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"More and more health organizations are recognizing the importance of nurses serving as board members ... as a safeguard for quality and accountability." —Divina Grossman |
FOSTERING LEADERSHIP THROUGH COLLABORATIONMove over, physicians. Nurses belong on health care boards, too. by Divina Grossman
In the last few years, I have learned much and, I hope, made an impact as board chairperson of Kendall Regional Medical Center, a for-profit hospital in Miami, Fla., that is part of the Hospital Corporation of America. I am also a board member of the Health Foundation of South Florida, a local philanthropic organization dedicated to promoting health and filling in health care gaps for the underserved. Both roles are challenging, requiring a broader perspective than what is required of me as an educator, nursing leader and dean of a school of nursing at a public university. I believe, however, that I make a valuable contribution to these boards because of my experience and expertise in nursing and health care. As board members, nurses contribute crucial perspectives that can positively influence decision-making, a view that needs to be articulated. Nurse leaders are contributing to health care and health organizations as board members at local, regional and national levels. For example, Anne Boykin, RN, PhD, dean of Florida Atlantic University’s Christine E. Lynn College of Nursing, is board chair of JFK Medical Center in Palm Beach, Fla., and a board member of the Gertrude E. Skelly Charitable Foundation. Joan Shaver, RN, PhD, FAAN, dean of the College of Nursing at the University of Illinois at Chicago, serves on the board of Advocate Health Care in Chicago. Joanne Disch, RN, PhD, FAAN, professor and director of the Katharine J. Densford International Center for Nursing Leadership at the University of Minnesota in Minneapolis, is board chair of AARP, formerly known as the American Association of Retired Persons, and a board member of Allina Health System, Minnesota’s largest health care delivery network. More and more health organizations are recognizing the importance of nurses serving as board members, not only as another forum for expression of nursing leadership, but as a safeguard for quality and accountability. However, a recent study by Prybil (2006) found that, of 203 voting members of 14 selected hospital boards, only four—just 2 percent—were nurses. By comparison, approximately 25 percent of hospital board members in the study were physicians. She recommended that hospital boards consider appointing nurse leaders as members because of “the magnitude of the nursing workforce and their impact on patient care quality and costs” (Pribyl, 2006, p. 228).Similarly, Berwick (2005) stated, “It is key that nurses be as involved as physicians, and I think boards should understand that the performance of the organization depends as much on the well-being, engagement and capabilities of nursing leaders as it does on physicians” (p. 7). Influencing policy and decisions Consider this example: A report presented to a hospital board indicates that an unacceptably high percentage of patients are being discharged from the hospital to their homes without receiving discharge instructions. Why is this happening? A series of probing questions should be asked, and nurses are more likely to ask those questions than others. For example, what is the current hospital policy regarding issuance of discharge instructions? How much nursing time is expended per patient in giving instructions prior to discharge, and how does this relate to the current nursing workload, the patient census and patient turnover in the unit? Have nurses received in-service training about discharge instructions? Are the forms for documenting discharge instructions clear and easy to use? What resources and supports are needed to ensure that patients who require discharge instructions will not leave the hospital without them? Or how about patient safety? When a hospital board examines how to eliminate misidentification of patients and the errors that may result when two or more patients have the same name, a nurse’s clinical perspective will cause him or her to raise a number of questions that help illuminate the problem and contribute to the development of workable measures to solve it. To call the attention of physicians, nurses, pharmacists and other health care workers to patients who have the same names, perhaps the computerized information system should flag the names of those patients and generate a daily list. Maybe a warning should be included on a patient’s medical record to indicate that there is another patient with the same name. Or, instead of putting two patients with the same names in the same unit, how about assigning them to different floors to further minimize the risk of errors? A nurse’s hospital experience is invaluable not only for gaining insight into the causative factors of the problem, but also in devising practical strategies that can be implemented to prevent recurrence of errors and thereby improve patient safety. The following statements from the three women mentioned earlier provide helpful insight on how nurses can make valuable contributions as members of boards.
Values-based governance Patient-centered worldview
When queried about her role as a member of the board of directors of Advocate Health Care, a large faith-based integrated system of eight hospitals as well as primary and home-care facilities in and around Chicago, Joan Shaver responded: “As nurses, we represent a worldview that is different from but complements that of our colleagues in medicine and health care administration, who are frequently chief executive officers. To balance dominant foci on disease processes and the application of biotechnology or business procedures, we raise questions about or emphasize systems for patient-centered or family-centered continuity of care that reaches from hospital to home. Since the nursing shortage has turned administrative attention to transforming hospitals into workplaces that honor nursing values and promote nurse satisfaction, as board members we are able to discuss what system changes are likely to make a difference to the nursing workforce. As a nurse, I have also come to understand better, through my service on the board, the enormous challenges we face to ensure a robust and self-supporting health care delivery system in the context of a very complex and chaotic health financing system. “There are many examples of the impact that nursing presence has made to the board of Advocate Health Care. Select nurse leaders have been admitted to a special leadership development program for all administrative levels within the system; nursing consequences are considered in system planning; a series of advertisements featuring quality care through competent nurses are aired on television and radio; nurses are featured in all videos developed to showcase Advocate Health Care initiatives; and there is widespread board acknowledgement of the nursing career ladder, Magnet status and other nursing initiatives.”
A holistic perspective “On both the AARP and Allina boards, there is great interest in improving our current health care system. Nurses approach these discussions with a broader understanding of how a revitalized health care system could look, moving away from an acute care and physician-dominant orientation toward a wellness and personalized care focus.” Getting involved on health care boards Divina Grossman, RN, PhD, FAAN, is dean of Florida International University School of Nursing in Miami, Fla. For information about Omada, a program sponsored by the Honor Society of Nursing that helps prepare nurses for board membership, click here. To read an article in this issue about the Omada program, click here. References Berwick, D. (2005, April). Great boards ask tough questions:
What to expect from management on quality. Boardroom Press,
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