For nearly two decades, nurses have been called upon to join boards that influence health and health care and to bring their personal and professional attributes to the boardroom table (Hassmiller, 2012a, 2012b; Hassmiller & Combes, 2012; Mullinix, 2011; Prybil et al., 2009). Nurses are cited as effective communicators who have curiosity, intelligence, a desire to serve, and a spirit of collaboration (Bleich, 2014). The education of nurses helps them to be holistic problem solvers—to consider context and the stakeholders around those they serve. They are also educated to consider cost, safety, and the quality of outcomes (Hassmiller, 2012c). Nurses are experts on patient advocacy, the patient experience, and the business of caring (Hassmiller, 2012c; Holt, 2010; Spinks, 2006). Some argue that the fundamental knowledge and skills that nurses need to serve on health care boards come during baccalaureate education (Thomas, Servello, & Williams, 2017). Others note that nurses with advanced education (nurse educators and nurse administrators) may have additional skills in meeting management and high-impact communications (Bleich, 2014). Doctorally prepared nurses are able and qualified to converse easily about data collection and analysis, outcome management, and financial management (Thorman, 2004). Despite these personal and professional attributes, nurses continue to be underrepresented on boards (Hassmiller, 2012c). A survey by the American Hospital Association (AHA Center for Healthcare Governance, 2014) of more than 1,000 hospitals in 2010 found that nurses occupied only 6% of board seats, whereas physicians held more than 20% of them. Today, the number of nurses in such positions continues to decline (AHA Center for Healthcare Governance, 2014).
In 2010, the Institute of Medicine (IOM) recommended increasing the number of nurses serving on boards as a strategy to meet Recommendations 2 and 7 in its report The Future of Nursing, which read, “Expand opportunities for nurses to lead and diffuse collaborative improvement efforts” (p. 11) and “Prepare and enable nurses to lead change to advance health” (p. 14), respectively. Several initiatives were already in place with this focus (Polansky, Gorski, Green, Perez, & Wise, 2017). In November 2014, the Nurses on Boards Coalition launched a well-structured effort to place 10,000 nurses on governing boards by 2020 ( https://campaignforaction.org/join-effort-get-10000-nurses-onto-boards-2020/; Kowalski, 2015), and several state action coalitions that were formed in response to the IOM report make clear the number of nurses serving on boards is a priority for action. As of this writing (fall 2017), 3,500 nurses are currently serving on boards, and the needle still has room to move. In the wake of these calls to serve, convincing arguments that nurses are essential board members, and initiatives to promote board service, little has been written for nurses about how to evaluate boards on which they might want to serve and how to receive an invitation. Bleich (2014) recommended examining opportunities, building relationships, and offering service as some initial steps to take. What follows is a how-to guide that nurse educators can use as they help nurses examine boards, identify the right board for them, gain an invitation to join, and decide whether to accept the invitation.
As a part of Future Milwaukee, a leadership development training, participants Colleen Fitzgerald and Connie Mullinix developed a how-to guide for joining a board. The Board Pyramid (Figure 1) explained in this article is one product of that work.
Board entry pyramid. Steps for obtaining an invitation to join a board. © 2013 C. Mullinix. Reprinted with permission from C. Mullinix.
Assume: Entry into Board Service
A nurse may need encouragement to join a board, yet a nurse's knowledge and connections may be needed by a board to accomplish an organization's mission. Once the nurse recognizes the unique contribution a nurse can make, systematic pursuit of entry into board service can begin.
Analysis: Matching the Board's Expectations with the Nurse's Expectations
A first step in receiving an invitation to join a board is determining what the prospective member finds exciting. What are they passionate about? What do they wish they could change? What board addresses that issue? Where could they contribute to make a positive change related to their passion? In other words, they need to decide where they want to expend their energy for impact. Nurses have chosen to work with the American Red Cross, the Wounded Warrior Project, and United Way, as well as health care-focused organizations such as hospice and hospitals. Volunteering for board service requires a lot of time, effort, and often even a financial commitment, so the focus must be something that will keep the new member's interest for the long-term. It should also be in an arena in which they have expertise and something to give, whether that is knowledge about the issue, contacts that may be useful to the board, or a willingness to work hard for the cause.
The purpose or philosophy of the board must be congruent with their own. Organizations usually post their mission, values, and vision statements on their websites and in written materials. Prospective members can also glean information about an organization and its activities from news items and its reputation in the community.
One key determinant of successful board service is whether a person has the time to commit to its work. Consider that there are board meetings, usually monthly or quarterly; preparation for those meetings, which includes the reading of committee reports in addition to financial documents; serving on a subcommittee, along with its associated tasks to be done outside of meetings; fundraising activities; and research on issues important to the organization. If the board meets during work hours and a would-be board member's commitments at work provide little flexibility, such as staffing a medical unit, board service is not feasible. Having child care responsibilities during evening hours when a board meets likewise may prevent board service. Existing commitments must be carefully considered.
The match between the skills a board needs and the skills a prospective member has is an important part of determining if that board is where the nurse should serve. There are general competencies needed by most boards, and these have been explicated along with the resources for developing them by the Nurses on Boards Coalition ( https://www.nursesonboardscoalition.org/). Most boards develop a profile of the expertise needs they have, and the nominating committee seeks members with those abilities. For example, most boards like to have a lawyer as a member to guide them on legal matters. The needs may be specific: a rape crisis center may need a nurse who speaks the language of health care to negotiate quality forensic examinations for the center's clients.
The next step is matching the potential member's expectations with those of the board. There should be an explicit conversation with either the board chair and/or the executive director to determine exactly what the board expects from his or her service. One way to ask this question is, “How did my name come to the attention of the board?” From the answer, nurses can learn whether the board wants to access their contacts with funders, use their expertise with the issue, or address one of many other needs it may have.
Simultaneously, prospective nurse board members should think about their motivation for joining this particular board and clearly articulate their expectations. They should look for congruence between the board's expectations and what they expect to gain. In other words, are what the board would gain from this person's service and what they would gain from being a part of the board congruent? A colleague is often asked to join a board. He is a psychologist and has a reputation for being a good facilitator. He always declines the invitations, then states, “Why would I spend my volunteer time doing what I do all day for pay?” It is clear to him that the invitation to join the board is predicated on its wanting his facilitation abilities and an assumption that he will make the board function better. On the other hand, he loves cars but has not found a board that works with cars. Such a board could get him excited, capture his time and attention, and provide him with much-needed rejuvenation from his everyday work.
One barrier to board service is the expectation that a board member must make a large annual donation to the organization. This assumption keeps nurses from seeking board membership. Of course, prospective nurse board members should ask what the expectations are of board members for yearly contributions. Most nurses do not have $10,000 of discretionary funds to use in that way. One nurse who has successfully served on many boards explained, “I cannot make a large monetary contribution to the organization, but I know where the money is that the organization can get, and I know where it is BEFORE others know about it.” Another nurse stated, “I am a skilled fundraiser, and I will meet my financial obligation to the organization by getting others to donate.” Yet another nurse said, “I hope to contribute financially by working very hard on the annual fundraiser. In fact, after I learn how you do the event, I would like to chair that effort.” The need to make financial contributions should not be an automatic barrier to a nurse's board service.
Action: Getting an Invitation From the Board
Unfortunately, nurses are often viewed as “functional doers” rather than “thoughtful strategists” (IOM, 2010). Dr. Larry Prybil (2016) theorized that outdated perceptions of nurses may contribute to their not being recruited to take board positions. He suggested that gender bias and a lack of understanding of nurses' roles in determining quality of care further contribute to nurses not being recruited as board members. Realizing the important role nurses play in health care, individual nurses may need to call attention to these abilities rather than waiting for society to revise its understanding of nursing. Therefore, the nurse seeking a board position must create a strategy for helping a board nominating committee to notice the nurse's ability and extend an invitation to join.
Three strategies should be considered for obtaining the invitation (Hall & Weaver, 1977). The first strategy is hanging around. The prospective nurse board member should meet as many people in the organization as possible; show genuine interest in its mission; attend fund-raisers; and make donations. Essentially, the nurse should use every opportunity to interact with staff and members of this board.
The next strategy is hustling. Hustling is volunteering to work for the organization. Essentially, the prospective member is saying, “I'll do it.” This work is often termed scut work. He or she should offer to help with an event if there is the opportunity. The point is to be viewed as a hard worker—someone who can help the board get its work done. Some boards ask non-board members to serve on committees; it is one way that boards get to know potential members. If there is an opportunity to be on a committee of the board, the would-be member should join it, show up for every meeting, be prepared, and demonstrate his or her abilities. Volunteering for any work that needs to be done and doing a good job with it helps to get a prospect noticed. Often hanging around and hustling are used in combination.
The final strategy is competence. This strategy is rarely used. It would be appropriate to use if, for instance, the prospective board member is the world's expert on AIDS and the organization's focus is housing and case management for people with AIDS. In such a case, the organization would be seeking this expert to join their board for the status the member would bring to it. Often, such experts lend their name but do little tangible work for the board.
Goal: The Invitation
When the invitation finally arrives to join the board, the prospective member's need to explore the organization does not cease. At this point, the invitee must explore with the board chair and staff what the next priorities are for the organization and what the board expects for its future, as well as whether the information gleaned to date about the organization and its expectations of the new member are accurate. Should the invitee decide not to join this board, a tactful approach should be used in declining. The invitee can always suggest that the timing of the invitation to join the board does not fit with his or her other responsibilities but make it clear that he or she truly is interested in the issue and hope the board will keep them on its list of potential members for the future.
Nurses are valuable members of boards, especially health-related boards. They have many skills applicable to board service that many people, even nurses, consider routine or do not recognize. Boards need this knowledge and the insights nurses bring. Nurses may be hesitant to do the work of gaining an invitation to join a board. However, a nurse's knowledge can contribute to improving patient care. Faculty, hospital educators, and nurse administrators can use this tool as a guide to help nurses gain entrance to boards. These influencers play a critical role in encouraging the next generation of nurse leaders (Judge, 2016). For health care boards, especially hospitals, Charlotte Huff (2014) wrote in the American Hospital Association's Trustee magazine, “Without a nurse trustee, boards lack an authority on the patient experience…” (para. 1). Go join a board.
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