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How Nurse Leaders in the Boardroom Can Transform America's Healthcare System


Thu Oct 13 2016

How Nurse Leaders in the Boardroom Can Transform America's Healthcare System

As healthcare systems struggle to overcome the hurdles that keep them from delivering quality, cost-effective patient care, they may not have to look any further than their own boardroom—and their nurse practitioners—to find a solution.   

In its landmark report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation discuss the important role that nurses play in shaping the future of healthcare, and put forth recommendations for strengthening the profession. One of these recommendations includes developing the leadership skills of nurses so they can be better prepared to affect change at the highest level of governance. 


The authors note that nurses are uniquely qualified to take on these leadership roles, and can contribute their expertise in health care delivery, quality, and safety. “We believe nurses have key roles to play as team members and leaders for a reformed and better integrated, patient-centered health care system,” the report states. 

Because nurses have daily interactions with patients, first-hand experience with clinical care issues, and expertise in health care systems and processes, they have the potential to impact boards on a variety of levels. Capella University collaborated with the Nurses on Boards Coalition to develop the whitepaper Nurses on Boards: The Time for Change is Now. The whitepaper explores three areas in which nurses can affect change at the system level: 

  • financial

  • quality and safety

  • patient and family experience. 

Unfortunately, the paper notes that despite the skills and experience of nurses in these areas, their numbers in the boardroom are few. The authors cite a report by the American Hospital Association (AHA), which shows that nurses make up only five percent of hospital boards, while physicians hold 20 percent of hospital board seats. 

The Push to Get Nurses on Boards

The Nurses on Boards Coalition (NOBC), a group of 21 health-care related organizations, is spearheading efforts to act on the recommendations put forth by the IOM. Its goal is to help ensure that at least 10,000 nurses are on boards by 2020. They also aim to raise awareness that all boards would benefit from the unique perspective of nurses to achieve the goals of improved health, and efficient and effective health care systems at the local, state and national levels. 

As of September 19, the NOBC has recorded that 2,317 nurses now hold board positions, and thousands more have registered that they would like to serve. 


Nurses and Financial Impacts at the System Level

Because they’re experts in managing patient care, nurses have the skillset needed to significantly impact health care costs in several areas, including length of stay, readmission rates and reimbursement, and selection of resources used in patient care. For example, nurses understand the importance of properly transitioning patients to the next level of care. With this knowledge, they can contribute to decision-making in the board room that could help curb readmission rates. 

Nurses also can impact costs in the purchase of materials or equipment. With the ability to consider patient implications when setting purchasing policies, as well as identify strategic gaps, nurses offer a holistic view that could contribute to lower care costs over time. Finally, when it comes to the fiduciary responsibilities of the board, registered nurses already have the financial expertise needed to carry out those responsibilities. 

Marla Weston, chief executive officer of the American Nurses Association and co-chair of the Nurses on Boards Coalition, notes in the whitepaper, “What people don’t often understand is that nurse managers manage multi-million dollar budgets. A nurse executive is managing at least 50 percent of the expenses in a hospital.” 

How Nurses Impact Quality and Safety in the Boardroom

The Affordable Care Act (ACA), has brought to the forefront the importance of being transparent and accountable in issues related to quality and safety. Because nurse leaders are experts in coordinating services for patients, and preventing communication breakdowns that lead to health care errors, they understand these issues firsthand. 

Held accountable to nursing-sensitive quality measures of the National Database of Nursing Quality Indicators (NDNQI), nurses are also attuned to such issues as: 

  • catheter-associated urinary tract infection rates

  • central line-associated blood stream infection rates

  • fall/injury fall rates

  • hospital/unit acquired pressure ulcer rates. 

Boards should look to nurses to answer questions around safety in delivering services, reliability, efficiency, timeliness and appropriateness. Nurse leaders also know how to understand and analyze the way teams, processes and systems must function in order to create conditions for organizational success. 

“Nurses are able to ask appropriate questions about safety reports, and question links between not just a medication error a nurse may have made, but the systems around it that should have caught it,” says Diana Mason, former president of the American Academy of Nursing. 

The Nurse’s Role in Patient and Family Experience

Nurses spend more time with patients than any other healthcare provider. They anticipate needs, deliver care, update patients and families on health issues, and teach them how to manage their care once they leave the hospital. 

With so much knowledge about their patients, nurses provide a unique perspective of the patient experience, providing insight into hospital and community environments, forging potential partnerships, and obtaining resources to optimize the patient experience long after they leave the hospital. 

“The nursing care protocols and training—which covers the systems, communications, and engagement that are part of the patient experience—make nurses experts at delivering an exceptional patient experience. That’s why most nurse leaders serve—to bring about the best possible outcomes—not just for the patient, but for the family, as well,” explains Laurie Benson, executive director for Nurses on Boards Coalition. 

The Time for Change Is Now

As this article illustrates, having the right nurse on the right board at the right time is critical for overcoming the myriad of complex issues healthcare systems face today.  Nurses with leadership skills and competencies, like complexity management, organizational awareness and strategic orientation, will be best prepared for board placement. Capella partners with healthcare organizations on solutions for developing nurse competencies and achieving education goals, ensuring they are developing the complex skills needed for a 21st century healthcare organization. 

Want to learn more about the initiative to get nurse leaders on boards? Download Nurses on Boards: The Time for Change Is Now. With original interviews from top nursing professionals and real-world stories, readers will gain a clear understanding of how nurse leaders can make a real difference in the boardroom.

For a deeper dive into the future of education in healthcare, join Ben Spedding and Jennifer Hoff from Capella University at ATD’s Healthcare Executive Summit.

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