Proud to be ‘The Nurse on the Board’!

Oct 8, 2014, 9:00 AM, Posted by Fran Roberts

This week marks the 4th anniversary of the Institute of Medicine’s future of nursing report. Fran Roberts, PhD, RN, FAAN, is owner and executive leader of the Fran Roberts Group, a consulting and contracting practice providing expertise on health care leadership, higher education, governance, regulation and patient safety. The Kate Aurelius Visiting Professor for the University of Arizona College of Medicine–Phoenix, Roberts serves on the boards of directors of several health care organizations, including the Presbyterian Central New Mexico Health System. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive News Fellows program.

“Leadership from nurses is needed at every level and across all settings.” That’s what the Institute of Medicine’s (IOM) Future of Nursing panel wrote in its 2011 report—a message I’ve taken to heart. Here’s why the IOM was exactly right.

I’ve served (and still serve) on several health-related boards, in most cases as the only nurse in a group dominated by physicians, local business leaders, and administrators. My experience on the Presbyterian Central New Mexico Healthcare Services board, which I now chair, is both representative and instructive. I joined the board about eight years ago, recruited by one of my colleagues in the RWJF Executive Nurse Fellows program, Kathy Davis, RN, the senior vice president and chief nursing officer at Presbyterian.

It was an honor to be asked, doubly so because I live and work out of state. But Presbyterian had concluded that it needed a nurse with executive experience on its board, so I got the call.

I started my first term on the board determined not to pigeon-hole myself as “the nurse on the board.” I didn’t want my fellow board members to think I had tunnel vision, unable to see beyond the need to advocate for nurses. That’s not to say I didn’t intend to advocate for nurses when that was called for, but I didn’t want to be limited to that, either in my colleagues’ estimation or in reality.

"[Nurses] see how the full life of a hospital unfolds, how its departments interact, where the seams are, where the stitchery is frayed."

Within six months, I concluded that I was pigeon-holing my profession! My fellow board members’ contributions to the board all reflected their professional experiences. Physicians on the board examined issues through the lens of their own practices. Business leaders on the board thought in terms of financial implications.

Nurses deserved to be represented in those discussions. But more than that, as a nurse, I felt I had a broader range of experiences to bring to the table. With due respect to physicians, nurses are the ones who actually live in hospitals. We’re there 365 days a year, holidays and weekends, 24 hours a day. We see how the full life of a hospital unfolds, how its departments interact, where the seams are, where the stitchery is frayed. We see hospital care through the eyes of our patients, because we’re with them at all phases of their care—those who come to the emergency room for a broken bone and are gone within a few hours, and those who come with more serious, life-threatening conditions who are with us for days and weeks. We help them heal, and we see them through the transition to rehab or back home. We understand the risks involved in those transitions. We meet their families, understand how their home environment affects their recovery, and how their cultural background comes into play.

Along the way, we live the experience of what it means to a hospital to be short-staffed. We see what it means in terms of patient care and safety, and its impact on the nursing staff. We experience the impact of staff cuts in ways doctors or business leaders usually don’t.

In short, we understand hospital care from the inside out, with a perspective unique to the system.

So my role isn’t just to stick up for what nurses want and need, it’s to stick up for what the whole system needs, along with its patients, families and communities.

The other role I’ve learned that nurses can play on a board is to translate medical-ese for the non-medical board members. In the same way that nurses routinely explain to patients and their families what doctors said earlier that day, then take time to answer their questions, I find that I can be helpful to my fellow board members breaking down some of the jargon from my physician colleagues on the board.

So after six months on the board, I met with the board chair and told him that I was coming out of the closet and intended to be the nurse on the board, and that I was going to be proud and articulate about it!

Since then, I’ve been a stronger board member, and rather than bringing a narrow, nurses-first-last-and-always perspective to the board’s deliberations, I’ve been able to bring a broader perspective, connecting the dots between financial issues and quality of care, staffing and more. My colleagues with a business background are trained to examine issues from a financial perspective. But as a nurse, I can see how staffing issues affect quality of care, and how that affects readmissions and the increased use of expensive contract labor and that, in turn, is reflected in bottom line costs. I can articulate every link in that chain to my fellow board members.

Before too long, I’ll cycle off of the Presbyterian board. I’m glad to say that my colleagues need no convincing that they need to find a nurse to take my seat. They’re right to think that, of course. But I think they’d do better to recruit two...or three...or...!

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.