Nurses at the table: A naturalistic inquiry of nurses on governing boards

Abstract

In an environment in which there is little or no nursing presence on governing boards in healthcare organizations (HCOs), physicians, and nonclinicians take responsibility for keeping the other board members apprised of the quality of patient care, including nursing‐generated, patient safety initiatives. Governing boards in HCOs are either not appointing nurses to governing boards or are not appointing nurses in numbers that are commensurate with the size and vital contributions of the profession. As a result, competent nursing professionals with an intimate understanding of quality care and patient safety are not in decision‐making roles that may redesign health care and improve patient care. The purpose of this qualitative study was to describe experiences of nurse board members who hold governing board appointments in HCOs, and to describe the facilitators of and barriers to holding governing board appointments, as experienced by those nurse board members. This novel research employed naturalistic inquiry to explore the experiences of 12 nurse board members who held appointments with voting privileges in HCOs. From the interview data emerged four distinct themes: leveraging relationships and networking, valuing the mission of the board, feeling respected for my participation, and committing to board work. Facilitators of and barriers to governing board appointments were suggested. Findings validated the few previous research studies found in the literature and have implications for nursing leadership and governance.

A scoping review about nurses on boards: 2016−2022

“…Two studies were published in 2021 17,18 . One study was published in each of the remaining years (2016, 26 2018, 21 2019, 20 2020, 19 2022 16 ). The sample characteristics are detailed in Table 2.…”

“…The rationale for using results, discussion points, and recommendations for this part of the analysis was to describe what the studies revealed (results), the authors' interpretation of the meaning of the results (discussion), and implications for practice and further research exploration (recommendations). Studies that reported results or discussion points about nurses' broad diversity, expertise, or independence including preparation for board service were categorized in the CMNOB concept of board composition 16–26 ( n = 11). Studies that reported results or discussed NOB' role and influence on strategic direction, resources, control, and monitoring were categorized in the CMNOB concept of board effectiveness 16,18,20,21,23,26 ( n = 6).…”

“…Studies that reported results or discussion points about nurses' broad diversity, expertise, or independence including preparation for board service were categorized in the CMNOB concept of board composition 16–26 ( n = 11). Studies that reported results or discussed NOB' role and influence on strategic direction, resources, control, and monitoring were categorized in the CMNOB concept of board effectiveness 16,18,20,21,23,26 ( n = 6). Studies that reported results or discussed NOB' influence about clinical quality and safety, financial performance, patient experience, or community service were categorized within the CMNOB concept of organizational performance 17,18,21,23,26 ( n = 5).…”

“…Studies that reported results or discussed NOB' influence about clinical quality and safety, financial performance, patient experience, or community service were categorized within the CMNOB concept of organizational performance 17,18,21,23,26 ( n = 5). Recommendations from the studies were categorized as follows: board composition 16–19,22,23,25,26 ( n = 8), board effectiveness 20,21,24 ( n = 3), and organizational performance 16,21 ( n = 2). Note that several studies were categorized within more than one CMNOB concept‐based on multiple results, discussion points, and recommendations.…”

“…), the purposes of the studies in the review were aggregated. Most of the studies (63.6%) focused on the experiences of NOB and nurses' preparation, qualifications, and competencies for board service 10,17,18,20,22,23,26 . Studies that centered on board preparation, qualifications, and readiness are congruent with recommendations to formally prepare for board service 12 .…”