California Boardrooms Awakening to Advantage of Nursing Perspective
Monday June 15, 2009
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She was even more intrigued when he said that he wanted to be the first to congratulate her.
Cordova told Hacker, RN, MBA, that the governance committee had decided to revise the hospital’s bylaws to appoint the chief nursing officer to the board of trustees.
The decision would make Hacker the first CNO in the hospital’s history to have a voting seat on the board.
Although fellow board members have attested that Hacker’s contributions to the board have been invaluable and even essential, studies suggest it is somewhat rare for nurses to have voting positions on hospital boards. One recent study of more than 120 community health systems showed that only 2.3% of the systems have nurses serving in that capacity on the hospital board.
However, that trend may be changing as boards in healthcare organizations and within the community begin to recognize the intrinsic value of the nursing point of view.
“When you consider that approximately half of today’s hospital workforce are nurses, and how important nurses are in patient care and their impact on quality and cost, we thought there would be a stronger presence of nurse leaders on boards,” Prybil says.
Then in 2009, Prybil and his colleagues published a study of the structures, practices, and cultures of community health system boards. In that study, titled “Governance in High-Performing Community Health Systems,” the researchers collected survey data from 123 hospital systems throughout the country and found that the percentage of nurse board members was 2% — similar to the figure from the 2005 study.
Prybil suggests several reasons for the lack of a nursing presence in the boardroom in a recent article in the Journal of Nursing Care Quality. In the article, “Engaging Nurses in Governing Hospitals and Health Systems,” Prybil writes that gender disparities continue to exist in the board composition of many large American organizations.
“There are still Fortune 500 companies that don’t have any women on the board,” Prybil says. “And most nurses are women, so to some extent the hospital board gender composition may be a reflection of the gender disparities that exist on the boards of many organizations.”
Prybil also suggests in his article that another reason for the small percentage of nurse board members is because many board leaders and CEOs view nurses simply as a large component of the workforce rather than skilled professionals with a significant impact on the quality and cost of patient care.
Hacker says she has sometimes observed a misperception about the leadership ability of nurses but believes many of the skills nurses use at the bedside also can prove valuable in the board room.
“Nurses are educated to assess the needs of a patient, build a plan, implement it, and then evaluate,” Hacker says. “That nursing process is extraordinarily important in the boardroom when it comes to problem solving and strategic planning. Sometimes nurses think their professional role is strictly as a clinician, but a big part of their role is leadership.”
Jack Pettker, co-chairman of the board of trustees at Childrens Hospital Los Angeles, has seen firsthand the benefits of Hacker’s participation and leadership in the boardroom.
“Nurses are the first line of communication with patients and families, and nurses reflect the cultural spirit of a hospital more than anyone else in the hospital,” Pettker says. “In terms of a board standpoint of fulfilling our mission and providing quality of service, I don’t think anyone is in a better position to judge and recognize quality than the nurses in the hospital. It is hard for me to think that a board can function well without having a very close communication link with its nurses.”
“The most challenging thing about serving on a board is to really understand the culture within the board and within the agency,” Hacker says.
“I think healthcare organizations are working expressly to add nurses to their boards when they can,” she says. “These boards are seeking out nurses because they offer a unique perspective on the delivery of healthcare.”
One of the boards Bradley has served on was for the California Hospital Association. She offered a nursing perspective during discussions about the nursing shortage and patient ratios.
“She was able to give us her perspective about where patient ratios could be beneficial, and where they could impede hospital flexibility,” says Duane Dauner, chief executive of the CHA. “Physicians deliver medical care, but they are not there 24 hours a day. Nurses give us the practical aspects of how policy will play out.”
For Bradley, the path to the boardroom started by getting involved in nursing leadership organizations such as the American Organization of Nurse Executives and the Association of California Nurse Leaders.
“If nurses are interested in being on boards, they need to let colleagues know they are interested,” Bradley says. “Networking is important.”
“The hospitals and health systems exist to serve their communities, and nurses have a tremendous impact on healthcare quality and cost, yet we have boards that are making strategic and policy decisions with limited input from nursing leaders,” Prybil says. “I have served on boards that have added nurse leaders, and I’ve observed the positive impact on the quality of the deliberations.”
Heather Stringer is a freelance writer for NurseWeek. To comment, e-mail editorCA@nurseweek.com.
