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.





Courageous Conversations for Nurse Board Leaders

courageLeadership requires the willingness to engage in courageous conversations. Courageous conversations serve a variety of purposes but always provide us with opportunities to reflect, evaluate, create new understandings, and shift perspectives. Certainly, the recent Presidential election has prompted many courageous conversations – and many, many more to come. When we fail to have courageous conversations, we fail to communicate fully and we fail to make decisions based on wholistic perspectives. Courageous conversations expose competing and synergistic needs, and pave the way toward mutually beneficial solutions and advancements.

As nurse leaders, we are obligated to engage in courageous conversations with the people in our care, on behalf of the people in our care, on behalf of our profession, our co-workers, our students, and our staff. These conversations may take place at the individual level, the organizational level, at state, regional, and national levels. As nurse board leaders, we are in positions to engage in courageous conversations about strategic direction of organizations – Who benefits from policy decisions and who is disadvantaged by the same decisions? Why do certain processes exist and for whom? What issues are accepted as normal and why is status quo normalized? Why are certain metrics never discussed? Why are funds allocated the way they are and what could be the outcome of a shift in allocations? The list goes on… Considering the fiduciary responsibilities inherent in governance and the obligations inherent in nursing to advocate and act for social justice, the ability to engage in cogent and articulate courageous conversations is a key skill set for all nurse board leaders (in fact, all nurse leaders and all board leaders regardless of profession).

Engaging in these essential conversations may be uncomfortable, especially if we are unaccustomed to exposing controversial issues and championing critical issues. However, if we are guided by fiduciary principles and the values of nursing, we create a pathway to engage confidently and courageously. The conversations are extensions of our roles, positions, and responsibilities. And it bears stating that when we are on the receiving end of courageous conversations, we are equally obligated to prioritize fiduciary guiding principles and nursing values over personal needs and emotions, to make considerations in the best interests of the people and organizations we serve.

Courageous conversations usher in opportunities for broadened perspectives, collaborative decision making, and advanced initiatives to improve health and healthcare (or whatever the topic at hand). Conversely, failure to engage in courageous conversations are opportunities lost. As nurse leaders, when we accept the responsibility to engage in strategic courageous conversations, we create an environment of possibility to move beyond status quo and toward advancements in health, healthcare, and social justice. A key skill set for nurse board leaders, courageous conversations align with the values of nursing and transfer directly to advocacy in the C-suite, on the unit, in the department, in the community, and in the boardroom.

What do boards have to do with nursing?


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.