Nurses on Boards and Healthy Communities

healthy-communitiesHealthy communities require groups of people working together in  partnership toward shared goals. Concepts in population health challenge us to apply upstream thinking to build healthier communities. Building healthy communities certainly requires attention to explicit health indicators and also requires attention to many other health correlates. These correlates or determinants of health are readily available on the Healthy People 2020 website. The categories of health determinants listed in Healthy People 2020 include policy making, social factors, health services, individual behaviors, biology and genetics. This list describes a very broad range of factors that affect the health of individuals and communities. Clearly, health is a complex matrix!

The Robert Wood Johnson Foundation is promoting its vision of healthy communities in its Culture of Health framework. The framework focuses on 4 action areas: 1. Making health a shared value; 2. Fostering cross-sector collaboration; 3. Creating healthier, more equitable communities; and 4. Strengthening integration of health services. These 4 action areas and their specific drivers work in combination to achieve “improved population health, well-being and equity.”

A very short list of components of healthy communities include:

  1. Easy access to healthcare services
  2. Available public transportation and roadways
  3. Access to healthy food choices
  4. Access to quality education
  5. Access to safe and healthy housing
  6. Safe parks and outdoor spaces
  7. Healthy recreation choices
  8. Access to social support services
  9. A sense of spirituality
  10. Freedom from crime
  11. A healthy natural environment

As nurse leaders, we are aware of these concepts and components as they relate to our patient groups. We know how important these components are in relation to the ability of our patients to be healthy, remain healthy, seek preventive healthcare and healthcare treatment. So how do the concepts of healthy communities relate to nurses’ roles in board governance?

Nurses on boards are in a unique position to focus boardroom discussions and decision making around the determinants of health that lead to and maintain healthier communities and healthier people. Even in organizations that are not specifically focused on healthcare, nurses can have influence over policies, processes, and goals that support health. For example, on youth development boards, nurses can use knowledge of age appropriate activities and health risks to shape decision making for programs. On sports boards, nurses can help frame discussions around risk management policies. Nurses can shape nutrition policies on school boards. Nurses can ensure that transportation committees focus on providing access to vulnerable populations. On community advisory boards, nurses can use their knowledge to promote safe outdoor spaces and access to healthy food choices. In the healthcare environment, nurses can influence governance decision making that places individuals and communities at the center of the mission and goals of the organization.  These are but a few examples.

Board leadership for nurses is an extension of nurses’ commitment to health and social justice (Sundean & Polifroni, 2016). Nursing knowledge is a key component of boardrooom discussions and decision making that affect the health of individuals and communities. In combination with board directors from other sectors, nurses help comprise the multi-sector stakeholder board groups that govern on behalf of organizations and communities they serve. Nurses’ board role is to ensure that decisions reflect the best interests of stakeholders that will lead to healthier communities and healthier people who live in those communities.

The concept of nurses on boards, at first glance, seems like a wandering from nursing. However, the metaparadigm of nursing tells us that nursing is essentially about nurse-environment-person-health (Fawcett, 1984). Advocating for programs, policies, processes, and structures that promote healthier communities is unequivocally a leadership role for nurses. It is incumbent on nurses to embrace the leadership role of nurses on boards along the continuum of our core role as health advocates. Nurse board leadership is not about straying from nursing, it is about leading communities toward population health as described by Healthy People 2020 and the Robert Wood Johnson Foundation Culture of Health framework. Advocating for health is a fundamental role for nurses whether at the bedside or in the boardroom. The power of the nursing voice in the boardroom is key for transformational change in healthcare and for building healthier communities.





Pushing the RESET Button for a Healthy New Year


Happy New Year to All!

New year, new goals, new deadlines, new President, new worries. While this time of year is surely one of quiet reflection, it is often also a time for mounting angst. And while it is frequently a time for meaningless resolutions, it is also a good time to start new routines. How will you quell the new year’s jitters? How about trying a new, healthy routine?

I know, I know… you’ve tried the gym-twice-a-day routine, the eat-only-grass-clippings routine, the drink only water-cayenne pepper-and-lemon juice routine. They all failed, I know. So what about something different? Here are a few ideas:

  1. Set a positive tone for each day. Wake up each morning and recognize a gratitude or something (however small) that you are excited about.
  2. Healthier eating. Try eating one new healthy food each week – and eliminate one not-so-healthy food. What kind of healthy food? Peruse your local fresh produce aisle for ideas.
  3. Get outside everyday. Go for a walk, a run, a bike ride, walk your dog, breathe deep. Ever consider a walking meeting? Your brain works well on activity and fresh air. Try scheduling your next meeting as an outdoor walking meeting – minutes can be taken by dictation into a smartphone. Appropriate shoe wear is a must. Winter weather? No problem! Dress for it!
  4. Begin a mindfulness practice – start with 10 minutes a day. There are plenty of apps to keep you on track. Headspace is one I particularly like:
  5. Sleep. Get it. Enough of it. Simply put, your mind and body needs adequate rest each day to function well.
  6. Life gets tough sometimes. Have a pocketful of affirmations to get you through those times: I can do it! That’s an easy one. How about: I’ve been through tough times before and I always come out of it better than I went in. Or simply: All will be well. Maybe: What’s the worst that can happen? How about this one: I am so excited about this challenge!  – Your brain responds to affirmations, so give them a try.

Try choosing 1,2 or 3 of these ideas – or a few of your own. They may not change the deadlines or challenges, but they might just help you manage the stress a little better. You might even find you have more energy and hope – which can translate to greater productivity in work and more time for play. Even leaders need to push the RESET button from time to time. Let this be your time. Here’s to a year of inspired health!

Every day something more or less kills me with delight ~ Mary Oliver


Lead By Truth


Three things cannot be hidden long – the sun, the moon, and the truth   ~ Buddha

Lead by truth. It seems so obvious but our current political climate demonstrates popular, untested beliefs and wants have a way of obfuscating the truth. Yes, we must honor the needs of our citizens, our clients, our patients, our staff, our colleagues -AND- we must do so within the context of truth backed by evidence and data. Leadership guidelines in a post-truth era will require a strong sense of fortitude.

Rule #1: Commit unrelentingly to the truth. Sometimes it is hidden. Do the digging necessary to unearth the truth. Sometimes it does not want to be heard. Let the truth be heard over other voices.

Rule #2: Question all assumptions. Sound decisions cannot be based on faulty assumptions and half-truths. Recognize that assumptions and truth can change over time. For example, the earth is not flat, margarine is not a healthy alternative to butter, and pressure ulcers are not an acceptable consequence of hospitalization. We must be open and humble, yet critical and discerning about assumptions that underlie truth.

Rule #3: Demand data and evidence, both quantitative and qualitative. Build an accurate picture of a situation from which decisions can be made. Stay open to the emergence of new truths based on solid evidence.

Rule #4: Understand counter-arguments. Consider alternative perspectives and points of view. Understand their genesis and logic or lack thereof. Engage in the civil discourse needed to uncover and uphold what is true. Call out falsehoods – yours and those of others.

Rule #5: Situate healthcare leadership within the context of social justice and principles of equity. Ask the questions: Whose truth is this? Does it hold true for all? Who is advantaged or disadvantaged by this truth? Will decisions based on this truth support and advance health equity and social justice or will decisions based on this truth lead to inequities and disparities?

Rule #6: Base decision making on truth and not popular beliefs. Stand firmly on truth to guide decisions. Popularity is wildly overrated. Truth endures.

As nurse leaders we are charged with upholding enduring truths and engaging in critical analysis and discourse to confirm what is true about any situation or strategy. A new year is just ahead and it requires us to double down on leadership through truth, to question assumptions, demand evidence and data, understand counter-arguments, situate leadership on principles of social justice and equity, and finally, to base decisions on enduring truths. Healthcare transformation relies on strong leaders, nurses and others, to guide our nation and world toward health and well-being for the long term. It is our obligation to lead healthcare transformation on the foundation of truth and to navigate the insidious seduction of falsehoods with fortitude and commitment to facts and accuracy. Onward and upward in 2017!