Operational Advancements

Improving Engagement Operations

Including nurses on governing boards has multiple benefits.

By Topic: Operations Patient Experience Governance Leadership Development


For years, the boards of directors of many hospitals and health systems have comprised business leaders, bankers, lawyers and physicians. Now, there is a growing call across the healthcare field for input and action from another group of individuals with important, unique and powerful perspectives on healthcare: registered nurses.

For the healthcare field to improve the health of this nation in a meaningful way, nurses in powerful positions of governance can be a key component of success. Nurses can use their voices, influence and front-line management experience to create the kind of holistic health model in which healthcare organizations work first to keep people healthy, reducing the need for more costly care when they’re sick.

Nurses have always taken care of the sick in this country. But they’ve also been the ones who have tried to figure out how to prevent illness, especially among the poor and vulnerable. Nurses have long taken a holistic approach to care, which today manifests itself in the field’s intense focus on the social determinants of health: the conditions under which people live, work, play and age. 

Today, as healthcare organizations take a more holistic approach to caring for their communities, it’s essential that nurses have a seat on the board to help influence the evolution—and improvement—of the healthcare system.

For the healthcare field to improve the health of this nation in a meaningful way, nurses in powerful positions of governance can be a key component to success.

Given that most experienced senior nurses have risen through the ranks—starting as a staff nurse and then charge nurse, head nurse and finally nursing management—they are as familiar with clinical operations as many hospital presidents. When there is a nurse executive on a board, the organization has someone who really knows how a hospital works, including how the entire continuum of care can operate most effectively and efficiently.

Nurses: A Critical Source of Information
CommonSpirit Health, which was formed in February 2019 through the merger of Denver-based Catholic Health Initiatives and San Francisco-based Dignity Health, has two registered nurses among the 15 members of its governing Board of Stewardship Trustees: Geraldine (Polly) Bednash, PhD, RN, FAAN, former CEO of the American Association of Colleges of Nursing, and Antoinette (Toni) Hardy-Waller, RN, CEO of The Leverage Network Inc., a nonprofit committed to the promotion and advancement of African Americans to governance roles in healthcare.

“Nurses are a critical source of information and expertise on clinical safety and the patient experience,” says Tessie Guillermo, who serves as board chairman of CommonSpirit. “Toni serves as the chair of our quality committee, providing even greater accountability by the board for patient outcomes, metrics and data analysis. And Polly, with her career in academic preparation and her credentials at the highest levels of achievement in the nursing profession, has provided the board with key insight on nursing education, training and clinical practice. Their contributions are incalculable.”

Nursing, the nation’s largest healthcare profession, received a huge reputational boost in 2011 with the release of the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. The report called on the nursing profession to take leadership roles in all areas of healthcare, including governance.

Significantly, the report cited the profession’s focus on the importance of data to measure the effectiveness of clinical care. If the nation’s organizations are going to focus on keeping people healthier—and taking care of them when they’re sick—nurses’ voices in leadership and governance roles will be critical.

A Coalition to Boost Nurses' Board Presence
In 2014, as a direct result of the IOM report, several associations created the Nurses on Boards Coalition, which has worked to improve health by increasing nurses’ presence on all boards, not only those in healthcare. Its initial goal was to raise awareness that every type of board would benefit from the unique perspective of nurses and to help ensure that nurses fill at least 10,000 board positions by the end of 2020.

As healthcare organizations take a more holistic approach to caring for their communities, it’s essential that nurses have a seat on the board to help influence the evolution—and improvement—of the healthcare system.

Pam Rudisill, DNP, RN, the coalition’s board chairman and executive director, says, “In today’s current environment amidst the pandemic, there has never been more awareness, recognition and visibility of the importance of including the nursing perspective in all settings, including the boardroom. While the most recent data continues to reflect a small percentage of nurses who serve as voting board members on health systems and hospital boards, the dynamics are certainly shifting for pragmatic and altruistic reasons. This presents a time of great opportunity for hospitals and health systems to consider and invite the voice of nursing to serve in diverse governance roles within their organizations.”

In its 2020 midyear report, the coalition, which now represents dozens of organizations, said it is about three-quarters of the way toward its goal, with an estimated 7,500 nurses now serving on all types of boards. It said the 2020 goal has been fully achieved in 18 states, with another 27 more than halfway to the goal of 10,000.

However, that initial goal was a starting point, and the coalition has its work cut out for it in the healthcare field: Only about 4% of all voting board members across the healthcare industry are nurses, according to the 2019 National Health Care Governance Survey Report by the American Hospital Association. The numbers are similarly small for minority groups among all voting board members: African Americans comprised 6%, followed by Hispanics/Latinos (3%) and Asian/Pacific Islanders (2%). Only 30% of voting board members are female.

As the nation makes changes in the way it provides care—to better serve all demographics—nurses can and should help lead the way. 

Kathleen Sanford, DBA, FACHE, is executive vice president/CNO, CommonSpirit Health, Chicago (kathleen.sanford@commonspirit.org).

Recruiting Nurses to the Board

Healthcare leaders can play a role in recruiting nurses to their organizations’ governing boards. Consider the following strategies:

  • Prepare a brief written summary defining the board position opportunity for a registered nurse. Include an overview of the organization and its mission, board meeting frequency, and a description of the required and preferred competencies, skills, experience and other desired qualifications.
  • Reach out to national organizations that can help search for diverse nursing candidates, including the National Black Nurses Association, the National Association of Hispanic Nurses and Leverage Network Inc.
  • Expand the search beyond hospitals and health systems. Look to the nurses in leadership roles at public health departments, the Red Cross, community health centers and independent hospices.
  • Contact the Nurses on Boards Coalition, which can provide qualified nursing candidates from its pool of over 13,000 nurses who have registered in the NOBC database, indicating their interest in serving on their first or an additional board.
  • When a nurse board member’s term expires, ask him or her to refer another nurse to fill the seat.