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Nursing Management Congress 2017

Let Your Voice Be Heard!

Nurse Leaders at the Board Table

Cyndy Dunlap, DNP, RN, NEA-BC, FACHEOctober 4, 2017

Objectives1. Describe the fundamentals of

boards and board service.

2. Define the needed competencies and preparation tactics for board service by nurses.

3. Identify strategies to become a board member.

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Challenge for Nursing▪ Nursing Profession challenged to:

• Achieve leadership roles including board service (IOM, 2011)

− Healthcare

− Community organizations

− Business

− Local, state, federal policy teams

• Have the skills, knowledge and competencies to be an effective board member (IOM, 2011)

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Significance for Nursing• Seeks leadership positions in practice,

organizations, policy, and politics (Porter-O’Grady, 2011).

• Assumes responsibility for education and skill sets (IOM, 2011).

• Supports Nurses on Boards Coalition’s goal of having 10,000 nurses on boards by 2020 (FNCA, 2014).

• Contributes to the knowledge and understanding of needs of nurses for board service.

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Representation of Nurses in Healthcare

▪ In studies from 2005-2015

- 2-6% of boards - nurses

- 14-26% - physicians(Prybil, 2016)

▪ 2013 Governance Institute study

- 63 systems and 478 hospitals

- 3% nurses

- 19% physicians

- 72% boards no nurses (The Governance Institute, 2013)

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Lack of Acknowledgement?

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Gallup survey of 2010 of 1500 leaders ranked nursing profession as least

influential in healthcare

• Viewed as non-decision makers

• Physicians driving revenue

• Should influence planning, policy management (Khoury, Blizzard, Moore, Hassmiller, 2011)

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Board Diversity

Board Diversity

▪Broad composition

▪Different perspectives

Lead to greater governance effectiveness (Sundean & McGrath, 2016)

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Why Nurses on Boards?

▪ Experience and Expertise

▪ Acute Care Knowledge

▪ System Operations

▪ Facility Awareness

▪ Continuum of Care

▪ Care Coordination

▪ Population Health

▪ Health Promotion and Wellness(Brown, 2015)

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Health Care Now BORDERLESS

Nurse leaders bring to the board table unique skills that match with strategic needs to improve the health of the community.

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The Reformation of Health Care Needs Nurses

• Nursing needs to see “vision”of the future

• Greater need for nursing leadership

• Passage of federal health care laws

–ACOs

–Care management

–Community collaboratives 10

Why Now?

Support Nurses on Boards Coalition

Goals:

▪ 10,000 Nurses on boards by 2020 (FNCA, 2014)

▪ Development of strategies to support nurses to serve on boards

▪ http://www.nursesonboardscoalition.org/

▪ State Action Coalitions (example: Texas Team)11

My Board Perspective▪ Local Mental Health Association Board (Member &

President)

▪ Formed 501(c)3 organization (President)

▪ Women’s organizations (Altrusa & Junior League)

▪ Professional Association/Advisory Boards

▪ Federal Credit Union (Member & President)

▪ TONE Board (Member & President)

▪ Hospital Board

▪ Health System Board12

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We Know “Why” We Need to Serve

What are the fundamentals of board service?

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Why Do Boards Exist?

American corporation statutes provide,

with minor variations in language, that a

corporation shall be managed by or under

the direction of its board of directors (Cantu,

2014).

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Types of Boards

▪ For-Profit boards

▪Not-For Profit boards

▪Public Boards, Advisory Councils

(local, state, national)

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Three Underlying Concepts1. Relationship of directors to the shareholders

(stakeholders)

2. Relationship of the directors to each other

3. Relationship of the directors to organization’s executives

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Three Legal Duties:

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1. Duty of Care

2. Duty of Loyalty

3. Duty of Obedience

(BoardSource, 2017).

Duty of Care

▪ Consistently attending board and committee meetings

▪ Being informed by obtaining and reviewing appropriate data and information

▪ Participating in board discussions and decisions

▪ Exercising independent judgment

▪ Periodically examining the performance of executive and trustees (Cantu, 2014).

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Duty of Loyalty

• Disclosing fully any potential conflicts of interest

• Complying with the organization’s conflict of interest

• Maintaining confidentiality as required

• Avoiding using organizational opportunities for personal interest or gain (Cantu, 2014)

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Duty of Obedience▪ Adhering to the organization’s mission and

bylaws

▪ Ensuring that all applicable laws and regulations are obeyed by individuals as well as organization

▪ Understanding all documents governing the board and operation

▪ Ensuring that board decisions further the organization’s mission and comply with the scope of governing documents 20

Key Roles of Health Boards

•Operational Oversight

•Quality Oversight

• Fiduciary Responsibility

•AdvocacyThe Governance Institute (2014). The board’s quality of care responsibilities: Dimensions of oversight. 11 (1). Lincoln, NE.

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What Competencies Should Nurses Possess for Board Service?

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Our Journey to Board Service

Nurses Need to:▪ Take responsibility for our professional and personal

growth

▪ Continue our education

▪ Seek opportunities to develop skills

▪ Acquire the skills, knowledge, and competencies to be an effective board member (IOM,2011). 23

Problem Statement• No study identified the needed skills,

knowledge, and competencies of nurses for board service

• Key attributes in literature based upon experiences and opinions of authors and subject matter experts

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Literature Synthesis

▪ Common themes of key attributes

− collaboration, finance, strategy, planning, visionary skills, communication (ANF, 2015; CHCG,

2009; Peregrine et al., 2012; Westphal & McNeil, 2014).

▪ Competencies from AACN on Governance Leadership

− global thinking, self-leadership, visioning, consensus building, delivering an effective message (AACN, 2006, Board Source, 2007, Cascio, 2004).

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Study of Texas Nurses

▪ Quantitative descriptive pilot study

▪ Survey tool incorporated from ANF Survey, AACN Governance competencies, national Nurses on Boards Coalition Workgroup #5 (ANF, 2015; AACN, 2006; NOBC, 2015)

▪ Exclusion criteria- RNs licensed outside of Texas- Board service external to nursing

▪ National comparisons possible due to common language in survey

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Study Results

Total # of participants = 191

RNs in Texas = 187

Serving or have served on a board external to our outside profession = 125

58 of the 187 did not qualify (31%)

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Skills and Knowledge (n=respondents)

Wished Prior to Board Service

Finance Strategic Planning Audit

53.6% (67) 47.2% (59) 41.6% (52)

Importance Communication Strategic Planning QI

70.47% (88) 66.4% (83) 38.4% (48)

Active Use Communication Strategic Planning Content Expertise

89.5% (112) 80.8% (101) 73.5% (92)

Frequency Communication Strategic Planning Content Expertise

86.4% (108) 56.0% (70) 39.2% (49)

Skills Highest Ranked to All Wished for Prior to Board Service

Skill Mean

Rank – Yes

(N)

Mean Rank

– No (N)

U Asympto-

matic Sig. (2-

sided)

Quality Improvement 102.99 (34) 48.06 (91) 2,906.5 .000

Human Resources 101.87 (27) 52.29 (98) 2,372.0 .000

Management 101.36 (33) 49.24 (92) 2,784.0 .000

Communication 96.29 (35) 50.06 (90) 2,740.0 .000

Competencies (n=respondents)

Not Developed Prior to Board Service

Importance

Self-leadership 72.6% (91) 44% (55)

Delivering Effective Message

62.4% (78) 60.8% (76)

Consensus Building 61.6% (77) 52.8% (66)

Visioning 56.0% (70) 55.2% (69)

Global Thinking 55.2% (69) 39.2% (49)

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What about Presence?

• Inspiring trust and confidence in others

• Being confident, poised, authentic

• Includes communication and social awareness (Yoder-Wise & Benton, 2017)

• “Creating an impression on others” (Hedges, 2012)

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A Formula for Executive Presence

(Yoder-Wise & Benton, 2017)

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Appearance Behavior/Gravitas

Communication

Being Genuine & Intentional Presence

ABCs of Presence

• Appearance

- Professional attire with manners

• Behavior

- Acting with integrity

- Keeping promises

• Communication

- Being with others

- Listening genuinely (Yoder-Wise & Benton, 2017)

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What avenues exist for nurses to gain the required skills and

attributes?

(Cantu, 2014). 34

Traditional Routes

▪Formal curricula (Lacasse, 2013)

▪Experiences in one’s career (Pate,

2013; Westphal & McNeil)

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Nurse Board Training• Sigma Theta Tau International

Annual Board Leadership Institute (Sigma Theta Tau

Institute, 2016).

• Nurses on Boards Coalition (Harper, 2016).

www.nursesonboardscoalition.org

• State Organizations of Nurse Executives

Texas, Virginia (Brown, 2015; Hassmiller & Quinn, 2015).

• BoardSource Governance Series Kit (www.boardsource.org)

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Reading/Online Tutorials▪ Trustee Magazine

(www.trusteemag.com)

▪ Board Leadership Magazine

(www.onlinelibrary.wiley.com)

▪ BoardSource

(www.boardsource.org)

▪ Center for Health Care Governance

(www.americangovernance.com)

▪ The Governance Institute

(www.governance.institute.com) 37

The Acquired and Preferred Methods for Learning

2.4%

16.0%

16.0%

28.0%

31.2%

34.4%

46.4%

48.0%

3

20

20

35

39

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58

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Blogs

Webinars

Readings

ContinuingEducation

Conferences

Coaching

Networking

Mentoring

Preferred Methods of Learning

(n) Overall %

Routes to Skills & Competencies

▪Mentors/Coaches

–Nurse Leaders

–CFO or Finance Department

–Strategic Planners

–Other Contacts39

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How to Become a Board Member?

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Gaining Board Appointments

Need…

• Strategic Thought

• Planning

• Groundwork (Sundean & Palifroni, 2016)

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Strategies to Become a Board Member

▪Preparation

▪Expertise

▪Relationships

▪Networking(Sundean & Palifroni, 2016)

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Preparation

Create A Personal Strategic Plan With Action Steps

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Preparation

Remember…

– it’s formal and informal

– refine, refine your skills

– consider boards that nurture novice board members (Sundean &

Palifroni, 2016)

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Look Locally!

• Literature supporting healthcare systems and

hospitals

• Healthcare reform and population health

strategies focusing on community health

• Think about other organizations

- Churches - Serve West Dallas

- Health organizations - Chamber of Commerce

- Public health department - School Boards

- Housing authority - Governmental Boards

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Expertise

▪Self-promotion plan

–Nursing organizations

–LinkedIn

–Speaking engagements

–Schedule time with CEO, Chair of Board

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Relationships▪Volunteering (Hill, 2008)

▪Serve on councils, committees or advisory boards

▪Seek out key influencers

▪Develop relationships outside of nursing (Sundean & Palifroni, 2016)

▪ “Roll up your sleeves and get the work done”(Sundean & McGrath, p.457, 2016)

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Networking▪ Intentional Process (Sundean & Palifroni, 2016)

▪Positive leadership presence– In person

– Online

▪Social and professional events

▪Make your intentions known (Sundean & Palifroni, 2016)

▪Mentoring as a facilitator to service (McDonald &

Westphal, 2013)48

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You’re

On

A

Board!

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Once on a Board…▪Orientation– Structured orientation

program

• Budget

• Job description for CEO

• Compensation policies

– Board charter, by-laws

– Legal and organizational obligations

– Annual strategic goals

– Timelines; time commitments

– Financial contribution

▪ Mentoring– Further orient new

members

– Promote individual & organizational learning

– Leadership succession

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Personal Plan of Action

Creating your own personal plan of action to become a board member or becoming a better board member…..

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What Better Way to…• Achieve greater leadership

• Gain new knowledge

• Get to know your own worth

• Impact health care delivery

• Obtain new skills

• Meet new people

• Expand your network

• Be inspired (Cantu, 2014).

(Cantu, 2014).

Thank you for your interest in Board Service!

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QUESTIONS?

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Cyndy Dunlap, DNP, RN, NEA-BC, FACHE

cdunlap12@outlook.com

(cell) 254-744-8472

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Support Nurses on Boards Coalition

▪Be counted for board service!

▪Go to Nurses on Boards Coalition

www.nursesonboardscoalition.org

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ReferencesAmerican Association of Critical Care Nurses. Framework for Governance Leadership Positions.

(2006). Retrieved from http://www.aacn.org/wed/volunteers/content/frameworkforgovernanceleadershippositions

BoardSource, (2007). Board matrix worksheet. Retrieved from http://www.boardsource.org

BoardSource. (2017) Roles and Responsibilities. Retrieved from https://boardsource.org/fundamental-topics-of-nonprofit-board-service/roles-responsibilities/

Cascio, W., (2004). Board governance: A social systems perspective. Academy of Management Perspectives, 18(1), 97-100. http://dx.doi.org/10.5465/AME.2004.12689560.

Center for Healthcare Governance. (2009). Competency-based governance: A foundation for board and organizational effectiveness. Retrieved from http://www.americangovernance.com/americangovernance/publications/competency-based-governance-enters-the health-care-boardroom.html.

Future of Nursing: Campaign for Action [FNCA]. (November 17, 2014). National coalition launches effort to place 10,000 nurses on governing boards by 2020. Retrieved from hppt://campaignforaction.org/news/national-coalition-launches-effort-place-10000-nurses-governing-boards-2020.

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References (continued)

Harper, K. (2015, March). Nurses on Boards: The importance of your voice. Paper presented at the Sigma Theta Tau Institute International Board Leadership, Indianapolis, IN.

Hassmiller, S., & Quinn, W. (2015). How nurse leaders can fix our healthcare system. Nurse Leader, 30(2), 31-35. http://dx.doi.org/10.1016/j.mnl.2015.01.008

Hedges, K. The power of presence: Unlock your potential to influence and engage others. New York, NY: AMACOM, 2012.

Hill, K. (2010). Nurses in the boardroom. Journal of Nursing Administration, 40(10), 402-403. http://dx.doi.org/10.1097/NNA.0b013e3181F2e930

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academics Press.

Khoury, C., Blizzard, R., Moore, L., & Hassmiller, S. (2011). Nursing leadership from bedside to boardroom: A Gallup national survey of opinion leaders. Journal of Nursing Administration, 41(7-8), 299-305. doi:10.197/NNA.0b013a3182250a0d

Lacasse, C. (2013). Developing nursing leaders for the future: Achieving competency for transformational leadership. Oncology Nursing Forum, 40(5), 431-433.

McDonald, M. & Westphal, J. (2013). Access denied: low mentoring of women and minority first-time directors and its negative effects on appointments to additional boards. Academic Management Journal, 56(4), 1169-1198.

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References (continued)

Nurses on Boards Coalition Workgroup #5 Interview Tool [Measurement Instrument]. (2015). Unpublished instrument. Indianapolis, IN: Nurses on Board Coalition Workgroup #5.

Peregrine, M., Will, M., & Nygren, D. (2012). Toward the professional board: Governance considerations for a consolidated sector. AHLA connections, 16(7), 10-14.

Porter-O’Grady, T. (2011). Leadership at all levels. Nursing Management, 42(5), 32-37. http://dx.doi.org/10/1097/01.NUMA.0000396347.49552.86

Prybil, L. (2016). Nursing engagement in governing health care organizations: Past, present, and future. Journal of Nursing Care Quality, 31(4), 299-303. doi:10.1097/NCQ.0000000000000182

Sigma Theta Tau International. (2016). Board Leadership Institute. Retrieved from http://www.nursingsociety.org/learn-grow/leadership-institute/board-leadership-institute-(bli)

Sundean, L. & Polifroni (2016). A feminist framework for nurses on boards. Journal of Professional Nursing, 32(6), 396-400. http://dx.doi.org/10.1016/j.profnurs.2016.03.007

Sundean, L. & McGrath, J. (2016). A metasynthesis exploring nurses and women on governing boards. Journal of Nursing Administration, 46 (9), 455-461. http://dx.doi.org/10.1097/NNA.0000000000000375 58

References (continued)

The American Nurses Foundation Board Service Survey [ANF] [Measurement instrument]. (2015). Unpublished instrument. Silver Spring, Maryland: American Nurses Foundation.

The Governance Institute. (2011). Dynamic governance: An analysis of board structure and practices in a shifting industry. San Diego, CA: The Governance Institute.

Westphal, J., & McNeil, P. (2014). Learn to lead in the boardroom. The Journal of Continuing Education in Nursing, 45(4), 162-168.

Yoder-Wise, P. & Benton, K. (2017). The essence of presence and how it enhances a leader’s value. Nurse Leader, 15(3), 174-175.

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