New study on nurses' representation on governing boards

Dr. David Keepnews, PhD, RN, JD, FAAN, and I just published a study of "Health Professionals' Representation on Governing Board of Health Care Organizations in New York City" in the Journal of Urban Health, an interprofessional journal sponsored by the New York Academy of Medicine.

The study was based upon the premise that the fiduciary responsibility of governing boards now goes beyond financial health. It includes the quality and safety of health care provided by the organization. But trustees who hold appointments because of their potential to bring in donations to the institution may have little grounding in how to promote the quality and safety of the care provided by their organizations.

We surveyed all hospitals, home care agencies, federally qualified health centers, and a sample of nursing homes in New York City. Physicians served on over 20% over hospital governing boards, while nurses served on less than 6% and no other health professionals appeared to be trustees. Home care agencies and nursing homes fared a bit better, however.

The IOM report challenges nurses and society to ensure that we are represented in leadership positions in health care, including governing boards. This study confirms national data on hospitals showing that nurses are underrepresented on these boards. Our study also included a qualitative component that ascertained the barriers and facilitators to getting such appointments.

The DOI for the paper is (DOI) 10.1007/s11524-012-9772-9. It was published online first and will appear in a future issue of the hard copy of the journal. Here is a link but it's time-limited and you'll probably need to go through your library to access it for free:

Diana J. Mason, PhD, RN, FAAN

by Diana Mason | December 10, 2012

Tags: data, education, capacity-building, interprofessional-collaboration, leadership, practice, new-york

Andrea Brassard

Congratulations Diana on a fabulous paper that I hope will be widely disseminated. Powerful quotation on page 8. "The worldview of nursing differentiates itself from the world view of other health professionals. They're very interesting and overlapping but the worldview of nursing is about how people live with whatever state of health they happen to be in at any one point...Nurse meet people where they are, in the social context of where they live, and that worldview...needs to be brought to the policy table because it's a little different from the 'interventionist, let me cure' view of some, or the 'how do you fit the social system' view of the nutritionists, physical therapist, and so on...And then there's a practical side of what nurses bring. Nurses-whether it's a survivor skill or taught - know something about how to make things happen. Sometimes they make do by going around things; sometimes they make it happen by doing it through the policy chain. But these sort of practical things can be very helpful on a board."
Posted on: December 12, 2012, 2:41 pm

Jasmine Samra

"The IOM report challenges nurses and society to ensure that we are represented in leadership positions in health care, including governing boards." The leadership course in baccalaureate programs is where the seeds are planted for students to begin to consider the importance of nurses representing the field. Since nursing practice is directly involved with the decisions of governing bodies, would it be appropriate to interweave leadership with every course in nursing school? I acknowledge the difficulty to edit course objectives, yet another field that needs reform.
Posted on: January 29, 2013, 10:50 am

Jasmine Samra

Hi Andrea, great reply! I was curious to see the content of the link you posted, but the page couldn't be found, could you repost the link?
Posted on: January 29, 2013, 10:54 am

Andrea Brassard

Posted on: January 30, 2013, 7:24 am

Victoria Vinton

Jasmine - I agree with you. Leadership should "interweave" within the entire curriculum. Leadership is an important skill to hone for all nurses to better advocate for patients. Leadership education can no longer be considered necessary only for administrators. Nebraska, in conjunction with the SIP grant is working to address leadership and make it part of the competency-based education model across all 20 schools in the state.
Posted on: January 30, 2013, 10:12 am

Pat Farmer

Leadership takes many forms in nursing, and it would be ideal to weave the content throughout the curriculum. However, there are issues which concern me. One is that it becomes challenging to show where in the curriculum the content is located. This may sound like a minor point, but our accrediting bodies need to be able to verify that critical content is present, and this becomes more complex when it is not centralized in a course. A related issue is that I have seen "interwoven content" become a thin veil for content being diminished or lost. As an example, in days gone by most programs had a course in geriatric care, a course in culturally competent care, sometimes one in history of nursing, etc. Each had dedicated faculty, time allotted, objectives, etc. Then most programs eliminated those courses and threaded the content through the curriculum. Faculty teaching other courses were expected to pick up that content, and that was done with varying degrees of success. One last twist to this issue is that as we work to align curriculum across institutions, we will have to assure that all these topics are interwoven in a manner that allows seamless progression.
Posted on: February 11, 2013, 2:44 pm

Pat Farmer

Diana, it is great to see some data on this important topic. A challenge in less formalized assessment of nursing presence within organizations is that they are often not identified as nurses in their title. I find that when an agency or institution lists their board members or directors, physicians are listed as "Jane Doe, MD" . Nurses, OTOH are simply listed as "Jane Doe". One has to seek a bio to find out that they are, in fact, nurses.
Posted on: February 11, 2013, 2:54 pm

Lisa Sundean

Pat, I can attest to your comment regarding listing nursing credentials on governing boards. I formerly sat on a hospital board and while I always signed in as RN, the minutes never reflected the credential. In contrast, the MDs were always listed with proper credentials. I currently sit on a board QI committee and the same is true. Another issue is that many nurses drop the RN credential as they climb the executive ladder because the credential is seen as a barrier to professional executive development. These are the nurses who will most likely end up on boards. After giving an evidence-based presentation to a hospital board nominating committee on the value of nurses on boards, I was treated with pleasantries, at best. No action was taken. Even after follow up 4 months later, I was told there were other priorities and they had not considered the presentation any further at that point. I do think it's a battle worth fighting to be sure the best interests of patients are represented in the board room - and who better to do it but the nurses who represent the front line of care?
Posted on: April 21, 2013, 5:03 pm

Iris Yuen

Lisa, that is such an unfortunate experience yet not surprising. The voices of nurses are often overridden by physicians. The title of RN holds so much more responsibilities than it seems. However, it is so unfair how with the huge amount of responsibility comes with it no power. This post is a great reminder to let nurses know they have to step up to the plate and represent their patients and the scope of nursing by fighting to get that position in governing boards and voicing their opinions.
Posted on: December 3, 2013, 12:09 pm

Susannah Williams

I agree with you all. Although I’m not a nurse, I’m beginning to understand the value of the nurse’s worldview as I experience it as a nursing student. They seem to be uniquely qualified to address quality of care and safety issues, as it is their main focus. Nurses, as patient advocates, can share patient’s concerns, giving more power to an individual’s voice. I’m glad that the paucity of nurse representation on health care governing boards has been identified and that it has created a need to increase those numbers. I feel that we’ll all benefit from it in the end. Susannah Williams Accelerated BSN Student Rutgers School of Nursing
Posted on: March 29, 2014, 6:19 am

Emily Clarke

As a current nursing student, I have been educated on the important roles a nurse plays throughout a health care organization, with emphasis on the role as patient advocate. I believe it is important that we have equal representation as members of an organization and speak up for our own needs to the larger healthcare community in order to provide optimal care. In regards to any business, including hospitals, the evidence shows a strong correlation between a healthy working environment and leadership at all levels of an organization. But I believe in order to foster healthy working conditions, the different entities need to work together at all levels. Physicians, nurses, social workers, pharmacy, dietitians, etc. all have to respect one another for their expertise in that specific field. I believe the idea of mutual respect should be fostered at the earliest possible time- during education. I think nursing schools and medical schools should integrate a course to foster interdisciplinary care. We should learn to work together now to provide care as a team so we can understand each other's roles. If we can learn to work together at the basic level, we can grow together as future leaders. I hope to see more nurses equally represented at the governing level. Emily Clarke Rutgers School of Nursing Resources: Sherman, R., & Pross, E. (2010). Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level. Retrieved June 22, 2014, from
Posted on: June 22, 2014, 12:02 pm

Jennifer Marlette

I appreciate the opinions and ideas offered to increase the level of nurses represented on governing boards. I agree that patient care and outcomes would be improved by having the voice of nurses involved at that level. So many boards can be out of touch with the actual day to day practice and of patient care. Having nurses involved in that level would bring a new perspective, hold higher accountability for safety and good outcomes. Nurses are the driving force behind healthcare and having that position and voice would only benefit all involved.
Posted on: October 26, 2014, 7:41 am

Elizabeth Scott Paulson

"The IOM report challenges nurses and society to ensure that we are represented in leadership positions in health care, including governing boards. This study confirms national data on hospitals showing that nurses are underrepresented on these boards. Our study also included a qualitative component that ascertained the barriers and facilitators to getting such appointments." The profession of nursing is evolving and calls for a higher level of education, two way communication with leadership and most importantly, nurses actively elected to such boards. We can transform patient care, patient outcomes and drive change but we have to do the work and communicate effectively utilizing evidence based research to convince the masses. We wear so many hats: patient care, advocacy, education, teaching, resource locaters, catalysts between multiple disciplines, cost analysts, quality and safety champions. Everyday we step out as a nurse, we not only represent our patients and organizations for which we work for but most importantly the profession of Nursing.
Posted on: November 6, 2014, 7:25 am

jennifer tudor

Dr. Keepnews and Dr. Mason's study on the amount of licensed personnel on healthcare governing boards is eye-opening. I find it interesting that only 20% of board members are physicians. It is even more interesting that only 6% of these members are nurses. Given that nursing is the biggest faction of the healthcare workforce, nurses are highly underrepresented in areas where rules and regulations are created. In healthcare, the ultimate goal is to do what is best for healthcare patrons. In order to ensure that our policies are in sync with the healthcare needs of the American population, those that understand health care best must be an integral part of the solution. It is the responsibility of these governing boards as well as appropriate healthcare personnel like nurses and doctors to represent healthcare clients’ needs by the best possible means.
Posted on: November 30, 2014, 1:15 pm

sephanie richardson

Pat I think that as nurses we should never drop the RN as we climb the executive ladder and our extra credintials should always be listed just the same as the doctors. We as nurses, NP, CNL's work hard to get those extra little letter. I often hear nurses say oh no I am not the doctor I am just the nurse. I think we also need to stop saying we are just a nurse. Nurses are just as important as doctors. with out the nurse the patient would get a diagnosis and orders but no one would be there to care for and carry out those orders. We need to step out and make our selves present in care and on the boards that represent who we are as a health care team.
Posted on: December 14, 2014, 6:51 pm

Ronel Manzo

I was aware of the limited role nurses have in the policies related to the healthcare. However this article shows the alarming disparity between the leadership roles nurses have compared to physicians. Having a voice in these organizations are important in respect to changes in nursing roles and protocols in hospitals. Nurses are commonly recognized as a healthcare provider who knows the patients the most because of the beside-care they provide. It is appropriate that nurses should have a greater presence in these hospitals is pertinent to the quality of care of a patient. Another importance for greater representation is that it allows for advocating of nurses. An example is the limited roles nurse practitioners have depending on the state; some states require nurse practitioners to be under the supervision of a physician due to reimbursement policies(Hain, 2014). The article depicts that only 6% of governing board members are nurses. Advocating for changes for nurses would require more nurses to take upon the leadership role. In essence, this article reflects the importance of leadership courses for nurses as a starting point for vital changes for the better quality care of patients and roles of nurses. Hain, D., Fleck, L., (May 31, 2014) "Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 2.
Posted on: July 3, 2015, 6:51 am

Belen Lastra

I agree with Stephanie in that we should not drop the RN, or look at ourselves as just nurses. We are on the front lines of healthcare, and a lot of what we do and accomplish in patient care could not be done without our expertise and compassion for our patients. I am a new nurse, and am continuing on to earn my MSN CNL. I hope to witness all of the exciting changes in the nursing field. Our scopes of practice are expanding, and we will be able to advocate and care for patients like never before, but it is going to take a lot of hard work, and unfortunately, a whole lot of politics. It's going to take some time, but I believe that we will get there.
Posted on: September 20, 2015, 10:49 pm

Carolyn Schmidt

According to Harden (2015) the top three hospitals are Massachusetts General, Mayo Clinic, followed by a tie with John Hopkins and UCLA Medical Center. When searching each hospitals website for the board of trustees and quickly googling their names I found that each hospital did not have any pharmacists on their board and only one, which was the Mayo Clinic had a nurse on their board. I found this information shocking. According to Prybil (2008), gender disparities continue to exist in the board composition of many large American organizations (pg. 7). I think more needs to be done to have a larger inter-professional team on boards that govern the hospitals. My father who works in finance does not know the difference between two medications, but what he can tell you is what is making or not making someone money. I don't see how hospitals can be successful with only a few doctors on their board. As a student nurse I see first hand that the nurse is with the patient in the hospital much more than the patient's doctor. If more nurses were on the board they would be able to help people like my father cut costs instead of cutting the things that are important. I also feel that having a diverse group can help people see things differently or think of ideas that may not have been thought of without someone else's voice. I also believe that politics play a huge role in the number of medical professionals on a board. This needs to change. With the way healthcare is turning hospitals are gearing themselves more towards patient care. This is a wonderful thing, however the hospital is still a business at the end of the day. Most successful businesses listen to their employees. If the hospital needs to cut costs they need to consider who to speak with. By having boards with no nurses, the nurses' voices can not be heard. This leaves the few doctors on the board to be a voice for the nurse. How is the doctor going to know that the changing a commonly used product is going to make the day harder for the nurse if the doctor doesn't use that product. All voices should be heard and we shouldn't have to depend on others who do not do our job to make decisions for us. Hardern, B. (2015). Best Hospitals 2015-16: an Overview. U.S. News & World Report. Retrieved from Prybil, L.D. (2008). Engaging Nurses in Governing Hospitals and Health Systems. Journal of Nursing Care Quality, 24(1). DOI: 10.1097/NCQ.0b013e31818f55b4
Posted on: September 24, 2015, 5:51 pm

Laura Davis

Hi Jasmine, I agree with you completely, I think leadership should definitely be included in nursing education, especially given how the profession is developing. I am currently in a Clinical Nurse Leader program after having worked as an RN for several years. What I am learning about leadership is so valuable to my practice as a nurse and what I am able to contribute to my organization.
Posted on: November 3, 2015, 8:55 pm

Brandi Brown

It's nice to see the nursing profession getting some recognition for our ability to be productive leaders and having quality input into healthcare organizations. We have a lot to offer and have the ability to foster nurturing relationships among the various disciplines. Having nurse representation on governing boards can only bring forth positive outcomes for the organization, the patient population, and the nursing profession.
Posted on: November 16, 2015, 9:11 pm

Linda Wysocki

I agree with you. The value of the view of a nurse is incredible. And addressing issues in quality of care and safety issues is such an important topic.. Increasing patients awareness and research will only help patients. Linda Wysocki MSN student Touro university.
Posted on: December 18, 2015, 2:10 pm

Linda Wysocki

I also believe nurses need to come together in all areas in partnership to create the energy, strength, and changes needed..Since we do hold so much responsibility why not make our numbers come together. Linda Wysocki, RN. MSN student Touro University
Posted on: December 18, 2015, 2:14 pm

Marissa Porter

Iris, I completely agree. The voice of nurses are overridden by Physicians and it is sad. Nurses have the most contact with the patients and are a valuable asset to the clinical team. We are the first to see changes in the patients and our titles should be respected by professions.
Posted on: December 25, 2015, 6:17 pm

Marissa Porter

I agree with you , Brandi. I believe that the CNL role will promote people to look closer at the value of a nurse. I hope that CNL role will change the way nurses are viewed. A higher education can positively impact the nursing field and can be seen as an assest to the governing boards.
Posted on: December 25, 2015, 6:25 pm

jose Coronado

It is important that the governing boards of health care organizations include professionals who are delivering the health care services. "Nursing is the nation's largest health care profession, with more than 3.1million registered nurses nationwide (American Association of Colleges of Nursing, 2015). Even though the nursing profession is the largest profession in the health care system, the profession is underrepresented in health care decisions. The nursing profession is effercgtive at all levels of care of the human being, from the moment the patient is born till the patient dies. In all of the health care settings the nurse is the one who most often knows more about the patient than any other health care professionals. In addition to traditional nursing education there must be core courses of business and professional leadership in order for the nurse to be prepared ant to be included in the decision making of the health care that is delivered not only in the community that he/she lives in, but in the nation as a whole
Posted on: December 26, 2015, 3:14 pm


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