatives of the AARP Foundation, AARP and the Robert Wood Johnson Foundation.

Just as I transitioned from effecting change one-on-one with patients to doing so at the policy level, there are many other nurses ready to contribute their clinical knowledge and business acumen to shaping strategy on America’s hospital boards.

Our work at the campaign is based on a 2010 report from the Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, which calls for shifts in America’s nursing profession, including a greater presence on more of America’s boards. The report states: “The growing attention of hospital boards to quality and safety issues reflects the increased visibility of these issues in recent years. ... This is one area ... in which nurse board members can have a significant impact.”

In calling on the profession to seek larger roles, The Future of Nursing report also calls on hospitals and health systems, educational institutions, legislators, businesses, consumers and community groups to embrace the wisdom that nurses offer.

In 2014, AARP, the RWJF and national nursing organizations came together to form the Nurses on Boards Coalition, the goal of which is to get 10,000 nurses on boards by the year 2020. And not just hospital boards: The nurse mindset can add value to every type of group. The coalition works to build healthier communities in America by increasing nurses’ presence on the executive decision-making bodies of corporate, health-related, business, community and social service organizations.

When I entered the field, I came to understand what drives nurses: They — we — care deeply about fixing things. There are many other nurses making decisions about finance, management and quality of care whose skills and experience would benefit a board. It would be a boon for America’s health if organizations of all kinds understood the deep experience and wisdom they gain when a nurse is on the board.

Susan Reinhard, R.N., Ph.D., FAAN (sreinhard@aarp.org) is senior vice president and director of AARP’s Public Policy Institute and chief strategist of AARP’s Center to Champion Nursing in America.

Inviting a nurse to the table

Hospitals are part of an increasingly complex health care environment and more than ever seek to form community partnerships. Hospital boards' historical focus on financial strength has shifted as quality of care and patient satisfaction have grown in importance as measures of success.

Nurses can add knowledge and insights to all aspects of care, as well as observations other board members might not have about community health, wellness, disease prevention and other public health issues. Nurses also work in community settings such as schools, clinics and businesses and can bring much-needed diversity to the boardroom.

Here are some suggestions for getting started on finding a nurse for your board:

Look within: Nurse leaders can be found, of course, within your hospital or health care system — but they might have to be asked. Early in her career, nurse Terrie P. Sterling was asked by her boss to serve on a committee. Sterling, now executive vice president and chief operating officer of Our Lady of the Lake Regional Medical Center in Baton Rouge, La., responded that she was too busy. Knowing Sterling’s outstanding skills could be of great use in a larger context, the nursing director told her: “You don’t have time not to.”
Look outside: America’s 3.6 million nurses are in communities filled with groups and organizations that boards can turn to in recruiting a nurse. For example, as described in the March 2012 issue of Trustee, start by considering the dean at a local community college with a nursing school; four-year schools; the Red Cross; the American Heart Association; and your public health department.
The American Nurses Foundation is developing a database that matches nursing leaders with boards. Organizations and companies can submit a request to www.anfonline.org/nurseboardleadership.
The Nurses on Boards Coalition tracks how many nurses are on boards in the United States and encourages nurses to register their involvement on its website, www.nursesonboardscoalition.org.
The Future of Nursing: Campaign for Action has Action Coalitions in every state and the District of Columbia and can provide recommendations.