How Nurses Can Forge a Path to the Boardroom and Improve Healthcare

Therese A. Fitzpatrick, PhD, RN

Therese A. Fitzpatrick, PhD, RN

Beth had just finished her presentation on clinical innovation and entrepreneurship to the nursing staff at Community Hospital. She had been asked to be the featured guest speaker at Community’s Nurses Week celebration based upon her experience in strategy development for clinical product lines. Beth’s innovative thinking and compelling communication style made her a sought-after national speaker. As she left the auditorium, she was asked by the chief nurse executive if she had ever considered a position as a member of a hospital board. In fact, Community was looking to fill a vacant board position, and the hospital’s president was anxious to add a clinical expert to the governance team. Though Beth was very flattered to be asked, she wondered if she possessed the right skillset for this important role.

It’s highly likely that an experienced nursing leader can easily develop the requisite skills to be an effective member of an organization’s board; however, to do so calls for a shift in leadership perspective that acknowledges how our clinical management roles prepare us for leadership roles: our work requires an understanding of particular patient populations and plans of care that will produce the best clinical outcome.

We are also responsible for creating an environment which leverages the talent and expertise of all care providers. We recognize that complex clinical issues are best addressed by highly engaged and expert professionals working in a culture that encourages shared decision making, professional development, and personal growth—a tall order, perhaps, but these are precisely the skills required for board service simply scaled to an organization level.

A Place at the Table

In order to give life to a strategy, a nurse leader must understand the clinical environment and how patients and staff respond to various interventions. This happens to be our greatest organizational strength—our unique perspective that is so valuable at the highest levels of corporate leadership. Nurses are:

• Firsthand observers of the impact of decisions on patients, staff, and physicians
• Evaluators of tactical interventions
• Managers of change and inventors of new solutions to persistent problems
• Effective advocates for the needs of both patients and staff in an environment moving at quantum speed

Our rightful place at the board table provides nurses the opportunity to serve the mission of the organization in a strategic capacity, thus leveraging our nursing know-how in service of the entire organization and larger community. Effective performance in a governance role, however, requires that we translate our lived experience at the level at which the services are provided into corporate strategies which will benefit the organization as a whole.

Connie Curran, in Nurse on Board: Planning your Path to the Boardroom (2015) identifies the requisite skills to sit at the governance table. It begins with an understanding of the significance of the healthcare industry within the entire economic structure of the nation. We know that healthcare costs consume an unreasonable portion of the gross domestic product of the US economy, and various reform efforts have been underway for some time.

Boards across the country are wrestling with the impact of these developments at a federal and state level and the resultant consequences for their respective organizations. What will this mean in terms of merger or acquisition strategies, what are the implications of purchasing physician practices, is this the right time to scale back inpatient services and the creation of an effective population health strategy for the community? These are but a sample of the conversations occurring across healthcare system boardrooms.

In addition to the board’s fiduciary responsibility, the ultimate responsibility for the quality of services provided rests with directors. Keeping in mind that most members of governing boards are not healthcare professionals, much of this quality and performance management information is communicated through the use of scorecards and dashboards. In fact, much of today’s board development activity and education are focused on understanding quality metrics.

But here’s the good news … as nurses we understand the complexities of the healthcare industry, population health trends and their impact on service requirements. We not only understand the complex dashboards reviewed at board meetings, we actually create the scorecards and collect the data reported to governing groups. In fact, in a world typically populated by local business people, we are the experts at the table.

Do Not Underestimate Your Expertise

Nurses who aspire to govern organizations often report that they view these roles as an extension of their commitment to care. Because nurses understand and have lived the experience at the bedside, they have a clear vision of systems and processes that will provide value to patients and the employees who directly interact with the customer.

When considering taking the first step on the path to the boardroom recognize that you utilize an important decision making tool every day in your clinical role—a methodology which will form the foundation of your strategic thinking as a member of the governance team—the nursing process.

In Claiming the Corner Office (2013), several nursing leaders described how the nursing process has served them well in examining important administrative issues, considering the implication of multiple options in addressing problems, and for outlining the path to implementation and subsequent evaluation.

Do not underestimate your expertise. You not only have an unrivaled understanding of the complexities of our industry and patient care, you possess the requisite skills of collaboration, professionalism, change management, innovative thinking and most important, the courage to make difficult decisions required as a member of the governance team.

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Terese Fitzpatrick, PhD, RN, is a principal leading the clinical strategy within consulting engagements for the Healthcare Transformation Services business of Philips Healthcare. She has served as chief nursing officer and chief operating officer in both academic and community healthcare systems. In 2013, she coauthored (with Connie Curran) Claiming the Corner Office: Executive Leadership Lessons for Nurses, a book that teaches nurses how to develop personal leadership potential in preparation for senior executive positions. You can find her work most recently as a contributor to the late Connie Curran’s new book Nurse on Board: Planning Your Path to the Boardroom.