Introduction

As nurses go about their day-to-day duties, whether in staff roles or management-level positions, many fail to realize the critical role that the board of directors (BOD) plays in every aspect of their clinical lives, from the types and numbers of patients they serve, to their pay, to the physicians admitted to practice, and even to quality outcome expectations. The fact of the matter is that the BOD has responsibility for all of these things, often without expert input from nurses.

Nurses represent the largest labor force in hospitals, are the largest human resource expense and, most importantly, are closest to the patients, their families, the physicians, and many other key stakeholders. Yet they have little to no input into the governance of healthcare organizations, regardless of their level in those organizations. Only a small fraction of healthcare board positions are held by nurses. The thousands of healthcare organizations, hundreds of disease-focused organizations, and innumerable nursing organizations will be greatly improved when informed nurses serve on their boards.

Although much of this book focuses on healthcare governance, it also explores corporate, advisory, start-up, and corporate boards. There are opportunities for nurses on all of these types of boards. Still, nurses rarely serve them.

This situation demands immediate attention. Over the past few years, organizations—including the Institute of Medicine (IOM), Sigma Theta Tau International (STTI), the American Nurses Association (ANA) Foundation, the American Organization of Nurse Executives (AONE), and the American Academy of Nurses (AAN)—have come forward decrying the woeful lack of nurses on hospital boards and urging nurses to step up to the plate. The problem is multidimensional:

• Nurses do not realize that boards present an opportunity to address their personal and professional passions and missions.

• Nurses are not sure what governance is and how boards work.

• Many nurses do not think they have the skills to serve in governance roles at the board level.

• Boards are often unaware of the skills and abilities that nurses possess.

• Nurses who wish to develop board-ready skills don't know where to begin.

This book addresses these issues via explanation of what boards are and what they do, takes a look at the skills and characteristics required of effective board members (and how to develop these skills), and offers a description of what and who nurses need to know. You will benefit from interviews with nurses who have held, or currently hold, board-level positions, whether in hospitals, other nonprofit organizations, nursing organizations, or corporate boards. These nurses address their positive and negative board experiences, describe the skills nurses need and may not know they have, and give advice to nurses who want to become “board ready.”

I served on more than a dozen corporate boards, a dozen nonprofit boards, and a handful of start-up boards. Throughout this book, I share my experiences and observations about board service. In addition, I have called upon the wisdom of a wide range of other leaders whose personal and practical experiences can help guide your pursuit of effective board service. You will get advice from:

• Laurie Benson, BSN, RN, an accomplished corporate executive, entrepreneur, and corporate board director. She has served on seven corporate boards in the technology, finance, insurance, manufacturing, and services industries. Additionally, she has expertise and is actively engaged in the healthcare industry through board service, executive leadership, and innovation roles. As a successful CEO of an IT consulting company, Benson grew revenues from start-up to $80M with 150+ employees across three offices. Currently, she is CEO of a board and strategy consulting company, LSB Unlimited.

• Gladys Campbell, MSN, RN, FAAN, is CEO of the Northwest Organization of Nurse Executives and chief nurse executive and senior leader for clinical strategy at the Washington State Hospital Association. Campbell has served as a fellow in the American Nurses Credentialing Center's Magnet Appraiser Program and as a fellow in the College of Critical Care Medicine. She is a past president of the American Association of Critical-Care Nurses, a career-long member of the American Nurses Association and Sigma Theta Tau International, a member of the American Organization of Nurse Executives, a past member of the board of directors for the Certification Corporation of AACN, and a fellow in the American Academy of Nursing.

• Joanne Disch, PhD, RN, FAAN, professor ad honorem at the University of Minnesota (UM) School of Nursing. Previously, she was the director of the Katharine J. Densford International Center for Nursing Leadership and the Katherine R. and C. Walton Lillehei Chair in Nursing Leadership. She has served as a board member on several major healthcare boards, such as Allina Health (in Minnesota) and the National Center for Healthcare Leadership. Currently she is a member of the board of Aurora Health Care and chair of the board of Chamberlain College of Nursing. She is the immediate past president of the American Academy of Nursing.

• Therese Fitzpatrick, PhD, RN, is a principal leading the clinical strategy within consulting engagements for the Healthcare Transformation Services business of Philips Healthcare. Fitzpatrick serves on several boards of directors, including the editorial board of the journal Nursing Economic$; Advocate Good Samaritan Hospital, Illinois; Turning Point Community Mental Health Center, Illinois; and the advisory board for the College of Science and Health at DePaul University, Chicago.

• James W. Gauss, MHA, chair of board services at Witt/Kieffer, an executive search firm in Irvine, California. He has more than three decades of experience advising board members and CEOs on board-succession planning, skill-set evaluation, and recruiting in periods of rapid change and transformation. Currently serving on the National Board of Advisors for the American Hospital Association Center for Healthcare Governance, Gauss thoroughly understands the culture of today's successful boards as well as the needs of high-performing boards in the future.

• Susan Groenwald, PhD, RN, ANEF, FAAN, is a pioneer who helped develop the specialty of oncology nursing. While holding a joint appointment at Rush University and Rush Medical Center, she was elected to the inaugural board of the Oncology Nursing Society (ONS), co-led a team that created the first standards for oncology nursing practice, and helped found the first chapter of ONS in Chicago, for which she served as vice president.

• Susan Hassmiller, PhD, RN, FAAN. Hassmiller is the Robert Wood Johnson Foundation senior adviser for nursing. She also serves as director of the Future of Nursing: Campaign for Action and codirector of the Future of Nursing Scholars program. Hassmiller has been involved with the Red Cross in many capacities and was a member of the National Board of Governors for the American Red Cross, serving as chair of the Disaster and Chapter Services committee and national chair of the 9/11 Recovery Program. She is now a member of the National Nursing committee and is serving as the board chair for the Central New Jersey Red Cross.

• Daniel Pesut, PhD, RN, PMHCNS-BC, FAAN, is professor of nursing in the Nursing Population Health and Systems Cooperative Unit of the School of Nursing at the University of Minnesota and director of the Katharine J. Densford International Center for Nursing Leadership. He is past president (2003-2005) of the Honor Society of Nursing, Sigma Theta Tau International. He served on the board of trustees of the Plexus Institute, which is an organization with the mission to foster the health of individuals, families, communities, organizations, and our natural environment by helping people use concepts emerging from the new science of complexity.

• Linda Procci, PhD, RN, is a clinical professor of nursing at the University of Wisconsin-Madison. Procci recently retired after 17 years as vice president of service line operations at Cedars-Sinai Medical Center in Los Angeles. Prior to that, she served for 15 years as vice president and chief operating officer at Good Samaritan Hospital in Los Angeles. She currently serves on the University of Wisconsin Foundation Board, the Board of Visitors for the UW School of Nursing, and the Wise & Healthy Aging Board.

Through our combined experiences and a look at the current climate in healthcare and board governance, you will learn:

• What governance is and how boards work

• Why it is important for nurses to become involved in the governance process

• What knowledge, skills, and abilities nurses need to achieve board-level roles

• How nurses can build their knowledge, skills, and abilities

• How to seek out a position and present yourself as a board-ready candidate

Dive in! You have a lot to learn about the opportunities that await you and how you can best position yourself to be on board. This book begins with a discussion of what governance is, generally as well as within the healthcare realm. Then I cover what nurses, specifically, need to know about governance. I take a look at the unique benefits they can bring to board service as well as areas where they may need to further develop their skills and broaden their experiences. Finally, I take a look at what nurses need to do now to begin building the portfolio of skills that will position them for board service on start-up, nonprofit, advisory, and corporate boards.

Along the way, you will learn about the different types of boards, the way they work, and the types of skills and experiences they are looking for. You will learn how boards make decisions about recruiting new board members and how you can best position yourself as a candidate. And you will learn how you can develop, nurture, and leverage your personal and professional networks to ensure that you are on the radar when board roles become available.

If you have ever considered the possibility of board service, this book will give you the insights you need to gain your first board role. Even if you have already served on boards, this book will provide you with best-practice advice from seasoned board leaders that you can put to work to further the value that you bring.