As American healthcare continues to intensify its focus on patient safety and the patient experience, nurses are in a unique position to help reform healthcare practices at the leadership level due to their close work with patients and their intricate understanding of the care process. Still, their numbers on leadership boards are disproportionately few. According to a report from the American Hospital Association, nurses filled just 5 percent of hospital board seats in 2014, while physicians accounted for 20 percent of board seats.
The Nurses on Boards Coalition is a cooperative effort launched in 2014 by 21 healthcare-related groups committed to working toward a goal of improving the health of communities and the nation through the service of 10,000 nurses on boards and other bodies by 2020. The coalition's mission was inspired by the landmark 2010 Institute of Medicine report, "The Future of Nursing: Leading Change, Advancing Health", which called for the increased presence of nurses in leadership roles on boards and commissions to improve healthcare systems and the health of patients across the country.
Recently, two leaders in the nursing profession spoke with Becker's about the NOBC and the future of nursing leadership. Kimberly Harper, MS, RN, is the CEO of the Indiana Center for Nursing and the Nursing Lead for the Indiana Action Coalition and the NOBC co-chair. F. Patrick Robinson, PhD, RN, FAAN, is the dean of Capella University's School of Nursing and Health Sciences where he has supported the University's involvement in the initiative.
Note: Responses have been lightly edited for length and clarity.
Question: What about nurses make them particularly valuable to boards during this pivotal moment in healthcare?
Kimberly Harper: I think that it's often been said nurses bring a unique skill set to whatever table they come to. They come with a systems thinking mindset — nurses have financial knowledge, regulatory compliance backgrounds and honed communication skills. Nurses are uniquely trained, educated and prepared for being a voice on leadership boards.
Dr. F. Patrick Robinson: I think the uniqueness is key to why we are the future of healthcare. Our experience of being at the bedside and in the community with patients gives us unique experience. We represent the profession that has the largest impact on the health of patients. As the landscape changes in finance and reimbursement in light of the ACA, our experience is becoming even more valuable. Nobody has walked in our shoes in terms of what we see on a daily basis. Our education is unique. Ours is broadly focused instead of narrowly focused. We become well prepared to assess what helps the patient. It's astonishing when I look at the pitiful numbers of nurses who have risen to the highest levels of leadership.
Q: Historically nurses have had a limited role on boards, why is this?
PR: It's not a dirty a secret that we do not live in an egalitarian society and that women still struggle to get equal rights. This all gets mixed up in our world. Women are still the minority in the executive board rooms. As goes the status of women in society, so goes the status of nursing. We are viewed in odd ways by our colleagues. There's such a thing as benevolent sexism, nurses are admired but seen as something soft and not provocative and powerful, which is what people look for in executive leadership. We are getting stronger and finding our voice and claiming our agency. I think things are rapidly changing.
KH: Just as a woman's place was in the home, a nurse's place was at the bedside not in the board room. Strong women changed that and strong nurse leaders are stepping up and saying we have more to offer.
Q: How does nurse education play a role with the Nurses on Boards initiative?
PR: I think it's critical. I do believe education is key to this advancement. We cannot expect to be at the table if we appear different from a credentialing perspective. Education provides nurses with greater understanding regarding what they already know and expands understanding of the system and population as a whole, which is vital. At Capella, we are very focused on the practice environment. I spend a lot of time with the hiring leaders who employ our graduates. We have a program called Nursing Track 80/20 where we work with specific employers to create a plan for achieving nurse development goals. We know the key to power within an organization is through the educated nurse. It's becoming increasingly common to have nursing executives with doctoral degrees.
Q: How can nurses in leadership positions influence positive change at the system level?
KH: The intense experience that we have. Nurses participate at every level of the care practice. As I said before, we are system thinkers. Nurses have the trust of the patients, and we are trusted to bring positive change. We've just got to find our voice. We have to prove what we already know. We didn't espouse to be at that top level in the beginning, we've been too busy doing the work on the front lines. Most of us never thought we would leave the bedside. We have to prove our worth at the leadership level and communicate our experience. People will listen.
Q: Where do you see the state of nursing leadership in five years?
KH: A whole lot further along than we are today. Nurses are getting strong and we are no longer a handmaiden to anyone. It's my belief five years from now, when I retire, we're going to be looking at a very different scenario. Nurses are going to step up and lead healthcare more and more. This is the very first time that all these nursing organizations have worked together on any one thing. It's very exciting — 10,000 nurses on leadership boards is our goal, and we're doing it, not for us, but to improve the health our nation by getting the voice of nurses on boards.
PR: The future is very, very bright for our profession. When the future is bright for our profession, the future is bright for healthcare. I'm very proud of the Nurses on Boards initiative because it is a grass roots effort. This is a collaboration by every corner of nursing. The consciousness raised by the IOM's future of nursing report, the new and emerging roles for nurses and the continuing implementation and the expansion of advanced practice nursing, all of these things now have strong momentum. It is an exciting time to be a nurse.
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