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For many nurses, governance is an unknown. Few nurses, as earlier chapters explored, have experience in governance, and many do not understand what the role of the board is as it interacts with an organization's chief executive officer (CEO) and senior staff. In this chapter, I offer you the inside scoop about board governance.


Boards operate at the highest levels of governance—or they should! As those who have served on boards will tell you, there is a wide range of difference between boards and their focus. At the corporate level, you are most likely to see boards governing at a high strategic level, focused on strategic direction, profits, and the health of the company. In smaller, nonprofit boards (and in hospital and nursing association boards), it is not uncommon to find the focus on more operational, less strategic issues such as budgets, human resources, and other day-to-day business activities. This is something that I believe needs to change. Governance is about governing; it is not about doing. Doing is the work of the management team for the organization you serve. Gladys Campbell, CEO of the Northwest Organization of Nurse Executives and chief nurse executive and senior leader for clinical strategy for the Washington State Hospital Association, believes that lesson can be hard to learn, especially because most nurses begin their board experience through small local boards.

When you're on a board for a small organization that has no staff, you begin your board experience believing that your job as a board member is to do operational work. An early experience like this is hard to shake and prevents some from having an easy shift to a strategic leadership role as a board member.

Campbell also served on some advisory boards that gave her a skewed perspective of “real” board service. “Advisory boards can create confusion,” she says. “You think you're having a board experience, and you're really not because the role of an advisory board is not governance.” (See Chapter 1, “Board Basics,” for more exploration of advisory boards.)

It was not until the late 1990s, when Campbell assumed a board role with the American Association of Critical-Care Nurses at the national level, that she says, “The light bulb went on, and it became crystal clear that my board role was not about operations. It was about being a strategic leader!”

Therese Fitzpatrick, the principal clinical strategic consultant for Healthcare Transformation Services within Philips Healthcare, agrees that it's important for nurses to understand the critical distinction between governance and management. “They are two very different sets of leadership skills,” she says. “One is, certainly, more about doing; the other is around influencing and advising. As nurses, we tend to get into a ‘Let's roll up the sleeves and get in there and do it ourselves,’” she notes. ...

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