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When Anne Hirsch, DNS, ARNP, senior associate dean for the Washington State University College of Nursing, was invited to be on the board for Empire Health Services in Eastern Washington, she knew she would be the only nurse among a group of physicians and community leaders.

What she did not realize, though, was that she was the first nurse in the history of this hospital system to join the board.

Although fellow board members have attested to the fact that Hirsch’s contribution to the board has 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 might be changing as boards in healthcare organizations and within the community begin to recognize the intrinsic value of the nursing point of view.

Unexpected Discovery

One study that initially revealed the lack of nurse board members within hospitals was led by Lawrence Prybil, MA, PhD, professor in the College of Public Health at the University of Iowa. The 2005 study of 14 nonprofit general hospitals found that only four of the 203 voting board members in the hospitals, or 2%, were nurses.

“When you consider that about 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 2.3% — similar to the figure from the 2005 study.

Prybil suggests several reasons for the lack of a nursing presence in the board room 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 another reason for the small percentage of nurse board members is because many board leaders and CEOs view nurses as simply a large component of the workforce rather than skilled professionals with a significant impact on the quality and cost of patient care.

As the first nurse on the Empire Health System board, Hirsch acknowledges that it took time for her to feel confident in a room filled with powerful businessmen.

“I knew I needed to establish some credibility,” she says. “It became pretty clear that the physicians on the board had areas of expertise, and there were members with financial expertise, but I needed to find my niche. My role became the voice of nursing and the voice of quality patient care.”

Michael Senske, a fellow board member, has seen firsthand the benefits of Hirsch’s participation and leadership in the board meetings.

“Anne’s experience and perspective about the importance of nursing was very different than anyone else’s on the board,” Senske says. “Without that perspective, I don’t know how the board could reach its full potential and manage the hospital in an optimal fashion.”

Making a Difference

Fran Roberts, RN, PhD, vice president of the College of Nursing and Health Sciences at Grand Canyon University in Phoenix, has served on three boards. In the past several years, she has seen an increasing interest in the healthcare industry to recruit nurses to be board members.

“Traditionally nurses have served on their own boards for nursing associations, but now we are seeing more and more professional nurses on hospital and health system boards,” Roberts says. “Now the more progressive boards are looking for professional nurses who can advocate for quality care, patient safety, and appropriate operation of the systems. Nursing really is the engine behind the systems.”

Roberts says her nursing background allows her to help the lay people in the meetings understand certain aspects of the information the board reviews, and the impact their decisions will have on hospital operations.

Path to Influence

Although the path to a boardroom seat varies for each individual, nurses on boards agree there are certain common steps most RNs who are interested in pursuing leadership within that setting can take. One practical step is getting involved in healthcare or community organizations and networking with leaders in those organizations.

“If nurses want to participate at the board level, then they have to let the board members know they are interested,” says Kristine Campbell, RN, PhD, executive director of the Oregon Center for Nursing in Portland. “If you hear of a board opening, tell board members why you are interested in serving on the board. You have to be committed to the mission of the organization.”

Kimberly McNally, RN, MN, was in her late 20s when she started pursuing board leadership opportunities. She responded to a newspaper advertisement stating that the Seattle Mental Health Institute was looking for board members. She has served on several different boards since then, including the American Society for Healthcare Education and Training, which provided her with valuable experience about how boards function.

McNally’s experience on boards, combined with an endorsement from another nurse board member, positioned her to be considered for a seat on the Harborview Medical Center Board in Seattle, Wash. She interviewed for the position and then was appointed by the executive of King County. For her, one of the rewards of serving on the board is influencing policies that impact the community’s health.

“Nurses understand what the community needs in terms of health and education, and nurses are good advocates, so they are naturals for boards,” she says. “It’s stimulating to work with other trustees who are committed to improving the quality and access to care for underserved people.”

The Bottom Line

Even though nurses like Hirsch, Roberts and McNally agree that it is personally rewarding to participate in boards that are making significant decisions, Prybil’s study suggests the benefit of recruiting nurses for boards extends to the overall operating success of a hospital.

In his 2009 study, he found that half of the high-performing hospital systems had nurses on their boards or were in the process of adding them.

“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.”

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Heather Stringer is a freelance writer for NurseWeek. To comment, e-mail editorMTW@nurseweek.com.

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