Salaries, staffing cutbacks, clinical outcomes, adding new programs, and ending old programs all are decisions made in the boardroom. Nurses have multiple opportunities to become involved with a board of directors. A wide range of boards exist, ranging from nonprofit boards (most hospital boards are nonprofit) to corporate (for profit) boards that govern very large, publicly held organizations. There are also advisory boards, start-up boards, and nursing or professional association boards. All these types of boards share common elements; however, there are important differences.
Educate yourself about the different types of boards, as well as how your specific board operates, who the stakeholders are, and what their roles are. Then, learn your responsibilities as a board member. Other members may not instruct you fully of your roles and responsibilities, even if you become a member.
Nonprofit status means that the organization does not have to pay federal income taxes and property taxes. In exchange for their nonprofit status, organizations are expected to benefit the communities in which they serve.
The concept of governance has existed for hundreds of years and traces back to European countries. It is the basis for much of what we now know as corporate governance. In the case of hospital boards, governance means responsibility for the hospital's performance.
In the United States, boards have nearly always governed corporations. In fact, an 1811 New York act (Birds-eye, 1890) established that “... the stock, property and concerns of such company shall be managed and conducted by trustees, who, except those for the first year, shall be elected at such time and place as shall be directed by the by-laws of the said company” (p. 1876).
Nonprofit and not-for-profit are often used interchangeably. However, for the purposes of this book, we will refer to nonprofit to indicate an organization established for purposes other than profit making and that is recognized by its government as tax exempt.
Daniel J. Pesut is a professor in the University of Minnesota-Twin Cities School of Nursing and director of the Katharine J. Densford International Center for Nursing Leadership. Pesut has a significant amount of board experience, most notably as a member of the board of directors for Sigma Theta Tau International (STTI), where he served for 8 years as a director, president-elect, and president.
“Having your finger on the pulse of what those stakeholders want is critical,” says Pesut. “You can't just sit in the boardroom. You've really got to pay attention to those people you serve and figure out how to engage them in strategic ways.” In other words, if you're on a hospital board, what is important to patients and staff? Board members represent the organization and are stewards of the organization, but they serve the stakeholders.