This summer, 26 Texas nurses gathered in Dallas for a one-day immersion in governance training, the inaugural class of what organizers describe as a multi-phase effort to fast-track more nurses into governance roles across the Lone Star State.

By the end of 2015, Texas organizers plan to develop 400 nurse prospects with the skills and confidence to serve on a variety of health-related boards — from hospitals to community organizations to state agencies, says Cole Edmonson, R.N. Edmonson, chief nursing officer at Texas Health Presbyterian Hospital Dallas, is the co-leader of the nursing training effort, which calls itself the Texas Team. The one-day July workshop, he says, gave the nurses "a sense of confidence that they were well-prepared to approach, and be appointed or elected to the board of their choice."

The Texas Team, which is working jointly with the Texas Healthcare Trustees, is one of 50 state-based coalitions that have formed since 2010 to prepare and promote nurses for board positions. The coalitions are part of a national initiative, The Future of Nursing: Campaign for Action, developed by AARP and the Robert Wood Johnson Foundation, which has more recently joined forces with some 20 nursing organizations including the American Organization of Nurse Executives, an American Hospital Association subsidiary, and Sigma Theta Tau.

Their similarly ambitious goal: to add 10,000 nurses to boards around the country by 2020. "But we're going to do it before then," says Susan Hassmiller, R.N., a senior adviser for nursing with the Robert Wood Johnson Foundation.

Nurses fill 6 percent of board seats, compared with 20 percent filled by physicians, according to the most recent AHA governance data. Other recent survey data, published in a Nurse Leader article, reflect even more limited representation, with 2–6 percent of hospital board seats filled by nurses. To better provide that clinical perspective, proponents argue that trustees should more actively seek out talented nurses, and nurses themselves should become better advocates.

With some effort, nurses can build the sort of speaking and advocacy expertise that will elevate their leadership profile, Hassmiller says. "We owe it to our patients to be their voices," she says. "I tell nurses to go with their passion. You might be passionate about neonatal care. You might be passionate about childhood obesity. Don't keep that to yourself. You're an advocate."

Beyond Your Walls

Sometimes trustees might not know many nurses beyond those at their own facility, and are understandably concerned about putting an employee on the board, says Lawrence Prybil, Norton Professor in Health Care Leadership at the University of Kentucky College of Public Health in Lexington. While some staff nurses have been successful in maintaining an arm's-length governance role, it can be challenging. "It takes a very special doctor or nurse who is employed to take that hat off," he says, "and be there as an independent thinker, and not as a representative of the nursing workforce or the physicians."

Moreover, given the deep bench of talented nurses in any community, "why go there?" Prybil asks. "I think it's a straw man that people throw up, for getting in the way of thinking outside the box just a little bit," he says.

Hospital leaders should have no difficulty finding exciting candidates, even in relatively small communities, he says. As an example, Prybil points out that Cedar Rapids, Iowa, has only a few local hospitals. But hospital leaders might recruit a go-getter nurse from the local health department, or by getting to know the nurse faculty at nearby University of Iowa, just a 30-minute drive, he says.

Another avenue might be to look into the background of nurses on various types of community boards, such as church boards or the local Red Cross board, says Patty Cochrell, R.N., vice president and leadership advisor at B.E. Smith, a health care executive search firm. Touch base with specific nursing associations, such as AONE, to see who they might recommend, she says.

The hospital's chief nursing officer and other nurse leaders also will be well-connected and might suggest some intriguing candidates, Cochrell says. A recently retired nurse might have the time and desire to give back in terms of board service, she says.

Grooming Prospects

Beware of short cuts while conducting a search, nurse proponents stress. Vet that nurse not just in terms of skills, but whether he or she is the right fit for the board, just as you should with a lawyer or banker or other governance prospect, Prybil says.

"You don't just say, 'Well, I know Nurse Jones down here at the community college and she'd be great. Let's invite her,'" he says. "That's sloppy."

Consider offering a nurse a ramp-up opportunity, such as by asking him or her to serve on a board committee in an advisory role, Prybil says. "That gives a potential board member a chance to feel out the environment with a much lesser commitment, and for you as the board to observe how that person behaves," he says. "Do they display the values? Do they understand the mission? Do they have commitment? Do they show up? Do they contribute?"

Once they meet all of those tests, the nurse will have a sense of what he or she is getting into by joining a board, and whether to make that time investment, Prybil says.

Meanwhile, nurses can take steps to be in the right place at the right time, Hassmiller says. She urges nurses to earn more advanced degrees and obtain other training. Pursuing one's passions doesn't necessarily mean standing before a ballroom podium, she says. Start smaller by writing or serving on related committees. "Do whatever you can to find your voice," she says. "And when you do, people will start listening."

And, she adds: "If you want to be on a board and you're not noticed, then ask someone to nominate you."

As the Texas Team's plans unfold, Edmonson and others are creating a state-wide inventory of nurse prospects, their expertise and geographic location among other details, along with a list of health-related boards. "[It's] almost like creating a type database," he says.

They also are moving forward with the next two phases of governance training. First, the inaugural group of 26 will train a similar number of nurses based in various regions of Texas to become trainers themselves. Then they can return to their communities and reach even more nurses with the curriculum, ideally a total of 400 by the end of 2015, Edmonson says.

"Texas is such a geographically diverse state," he says. "To have a nurse trained in Fort Worth to try and serve on a board in Austin is probably not going to work."

The training and boosted confidence has already paid off, Edmonson says. Within a few days after the July course, one of the nurses landed her first board appointment.
She had approached the board previously and got in touch again after completing the governance workshop, he says. "That was an accelerator, we believe, to her getting positioned on that board."

For more on the need for nurses on the board, read the September cover story, "The Case for a Nurse Trustee."

Charlotte Huff is a health and business writer in Fort Worth, Texas.