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Is Your Board Missing a Nurse?

 |  By  
   April 06, 2010

Are you making key decisions about patient safety, quality, and the direction of your organization without involving representatives from the field that knows it best?

A University of Iowa study last year reviewed 201 health systems with a total of 2,046 voting board members and found that only 2.4% were nurses. These numbers seem inadequate, especially considering that the study found that physicians represented 22% of voting board members.

I spoke with Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing and director of the RWJF Initiative on the Future of Nursing at the Institute of Medicine. Hasmiller says five years ago she held a national meeting of nursing leaders to advise RWJF about moving nursing to a better place that would benefit patients and the healthcare system.

"One of their No. 1 priorities was that we need to have a stronger voice at the committee and board level," says Hassmiller.

Following this conversation, Hassmiller did a little experiment. She looked at the top 10 organizations that oversee quality, the top 10 hospitals and health systems, and the top 10 peer-reviewed non-nursing journals. And she counted how many nurses were on their boards.

She found that only 2% to 4% of board spots were taken by nurses.

"How can an organization that is all about delivering high-quality patient care not have a nurse on the board?" Hassmiller asks. "It's great they have all these people—such as people representing the community—but to not have one nurse to say what's going to work on the frontlines, it just boggles the mind."

The Iowa study recommended that board governance include nurses.

It makes sense. I can't count the number of times I have heard stories from staff nurses about hospitals spending vast sums of money on some new technology, which ends up being unusable at the unit level, because no one thought to involve the people who will actually use it.

Expertise in nursing processes is not the only thing nurses bring to a board. Senior nursing leaders can provide insight on the entire care delivery process, including quality and safety initiatives, patient and family involvement, and patient and staff satisfaction.

One final note: the Iowa study examined 10 "high-performing" hospitals and found that half either had nurses on the board or were recruiting them.

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Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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