Lisa J. Sundean, RN, MSN, MHA, PhD Candidate

In 2010, The Institute of Medicine released The Future of Nursing: Leading Change Advancing Health outlining recommendations for nurses to robustly engage in the transformation of healthcare. Among its cogent recommendations was for nurses to engage in leadership on boards of directors – boards. I was serving on a hospital board when the IOM report was released and I was acutely aware of being the lone nurse on the board. This acute awareness sparked my academic interests and activist inclinations to study and research the subject of nurses on boards. Two masters degrees, a doctorate education, and a couple of board positions later, I am still surprised by nurses who a. do not understand what is meant by nurses on boards, and b. do not connect with the term ‘board’ and how it relates to nursing. Let me explain.

Boards of directors – boards – are the group of people who exercise governance leadership for an organization, either a corporation or nonprofit organization. Boards of directors set organizational mission, vision, values, strategy, and executive compensation. Board members have fiduciary responsibilities or legal obligations to act in the best interests of the organization, as stewards for its stakeholders (communities, employees, shareholders), and to act in accordance with laws and regulations. Together these are known as fiduciary duties of care, loyalty, and obedience. It’s a serious responsibility that requires commitment, integrity, and skill sets to provide governance oversight and to ensure that an organization is lawfully and prudently achieving its mission to serve its stakeholder group.

So how does this relate to nursing? How is all this business and legal talk possibly relate to the work of nurses? How is the idea of nurses on boards significant for nursing?

As a board member, a nurse is in a key position to influence decisions that affect healthcare policies, allocation of resources, and strategic direction. Based on nursing knowledge, perspectives, and understandings about the health and healthcare needs of individuals, populations, and communities, the nurse board member offers critical contributions to inform board decisions. These decisions can have far-reaching impact. Board decisions can determine, for instance, access to healthcare in medically underserved areas and access to healthcare for minority populations. Board decisions can determine specific services an organization offers and may support communities or leave them at a distinct disadvantage. Board decisions can determine resources that are allocated in support of quality care or can stretch a budget so thin that quality care is jeopardized. Board decisions can determine and influence policies that impact the culture of an organization and the health of communities. In each example, a nurse can provide the educated voice to ensure that decisions are made in support of care, caring, social justice, and healthy outcomes. Certainly, all board members, through their fiduciary duties, should come to the right conclusions to support prudent decision making. Nurses are not the only board members who can illuminate the issues. However, nurses have unique and relevant professional experiences, education, and perspectives to contribute to healthcare governance leadership decisions.

Are you still confused about the significance of nurses on boards? Consider contemporary discussions about population health and applications of upstream thinking. This is the concept of addressing the root of a problem rather than addressing the consequences; prevention vs. intervention. Nurses on boards provide the upstream thinking to address organizational strategies, policies, and resources to promote health, well-being, and quality outcomes thus reducing costly healthcare utilization and negative outcomes. Sounds a lot like the Triple Aim, right? Nursing leadership at the governance level through board service is directly related to patient care and promotion of health by applying nursing concepts to organizational decision making to support quality care, health, and well-being of patients and populations.

So, are you ready to join a board? Take the Healthcare Board Competency Survey for Nurses. This survey will help you identify your strengths and opportunities for professional development to prepare for board service.

If you are interested in more information, check out this book by the late Connie Curran: Nurse on Board: Planning Your Path to the Boardroom.

If you serve on a board, be counted on the Nurses on Boards Coalition database. If you are not currently serving, but you are interested in serving, you can also log into the database. Together, our voice is stronger. And together, we can transform healthcare.

So… a board is not a board. A board is a place for nurses to exercise their professional voices and obligations to support quality healthcare and to promote health through nursing leadership, knowledge, and expertise.