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Nurse leaders in the boardroom: a fitting choice.

Take a look at the makeup of most hospital and health system boards of directors. You might find a community philanthropist, a banker, a partner in a prestigious law firm, several successful business executives, and perhaps a physician. But chances are you won't find a nurse.While nurses act in leadership roles in many healthcare settings, they remain largely overlooked for board positions - the highest level of organizational leadership. A recent survey of more than 1,000 hospital boards (AHA 201 1) found that just 6 percent of board members were nurses; 20 percent were physicians.The reasons behind this omission are worth exploring. After reviewing the board leadership of more than 200 health systems and interviewing many of their members, researcher Lawrence Prybil (2009) theorized that gender bias, the outdated perception that nurses do not have leadership skills, and lack of understanding of nurses' roles in determining care quality could be preventing decision makers from considering nurses as board members. Another factor may be concerns that nurses are largely focused on their profession and will act more as employee representatives than in the interest of their healthcare institution (Prybil 2009), although the appointment of physicians does not appear to arouse such fears.In a field facing an astonishing rate of change, that healthcare systems appear reluctant to welcome nurse leaders in the boardroom is short-sighted. Comprehending that a significant cadre of our nation's nurses possesses the experience and skills to serve in leadership is one change long overdue.Other research has found the same misperceptions as Prybil's work did. Opinion leaders in a Gallup poll conducted for the Robert Wood Johnson Foundation reported that they believe nurses are seldom viewed as leaders in the development of healthcare systems and delivery (Khoury et al. 201 1). The survey results identified perception as the greatest barrier; the 1,500 opinion leaders polled said nurses were not seen as important healthcare decision makers compared to physicians.However, in the same poll these opinion leaders said nurses should have more influence in reducing medical errors (90 percent agreed), increasing quality of care (89 percent), promoting wellness and expanding preventative care (86 percent), and improving healthcare efficiency and reducing costs (84 percent). Respondents also believed that nurses should have more input and impact in planning, policy development, and management (Khoury et al. 201 1).A SKILL SET THAT FITSThe Institute of Medicine's 2011 landmark report The Future of Nursing: Leading Change, Advancing Health emphasizes the importance of nurse leadership in improving America's healthcare system:By virtue of its numbers and adaptive capacity, the nursing profession has the potential to effect wide-reaching changes in the healthcare system. Nurses' regular, dose proximity to patients and scientific understanding of care processes across the continuum of care give them a unique ability to act as partners with other health professionals and to lead in the improvement and redesign of the healthcare system and its many practice environments. (IOM2011)The report calls for healthcare decision makers to ensure that leadership positions are available to, and filled by, nurses: "Private, public, and governmental healthcare decision makers at every level should include representation from nursing on boards, on executive management teams, and in other key leadership positions" (IOM 201 1).How can this goal be brought to fruition? One way may be for health systems to embrace the literature that outlines the knowledge and skills necessary for successful healthcare board leadership. In its research-based report Competency-Based Governance: A Foundation for Board and Organizational Effectiveness (2009), the American Hospital Association's Center for Healthcare Governance details a series of core competencies and personal capabilities that healthcare boards should seek in their members. …