Advanced practice nurses as members of healthcare boards


Nurses on Healthcare Boards

A smart and logical move to make.

As the spotlight on healthcare reform continues, it is becoming clear that hospitals need to focus on improving value by optimizing the balance among healthcare cost, quality and accessibility for patients and other stakeholders. In moving toward a more value-driven basis for healthcare delivery, hospital boards and leaders will benefit from tapping resources with clinical care expertise and an understanding of patient and com- munity needs. Add to that skills in communications, decision making, management and leadership, and you have the basic job description of many of todays nurse executives.

Research on nonprofit hospital gov- erning boards indicates that only about 2 percent of their members are nurses. In this column we examine why hospital boards should take a closer look At nurses—a governance resource that remains largely untapped by most boards.

The value nurses can bring to the board table has been acknowledged and supported by many healthcare leaders. Donald M. Berwick, MD, president and CEO ofthe Institute for Healthcare Improvement, noted in the April 2005 issue oîBoardRoom Press, ‘̂It is key that nurses be as involved as physicians, and I think

boards should understand that the performance ofthe organization depends as much on the well-being, engagement, and capabilities of nurs- ing and nursing leaders as it does on physicians. I would encourage much closer relationship between nursing and the board.”

Because nurses have the most

contact with patients, families

and physicians, nurses have

in-depth knowledge of

healthcare delivery that could

prove valuable to a board of

trustees on relevant issues.

In 2007, the Center for Healthcare Govertiatice’s Blue Ribbon Panel on Health Care Governance recom- mended that boards “include physi- cians, nurses and other clinicians on the board. Their clinical competence and viewpoints are valuable to other board members and will help the board better understand the needs and concerns of several ofthe orga- nization’s stakeholders.”

And a 2009 Grant Thornton LLP study of governance in community health systems urged that “All boards

should consider enriching their mem- bership with greater racial and gender diversity; they also should consider the appointment of highly respected and experienced nursing leaders as voting members ofthe board to com- plement physician members and strengthen clinical input in board deliberations.” The study also said, “Engaging leaders in the nursing profession on hospital and health sys- tem boards has not yet become the norm, nor has it been accepted as a benchmark of good governance. However, given the importance of nursing in the provision of̂ patient care, it seems likely that the idea of engaging nurses on boards and board committees will receive growing con- sideration in the future.”

Exploring Nurse Executive Skills Nurses are the largest group of healthcare professionals and the fastest growing group of primary care professionals in the United States, according to the National Nursing Centers Consortium. As boards consider governance effec- tiveness under healthcare reform, the skills and attributes that nurses can bring to the board table are worth closer examination.

Because nurses have the most con- tact with patients, families and

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Governance Insights

physicians, nurses have in-depth knowledge of healthcare delivery that could prove valuable to a board of trustees on relevant issues. Nurse leaders also possess addi- tional attributes that make them a key asset for healthcare organiza- tion governing boards. These include having:

‘ Credibility with policy-makers, employees, health plan administra- tors, physicians and executives.

• The ability to identify and triage


• An understanding of issues concerning hospital staff and

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• Av ‘̂areness of comtnunity health needs.

Despite these positive qualities, nurses are not solidly among the ranks of todays healthcare governing board members, and this practice needs to be re-examined in light of current realities in healthcare, according to Lawrence D. Prybil, PhD, FACHE, governance researcher and professor at the Department of Health Management and Policy at the University of Iowa. Potential conflicts of interest issues may arise during the selection process of a nurse to the board, btit questions can easily be resolved, he says. For example, as they sometimes do with physician board candidates, hospital boards can consider nurses who hold leadership positions at organizations outside of the hospital’s service area. Or, if a nurse trustee is a member of the board of a hospital where he or she is also employed, the board should ensure that any conflicts are disclosed and handled in accordance with the board’s conflict of interest policy and process.

Removing obstacles to nurse partici- pation on boards and embracing what nurses can bring to governance are good first steps. The number of nurses on boards also is likely to increase when nurses themselves focus on the advantages of serving on boards and better understand what it takes to be an effective trustee.

“Board service brings with it both valuable benefits and awesome responsibility,” says Connie Curran, RN, EdD, CEO of Best On Board, an organization that provides

86 Ht-althcarc hxciurlve MAY/JUNE 2010

integrated governance education, testing and certification services for current and potential healthcare organization board members and leaders. “As healthcare boards seek to expand the diversity of their member- ship, they will view nurses as a ready resource to draw on as they become more aware of what nurses can bring (o the board table and as nurses take the initiative and prepare themselves to become trustees.”

CAjrran suggests a number of actions healthcare boards and CEOs can take to increase nurse participation on boards. These include;

• Seeking nurse leaders from within and outside of their orga- nizations CO serve on the board.

Schools of nursing and other community organizations, such as the American Cancer Society, American Heart Association or Visiting Nurses Association, are good resources to tap.

Supporting and encouraging nurse leaders within their organizations to prepare for board service by educating themselves on healthcare gover- nance issues and board roles and responsibilities.

Working with organizations, such as the Robert Wood Johnson Foundation, that have developed initiatives to help nurses become hospital board members.

As healthcare organizations and their boards grapple with how to ‘ address issues of cost, quality and access under healthcare reform, they should embrace the stakeholder per- spective, clinical expertise and other contributions nurse trustees can bring to governance. •

Mary K. Totten is director of content development for the Center for Healthcare Governance, a community of board members, executitm and thought leaders dedicated to advancing excellence, innovation and accountabil- ity in healthcare governance.

Center for Healthcare Governance 155 N. Wacker Dr., Ste. 400 Chicago, IL 60606 (888) 540-6111

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