The 2010 Institute of Medicine (IOM) report Future of Nursing: Leading Change, Advancing Health recommended several goals to improve health in America through nursing (IOM, 2010). These goals include the need for nurses to lead and serve in building a culture of health (COH) to improve population health. COH, a vision of the Robert Wood Johnson Foundation (RWJF), means “placing well-being at the center of every aspect of our lives. In a culture of health, Americans understand that we're all in this together—no one is excluded. Everyone has access to the care they need and a fair and just opportunity to make healthier choices. In a culture of health, communities flourish and individuals thrive” (RWJF, 2020, para. 1). As a result of the IOM report, the Future of Nursing: Campaign for Action was created by the AARP, AARP Foundation, and the RWJF to actualize the goals of the report (AARP, AARP Foundation, and Robert Wood Johnson Foundation, 2018). Progress toward the goals occurs through the work of state Action Coalitions in all states and the District of Columbia. Nurses are the largest health profession group, with almost 4 million nurses in the United States. They comprise the most trusted profession and practice everywhere—in communities, hospitals, schools, health systems, and businesses—which makes them the ideal group to catalyze changes in health and health care.
In a series of recommendations, the IOM report endorsed increasing the number of nurse leaders in decision-making roles on boards and commissions, especially those that intersect with the health and health care of individuals, families, and communities (IOM, 2010). However, many nurses reported limited skills and competence in leadership and health system change. Regional public health, academic, clinical, and community-based nurse leaders, in association with their state Action Coalitions, collaborated on actions to prepare nurses to lead efforts to improve population health. In some states, Action Coalitions exist with or are restructured as centers for nursing, are part of the state board of nursing, are housed in schools of nursing, or collaborate with one or more like-minded established organizations to carry out the IOM recommendations. Successively, the Nurses on Boards Coalition (NOBC) was formed as a national effort to increase leadership skills of nurses, to promote nurses serving on boards, and to provide national data on-board service by nurses, with the goal of having 10,000 nurses on boards by 2020 (Curran, 2016; Mullinex et al., 2017; Nurses on Boards Coalition, 2020; Walton et al., 2015). However, questions remained and needed to be addressed, such as how nurses become confident in their ability to lead and how nurses use their knowledge, skills, experiences, and expertise to serve on boards that promote a COH but are not traditionally considered health related.
This article describes development and evaluation of an evidence-informed, innovative, interactive NOBC professional development model created, implemented, and refined by nurse leaders from three state Action Coalitions and centers for nursing. This education model prepares nurses for board service and leadership roles. Ultimately, the participating nurses then collaborate with others through their board service to implement strategies for building a COH in their respective states to improve population health for all.
Nurse leaders from three bordering U.S. states (Arkansas, Missouri, and Tennessee) collaboratively planned, facilitated, implemented, and evaluated a model NOBC education program. These leaders met, discovered, and identified mutual passions and interests through participation in national meetings with other state Action Coalitions, Future of Nursing: Campaign for Action leaders, and RWJF Culture of Health and Public Health nurse leaders. At these meetings, discussions ensued about the health issues common to the three states and the need for nurses to engage in upstream approaches to health. These discussions became the foundation for the tristate NOBC education program that could prepare nurses to serve on boards that promote a COH in the three states.
This tristate nurse leader team developed the 2018 and 2019 tristate NOBC education program through three primary methods: (a) review of the literature, (b) evaluation of data from previous NOBC education in the individual states, and (c) key informant interviews with national NOBC experts and developers of NOBC curricula. The team met at least monthly over 2 years to plan the 2018 and 2019 NOBC education programs. These virtual meetings and regular, personal communications were critical to developing a professional, cohesive, strong, and fun team that grew as new facilitators who had attended previous NOBC education joined the team.
Literature on leadership, NOBC, and COH provided a background for model development and curricular content (McBride et al., 2017; Mullinix & Walton, 2018; National Academies of Sciences, Engineering, and Medicine, 2015; National Advisory Council on Nurse Education & Practice, 2016; Plough, 2018). Posteducation evaluations from previous state NOBC education programs held for 25 Arkansas 40 Under 40 nurse leaders in 2016, and 43 emerging leaders and educators from Arkansas and Missouri in 2017 informed additional modules and improvements to the content, teaching methods, and learner engagement strategies. National experts, who previously developed NOBC education, kindly shared and encouraged use of their ideas and resources (C. Mullinix, personal communication, December 18, 2018; A. Walton, personal communication, December 19, 2018; and M. Karr, personal communication, November 13, 2018 (Table 1).
Nurses On Boards Coalition (NOBC) Curriculum Content
In October 2018, 41 nurses attended the 2-day tristate NOBC in-person education program held in Missouri. Following educational program evaluation and refinement, 29 nurses participated in the second tristate 2-day, in-person program held in fall 2019 in Tennessee. Educators and facilitators were the leaders from the three state Action Coalitions and centers for nursing who developed the NOBC program. Two were RWJF Culture of Health and Public Health nurse leaders. Awarding of continuing education contact hours was approved by a regional nursing organization accredited by the American Nurses Credentialing Center's Commission on Accreditation.
Evaluation Results and Future Education
Immediate posteducation evaluations solicited feedback from attendees of both the 2018 and 2019 education programs. Participants reported on satisfaction with educators' knowledge, expertise, and presentation skills. Participants also made recommendations to strengthen the program, identified further leadership development needs, and reported subsequent service on boards. Evaluation data were analyzed by the team using descriptive statistics and group review of comments and suggestions. All participants from the 2018 NOBC education programs reported increased knowledge about social and environmental influences on health, COH, and how population health can be influenced through service by nurses on health-promoting boards. Ninety-seven percent reported increased knowledge of their own leadership style and how to apply leadership skills to board service. With a program aim of preparing additional NOBC educators, 51% said they were interested in serving as facilitators of future NOBC education. Mock board simulation was recommended as an addition to the existing educational program with a more “nuts and bolts approach” to board service, as well as more interactive exercises and quiet reflective time during the program.
Six months following the 2018 education, telephone interviews with attendees gleaned additional information about needs and whether participants met personal goals established during the NOBC education program. Interviews were scripted and transcribed verbatim by NOBC faculty who called attendees within their own states. These interviews added a personal connection that previous attendees from the 2017 training had requested, and afforded the opportunity to identify and introduce participants to local boards. Following each state's team review of their own state's attendees' interview responses, the tristate team conducted a final thematic analysis from the collective responses across all three states (Table 2).
2018 Nurses on Boards Coalition (NOBC) Education Evaluation Themes
Twenty-four (58%) of the 2018 program attendees participated in the individual interviews 6 months posteducation. All reported a desire to serve on health-promoting boards, and 37% reported serving on new boards. Participants shared an understanding of the importance of building connections and relationships in their communities; having increased confidence, motivation, and comfort in serving on boards, including boards on which they currently served; integrating new knowledge into their nursing practice; increased awareness of their own strengths and others' strengths; increased insight into and tolerance of others' ways of thinking and doing; and awareness of the need to evaluate life balance regarding timing and commitment to board service.
The evaluation results from the 2018 education program informed the team about revisions needed for the 2019 education program. Additions to the 2019 curriculum consisted of a board simulation exercise, updates to the interactive work to increase understanding of social determinants of health, and a life course game to improve recognition of the cumulative influences on health (CityMatch, 2017; Halfon et. al., 2014). We included the leadership assessment tool used in 2018 (Clifton Strengths, 2020) that participants found to be helpful in work and personal life. Quiet reflective time was included for participants to consider how to integrate the new concepts into strategies to achieve their own identified goals. In the immediate posteducation evaluations, the 2019 participants reported increased knowledge of leadership styles and how to apply leadership skills, increased knowledge about social and environmental influences on health and COH, and nursing's impact on health through service on health-promoting boards.
The results of the 2019 6-month posteducation interviews are pending. Due to the COVID-19 pandemic and resulting practice changes and demands on nurses, the tristate NOBC team decided to postpone conducting telephone interviews. NOBC education in the near future will be evaluated, will be modified, and may be offered as didactic education on the individual states' Action Coalition and Center for Nursing websites with interactive components through social media platforms.
Implications for Nursing
Nurses comprise the largest segment of the health care workforce and are uniquely suited to advocate for building COH by serving on health-promoting boards. Based on evidence found in the literature and from data generated by our evaluations and interviews, a Nurses on Boards education model was developed that can be replicated and used by other nursing leaders nationally and globally to help develop nurses for board service. Expected outcomes are improvements in population health. This model for professional leadership development is applicable to other organizations and communities.
Now in 2020, RWJF and the National Academies of Sciences, Engineering, and Medicine have again collaborated on the issues and goals for the next decade of the nursing profession to help improve health and reduce health disparities to realize a COH in the United States (Brown, 2019). This new report on the future of nursing will envision a more powerful role for the nursing profession in helping to build a COH.
Clearly, the impact of the COVID-19 pandemic has highlighted the cultural, economic, educational, health, political, and social disparities of the U.S. population and the vulnerabilities affecting population health. Nurses in 2020, the Year of the Nurse and Midwife, have been at the forefront of the pandemic and have demonstrated leadership acumen. The need for nurses to seize this opportunity, using their leadership expertise and building on the public's trust, and serve on health-promoting boards has never been greater to improve population health in the next decade.
- AARP, AARP Foundation, and Robert Wood Johnson Foundation. (2018). Future of Nursing: Campaign for Action. https://campaignforaction.org/
- Brown, T. (2019). New study to explore issues, vision for next decade of nursing. https://campaignforaction.org/new-future-of-nursing-study-to-look-to-2030-watch-opening-session/
- Center for Creative Leadership. (2019). Visual explorer. https://ccl-explorer.org/category/visualexplorer/
- CityMatch. (2017). Lifecourse game. https://www.citymatch.org/mch-life-course/
- Clifton Strengths (2020). Clifton StrengthsFinders34. https://www.gallup.com/cliftonstrengths/en/strengthsfinder.aspx
- Curran, C. (2016). Nurse on board: Planning your path to the board-room. Sigma Theta Tau International.
- Go Noodle. (2020). Release your warrior. https://www.gonoodle.com/
- Halfon, N., Larson, K., Lu, M., Tullis, E. & Russ, S. (2014). Lifecourse health development: Past, present and future. Maternal and Child Health Journal, 18(2), 344–365 doi:10.1007/s10995-013-1346-2 [CrossRef]
- Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. The National Academies Press.
- McBride, A. B., Campbell, J., Woods, N. F. & Manson, S. M. (2017). Building a mentoring network. Nursing Outlook, 3(65), 305–314 doi:10.1016/j.outlook.2016.12.001 [CrossRef]
- Mullinix, C., Walton, A. & Ruiz, D. (2017). From the bedside to the boardroom: Are you ready to serve?American Nurse Today, 12(7), 28–30 https://www.myamericannurse.com/bedside-boardroom-ready-serve/
- Mullinix, C. F. & Walton, A. M. (2018). How to join a board: A practical guide. The Journal of Continuing Education in Nursing, 49(12), 559–562 doi:10.3928/00220124-20181116-07 [CrossRef]
- National Academies of Sciences, Engineering, and Medicine. (2015). Assessing progress on the Institute of Medicine report, The Future of Nursing. The National Academies Press.
- National Advisory Council on Nurse Education & Practice. (2016). Preparing nurses for new roles in population health management. https://www.hrsa.gov/advisorycommittees/pradvisory/nacnep/Reports/fourteenthreport.pdf
- Nurses on Boards Coalition. (2020). Our story. https://www.nursesonboardscoalition.org/
- Plough, A. L. (2018). Knowledge to action: Accelerating progress in health, well-being and equity. Oxford University Press.
- Robert Wood Johnson Foundation. (2020). Building a culture of health. https://www.rwjf.org/en/cultureofhealth/about.html
- Walton, A., Lake, D., Mullinix, C., Allen, D. & Mooney, K. (2015). Enabling nurses to lead change: The orientation experiences of nurses to boards. Nursing Outlook, 63(2), 110–116 doi:10.1016%2Fj.outlook.2014.12.015 [CrossRef]
Nurses On Boards Coalition (NOBC) Curriculum Content
|Day 1 Curriculum (1:00 p.m. to 6:00 p.m.)||Content|
|Welcome from host state Nurses Association President|
|Background on need for NOBC||Institute of Medicine (IOM) 2010 report on the Future of Nursing.|
|Future of Nursing: Campaign for Action and NOBC.|
|Tristate responses to IOM report and recommendations.|
|Nurses building a culture of health—coloring outside the lines||More than just health care.|
|Culture of health framework.|
|Lifecourse Game activity (CityMatch, 2017).|
|Physical activity, snack, and brain break (Go Noodle, 2020)|
|Promoting a culture of health through board service||Definitions, exemplars, and nuts and bolts.|
|Board service pyramid (Mullinix & Walton, 2018).|
|Physical activity, snack, and brain break (Go Noodle, 2020)|
|Mentorship||Finding and being a mentor.|
|StrengthsFinder (Clifton Strengths, 2019)||Homework, description, and plan for tomorrow's leadership activity.|
|Quiet reflection time||Visual Explorer Imagery activity (Center for Creative Leadership, 2019)|
|Day 2 Curriculum (8:00 a.m. to 1:00 p.m.)||Content|
|Leadership and skill building—StrengthsFinder||Background.|
|Understanding your profile and using it in your work.|
|Brunch and leadership panel||Tristate leaders share their experiences and open discussion.|
|Board simulation—four groups with rotations||Search; Application; Interview; Service.|
|Summary and reflection on personal goals||Completion of board service worksheet and personal goals for self-addressed mailing to review at 6-month follow-up interview.|
2018 Nurses on Boards Coalition (NOBC) Education Evaluation Themes
|Theme||Supporting Participant Quotes|
|Connections and building relationships||“I'm currently building relationships in an effort to get on a board.”|
|“…when I wasn't selected, I realized no one knew me and I needed to start in a small role and make connections first.”|
|“I found a mentor in a colleague who serves on the same board. Together we have a stronger voice.”|
|“One of the trainers recommended me for a state-wide interprofessional practice and education consortium because of my expertise, and I now co-lead a workgroup on that consortium.”|
|Increased confidence and comfort||“I wanted to establish presence on a board I currently serve on. Before the training, I would bite my tongue. Now I have more confidence to speak up. I took away from the training the importance of nurses' voices.”|
|“Without this training I would not have had the guts to join a board.”|
|Integration of knowledge gained at training into practice and life (practice includes clinical, academic, and administrative work)||“I have now included the culture of health concepts in my courses.”|
|“I explored opportunities to expand my knowledge…striving to expand my awareness of culture of health locally.”|
|“Learning about social determinants and culture of health opened my eyes…Helps me understand struggles and root causes for people and systems.”|
|“Right after the training, I joined a local women's running group. Shortly thereafter I was asked to serve on their board and start a local chapter.”|
|“I knew we could sit on boards but always thought they had to be healthcare related boards. This opens up new doors for all of us.”|
|Awareness of strengths of self and others, Increased insight into and tolerance of others' ways of thinking and doing||“I was able to look at my areas needing growth and how I can maximize my strengths.”|
|“There is another leader here and we are complete opposites. We didn't get along at all at first and now we understand each other.”|
|“StrengthsFinder helped me to understand strengths of my colleagues…. how the combination of strengths and skills helps us to get things done!”|
|“I apply it with organizations I'm involved with outside of work. The leadership strength assessment helped me to work more closely with my team and work partner. We now push each other to take risks the individual wouldn't have done otherwise.”|
|Life balance||“Time is a big constraint for most nurses…”|
|“Need to discuss realistic expectations at the training.”|