The Problem: With their experience and knowledge, nurses should be natural assets to the board of directors of health care organizations. Yet, they are rarely represented. Some organizations have not recognized nurses as important resources for their boards; others have had difficulty finding qualified candidates. As a nurse who has served on the boards of a wide range of organizations, Shirley Chater, Ph.D., R.N., knows firsthand the value of having nurses sit on boards and also what nurses must know to serve effectively.
Background: When she was growing up in Pennsylvania, Chater's father told her that she could be anything she wanted to be "as long as it helped people." As a teen, Chater worked in her family doctor's office—and loved it. She saw patients' need for communication and often stepped in to reinforce the doctor's instructions and to give patients an opportunity to ask questions. From there, she says, "It was natural that I become a nurse."
Chater's leadership potential was recognized early in her career. At age 20, she was offered a faculty position upon graduation from the University of Pennsylvania's hospital nursing program, which she attended on a full scholarship. She received the Florence Nightingale Award for the student showing the most promise upon receiving her diploma. To expand her horizons after completing a bachelor's degree, Chater headed west for a nursing master's degree from the University of California at San Francisco (UCSF), and a doctorate in education from University of California, Berkeley.
At the time, she was one of only 64 nurses with a Ph.D. in the country. Not surprisingly, she has been in great demand ever since.
Included among the many positions Chater has held during her meteoric rise as a leader are vice chancellor for academic affairs at UCSF from 1977 to 1982—she was the first woman vice chancellor and the highest ranking woman in the University of California system—and president of Texas Woman's University from 1986 until 1993. She also served as commissioner of the Social Security Administration during President Bill Clinton's first term.
Today, Chater consults with universities, organizations, foundations and individuals on management and leadership issues. While her career has taken her far from her bedside training, nursing is still foremost in her mind.
"Looking at the positions I have held, people say, 'Oh, you've left nursing,' but what I have as a nurse, I carry with me. The nursing curriculum builds important observational and assessment skills and I took these skills with me wherever I went," Chater says. "But number one is the concept of patient-centered care, which I have applied even to large institutions. It has been a theme throughout my career-putting patients first, putting students first, putting customers first."
One way Chater applied that principle at Texas Woman's University was by initiating a special baccalaureate program for single mothers—offering campus housing, child-care and work study—that has served as a model for other universities. Other programs included one to introduce young girls to science and another to bring Hispanic students and their parents to campus. "The university had been paying attention to the faculty, rather than to the needs of students," says Chater. "We turned this around and made it a student-centered campus."
In a similar vein, at the Social Security Administration, Chater embarked on a "putting customers first" strategy and redesigned business processes for more efficient and effective services for distribution of benefits to clients. "With Social Security you can help people have economic security, so then they can have health security," she says.
It is a combination of all of her experiences, training, education and drive to serve that has led to her reputation as such a strong leader (she was named a "Living Legend" in 2000 by the American Academy of Nursing) and to her appointment to the board of directors of so many organizations. She says she "has sat on more boards than I can count," including the National League for Nursing, the First Bank of Texas, the American Council on Education, the Social Security and Medicare Trust Funds Board, the Susan G. Komen Breast Cancer Foundation, the Carnegie Foundation for the Advancement of Teaching and many others. "Each board experience gave me a different way of looking at ideas and issues and an opportunity to use the knowledge I had gained along the way," she says.
Following her father's mandate to help people has led Chater into realms her father probably never envisioned. Just as she has used her own nursing background to help organizations improve what they do, Chater urges other nurse leaders "to take a look at ways to change nursing care for the better." If all nurse leaders did that, she says, "We would have a fantastically different health care system."
RWJF Perspective: In 1997, former Robert Wood Johnson Vice President Terrance Keenan approached Chater about helping advanced-level nursing leaders stay on the cutting edge by becoming better risk-takers and agents of change. The idea grew into the Robert Wood Johnson Executive Nurse Fellows Program and Chater still chairs its national advisory committee. "The fellows are doing wonderful projects in nursing," she says. "They are re-envisioning how nursing care can be given. It gives me hope for the future."
RWJF recently created a new program, Pipeline to Placement: Nurse Leaders in the Boardroom, to strengthen health care organizations with the special skills and experiences that nurses can offer. Foundation staff believes that helping to place nurses on the executive boards of nonprofit health care organizations, health insurers, accrediting organizations, journals and large system providers—where their insight and skill can shape policy will ultimately improve the quality of health care in this country. Not surprisingly, Chater was asked to join the new program's national advisory committee.
"Shirley Chater is an excellent example of just what we are aiming for with Pipeline to Placement," states Susan Hassmiller, Ph.D., R.N., RWJF senior program officer and team leader of RWJF's Building Human Capital Portfolio. "Shirley's vast involvement as a nurse leader in this country, including being commissioner of the Social Security Administration under Clinton and her many board appointments, is testament to the contribution that nurse leaders can make at the highest levels of health care, government, academia and other organizations. We look forward to increasing the number of nurse leaders who can make similar contributions."
The immediate goal of the Pipeline to Placement program is to facilitate the placement of at least 12 top nurse executives on various key boards around the country by 2009. Although the two programs are not officially linked, some members of Executive Nurse Fellows may be selected as candidates for the Pipeline program.
Included among the qualities that make nurse leaders a natural asset to the executive boards of health care organizations are:
- Credibility with policy makers, employees, health plan administrators, physicians and health care executives.
- Public trust (nursing is a top ranked profession in a Gallup poll of honesty and ethics).
- Assessment skills to tackle and triage problems.
- Awareness of effective employee-retention strategies.
- Firsthand insight into the views and concerns of patients and families.
RWJF is exploring a variety of training and mentoring opportunities that might be available to nurses in the future through the Pipeline to Placement program. For nurse leaders interested in serving on an executive board, Chater stresses the importance of a strategy. Her suggestions:
- Tailor your resume to include skills useful to the board you wish to serve on. An academic curriculum vitae is not enough to inform a board about your qualifications.
- Find out who is on the board; if you know a board member—or know someone who does—ask them to recommend you to the board.
- Make known your desire to serve on a board by attending training offered through the Pipeline to Placement program.
- Develop your skills beyond nursing. "A management program at MIT gave me the knowledge and language I needed to deal effectively with financial and other board matters," Chater says.
- If you are nominated to the board of an organization you know little about, schedule a visit to informally talk with people there.
- Remember, as a board member, you serve the goals of the organization. Be a team player; you are not there to remodel the board.