CHAPTER 7: WHAT'S HOLDING YOU BACK?

INTRODUCTION

The number of nurses on boards, even healthcare boards, remains woefully low. This metric needs to be changed, and numerous groups—from the Institute of Medicine (2010), to the Robert Wood Johnson Foundation (2014), and many other nursing organizations—are calling for greater representation of women—and especially nurses—in board roles.

Why are few nurses involved in governance? Certainly not due to lack of skill. It can be a challenge to get others to recognize that potential value, however.

One of the issues, says Joanne Disch, former academic executive, professor, and seasoned board member of numerous healthcare organizations, is the “long-held belief across the country that is so pervasive: that if you have a physician on the board, they can speak on any issue.” She relays an analogy that she has heard is a twist on the old apples-to-oranges comparison. Nurses, she says, aren't a slice of the apple, with the physicians being the apple. Nurses are the orange and are not subsumed by the physician's expertise. In fact, “what nurses have to offer is complementary and very distinctive.”

What are some of the potential drawbacks that keep nurses from being more broadly represented?

REFOCUS EFFORTS

Areas of opportunity for nurses can benefit them and the organizations they serve. Assess your own competencies and take steps to close any gaps you find:

• A general understanding of business principles

• The ability to understand a balance sheet and a profit and loss (P&L) statement

• Recognizing that profit is “a good thing” and why, even for nonprofit organizations

• Community and industry experience

• The ability to integrate the knowledge, skills, and experience that you have in a language that all those in the boardroom will understand

• The ability to distill this wisdom down into a few pragmatic points

• Regulatory and compliance knowledge and experience

• Confidence

“Most importantly,” says CEO and board consultant Laurie Benson, “nurses need to take a stand after they land a board role. Nobody should wonder where you are coming from in the boardroom. Take a stand when it counts.”

There are common areas where nurse leaders may find themselves struggling before they gain board experience.

TOO FOCUSED ON OPERATIONS

One of the things that may hold nurses back, as noted throughout the book, is that their focus is placed too much on nursing and at an operational level, and not enough on the higher-level, strategic issues.

Benson says that her least-rewarding board experiences have been in situations where “there's micro-managing, with too many people wanting to take control.” In some cases, she says, boards will recruit seated or former CEOs, “but some CEOs don't know how to act as a board member— they know how to be a great CEO.”