Qualifications of Executive Nurses for Service on Hospital Boards.

OBJECTIVE: The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment. BACKGROUND: Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight. METHODS: Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale. RESULTS: Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance. CONCLUSION: This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments.

Guidelines as governance: Critical reflections from a documentary analysis of guidelines to support user involvement in research.

Although guidelines to regulate user involvement in research have been advocated and implemented for several years, literature still describes the process as challenging. In this qualitative study, we take a critical view on guidelines that are developed to regulate and govern the collaboration process of user involvement in research. We adapt a social constructivist view of guidelines and our aim is to explore how guidelines construct the perception of users and researchers and thus the process of involvement. Twenty-two guidelines published between 2006 and 2019 were analyzed iteratively. The analysis focuses on values which are emphasized in the guidelines on the distribution of entities, knowledge, and tasks between users and researchers. The analysis indicates that users and researchers are constructed differently; researchers are mainly constructed as responsible initiators and caretakers, while users are constructed as powerless and vulnerable. The guidelines portray the collaboration process as harmonious and assume a normative perspective. In doing so, challenges described in the literature related to power imbalances are not addressed. Based on these findings, we ask if these guidelines might function to maintain existing power imbalances between users and researchers.

The Journey: Nurses on Boards Coalition Preparation and Support Work Group.

Nurses have the knowledge, skills, and expertise to bring value and leadership to a myriad of boards throughout the United States, with nursing leadership critical to the transformation of complex health care systems. The 2011 Institute of Medicine Future of Nursing report calls on nurses to lead at all levels in systems as well as in board rooms. In 2014, the Nurses on Boards Coalition (NOBC) aligned its mission with this charge, creating a goal, as stated on its Web site, to "improve the health of communities and the nation through the service of nurses on boards and other bodies." A specific goal of NOBC was to have 10 000 nurses on boards by 2020. Through a partnership with the Robert Wood Johnson Foundation and the America Association of Retired Persons, NOBC worked strategically to achieve its goal. The accomplishments of one of its work groups, Preparation and Support, are highlighted.

The Value of Including the Nursing Perspective in the Boardroom.

In response to the Future of Nursing Report, the Nurses on Boards Coalition promotes the health of communities and the nation by engaging nurses in board service. Nurses possess knowledge and skills that when leveraged in boardroom discussions and decisions may impact the health of the populations served by the board. This article highlights the insights of organizational board leaders, as they describe the impact and influence of nurse board members within their organizations.

Mapping the peer-reviewed literature on accommodating nurses' return to work after leaves of absence for mental health issues: a scoping review.

BACKGROUND: The complexity of nursing practice increases the risk of nurses suffering from mental health issues, such as substance use disorders, anxiety, burnout, depression, and posttraumatic stress disorder (PTSD). These mental health issues can potentially lead to nurses taking leaves of absence and may require accommodations for their return to work. The purpose of this review was to map key themes in the peer-reviewed literature about accommodations for nurses' return to work following leaves of absence for mental health issues. METHODS: A six-step methodological framework for scoping reviews was used to summarize the amount, types, sources, and distribution of the literature. The academic literature was searched through nine electronic databases. Electronic charts were used to extract code and collate the data. Findings were derived inductively and summarized thematically and numerically. RESULTS: Academic literature is scarce regarding interventions for nurses' return to work following leaves of absence for mental health issues, and most focused on substance use concerns. Search of the peer-reviewed literature yielded only six records. The records were primarily quantitative studies (n = 4, 68%), published between 1997 and 2018, and originated in the United States (n = 6, 100%). The qualitative thematic findings addressed three major themes: alternative to discipline programs (ADPs), peer support, and return to work policies, procedures, and practices. CONCLUSIONS: While the literature supports alternative to discipline programs as a primary accommodation supporting return to work of nurses, more on the effectiveness of such programs is required. Empirical evidence is necessary to develop, maintain, and refine much needed return to work accommodations for nurses after leaves of absence for mental health issues.

Diversity in Professionalism Framings Across U.S. Medical Boards.

Lapses in professionalism are a common cause of disciplinary action against physicians by U.S. medical boards. However, the exact definition of "professionalism" is unclear, making it likely that a physician will not train or practice under the same framing of professionalism and so may fail to develop certain skills. The goal of this study was to identify and compare the professionalism framings of medical boards. The medical board web pages for all 50 states, the District of Columbia, and four territories were examined in June 2017 for use of the word "professionalism" or "professional" in their application, rules, or laws, which was then coded as a best fit to one of six core framings of professionalism. Of the 55 states and territories, integrity was the most common professionalism framing (40.0%), followed by excellence (23.6%), behavior (12.7%), mixed (9.1%), unclear (9.1%), and absent (5.5%). Although integrity was the most common framing, diversity exists among medical boards, which could lead to board misunderstandings of incidents labeled as professionalism violations and ineffective remediation of offenses. In order to best communicate the nature of the offense and thus best facilitate remediation, the incident should be called by its true name rather than the all-encompassing term "professionalism."

The rationale for nurses on boards in the voices of nurses who serve.

BACKGROUND: Inclusion of nurses on boards (NOB) to enhance health care transformation is recommended; however, there is no research-based rationale for NOB. PURPOSE: To articulate the rationale for NOB in the voices of nurses who serve. METHODS: An explanatory sequential mixed methods design was used with priority on the quantitative strand (Delphi method). The qualitative strand was accomplished with focus groups. FINDINGS: Twenty-nine NOB participants (Delphi phase) and nine NOB participants (focus groups) agreed the rationale for NOB is embedded in specific knowledge, skills, and perspectives that nurses contribute for boardroom discussions and policymaking. This study supported anecdotal literature promoting nurses for board leadership. DISCUSSION: Nurses should be appointed to boards of directors based on their knowledge, skills, and perspectives about health care. Board leadership leverages the public's trust in nursing, advances the profession, and positions nurses to influence health care transformation. Further research is recommended.

Do governing body and CSU nurses on clinical commissioning groups really lead a nursing agenda? Findings from a 2015 Survey of the Commissioning Nurse Leaders' Network Membership.

AIMS: This paper reports the findings from a 2015 survey of the Commissioning Nurse Leaders' Network. Our aim was to understand how governing body nurses perceive their influence and leadership on clinical commissioning groups. METHODS: An online survey method was used with a census sample of 238 governing body nurses and nurses working in Commissioning Support Units, who were members of the Commissioning Nurse Leaders' Network. The response rate was 40.7% (n = 97). RESULTS: While most governing body nurses felt confident in their leadership role, this was less so for non-executive governing body nurses. Nurses in Commissioning Support Units were much less positive than governing body nurses about their influence on clinical commissioning groups. CONCLUSION: Governing body nurses were satisfied with their impact on clinical commissioning groups and so could be said to be leading a nursing agenda but this evidence is limited to their own perceptions and more objective or diverse measures of impact are needed. The purpose of such roles to 'represent nursing, and ensure the patient voice is heard' may be a flawed aspiration, conflating nursing leadership and patient voice. IMPLICATIONS FOR NURSING MANAGEMENT: This is the first study to explore explicitly the differences between executive and non-executive governing body nurses and nurses working in commissioning support units. Achieving clinical commissioning groups' goals, including developing and embedding nursing leadership roles in clinical commissioning groups, may be threatened if the contributions of governing body nurses, and other nurses supporting clinical commissioning groups, go unrecognised within the profession, or if general practitioners or other clinical commissioning group executive members dominate decision-making on clinical commissioning groups.

Supporting public involvement in interview and other panels: a systematic review.

BACKGROUND: Members of the public are increasingly being invited to become members of a variety of different panels and boards. OBJECTIVE: This study aimed to systematically search the literature to identify studies relating to support or training provided to members of the public who are asked to be members of an interview panel. SEARCH STRATEGY: A systematic search for published and unpublished studies was carried out from June to September 2015. The search methods included electronic database searching, reference list screening, citation searching and scrutinizing online sources. INCLUSION CRITERIA: We included studies of any design including published and unpublished documents which outlined preparation or guidance relating to public participants who were members of interview panels or representatives on other types of panels or committees. DATA SYNTHESIS: Results were synthesised via narrative methods. MAIN RESULTS: Thirty-six documents were included in the review. Scrutiny of this literature highlighted ten areas which require consideration when including members of the public on interview panels: financial resources; clarity of role; role in the interview process; role in evaluation; training; orientation/induction; information needs; terminology; support; and other public representative needs such as timing, accessibility and support with information technology. DISCUSSION AND CONCLUSIONS: The results of the review emphasize a range of elements that need to be fully considered when planning the involvement of public participants on interview panels. It highlights potential issues relating to the degree of involvement of public representatives in evaluating/grading decisions and the need for preparation and on-going support.

The Board evaluation: method, findings and recommendations.

OBJECTIVES: To describe the background, method, findings and recommendations of the Royal Australian and New Zealand College of Psychiatrists Board evaluation. CONCLUSIONS: An evaluation of the Board in the first half of its initial term indicates that the Board and the new governance processes are developing well. There appears to be a healthy group dynamic and effective working relationships with the Chief Executive Officer and management. A number of priority areas emerged for the Board's attention. The nature and low level of response from the wider membership indicate a low level of engagement in governance matters. It also seems that there are low levels of 'governance literacy' and that a different approach, perhaps facilitated focus groups, may be a more effective method for eliciting effective feedback on Board performance from the membership.

Governance Resilience: The Presbyterian Journey.

Presbyterian Healthcare Services, based in Albuquerque, New Mexico, is the state's only private, not-for-profit integrated healthcare system. It was founded in 1908 as a sanitorium for tuberculosis patients who came to the arid Southwest in search of a cure. Today, Presbyterian is thriving as a twenty-first-century integrated healthcare system, serving one in three New Mexicans in its statewide hospital system; it also includes a 440,000-member health plan and a 700-plus provider medical group. Presbyterian remains dedicated to its singular purpose of improving the health of the patients, members, and communities it serves. Just as Presbyterian has progressed and grown during its 106-year history, its governance system has evolved over time. Presbyterian has always believed that the New Mexico communities it serves deserve not just good governance but great governance and relies on strong structure and processes to lead it to superior outcomes. The ebb and flow of change, our ability to learn from trial and error, and our commitment to success in spite of obstacles make up the story of Presbyterian's strong governance system.

The case for nursing leaders on hospital boards.

At Children's Hospital Los Angeles (CHLA), the participation of our chief nursing officer (CNO) as a voting member on our governing board has been crucial to effective functioning in several areas, particularly those that impact the safety and quality of our patient care services, as well as our entire organization's financial and operational efficiency. As a voting member of our Board of Trustees and 2 standing committees, our CNO has a voice that carries authority and credibility, serving as a conduit between her Trustee colleagues and the nursing troops she leads, who constitute more than half of CHLA employees. Our CNO communicates to the board our nurses' concerns and perspective and in return conveys to nurses the information necessary to implement the board's policies and strategic decisions. As we consider how to ensure CHLA's future as a premier pediatric academic medical center, we understand that the results of the board's work would be impaired if it did not take into account the responsibilities and challenges faced by nurses. We would miss a vital contributor if our CNO was not involved in the hospital's governance at the highest levels.

Increasing board diversity: an imperative for success in the next era.

As health care organizations undertake transformational change, governance will evolve along with organizational leadership. Increasing diversity on Boards of Directors should be a goal for all health care systems to understand and address. This will include a consideration of previously underrepresented professionals such as nurses. It will also involve the recruitment of culturally and racially diverse trustees, as a reflection of the organization's community. As a strategic plan for adding diversity to a board, individuals with varied experience, background, culture, age, race, and gender should be pursued. Boards that attain a new blend of trustees will increase their potential for innovative and effective governance, but this will require looking for candidates in new places. This article discusses why this is an important issue for the future, as well as where prospective diverse candidates may be discovered.

A New Model of Governance: One University's Journey.

In the nearly 50 years, since the Medicare Program established funding for nursing education in the United States, there has been a steady migration away from hospital-controlled programs toward those which function as wholly owned subsidiaries within larger health care systems. Private sector health care organizations in particular are under increasing pressure to adapt at the risk of losing all of their funding. However, accomplishing this presents multiple challenges for today's nursing education programs in terms of their regulatory compliance, accreditation, autonomy, and, above all, governance model. The authors outline the journey toward, and specific challenges involved in creating, implementing and administering a new governance model, which sustains the overall mission and vision of the education institution while functioning seamlessly within a modern corporate health care system.

Assessing the role of regulatory bodies in managing health professional issues and errors in Europe.

OBJECTIVE: This paper explores how medical regulatory bodies in nine European countries manage professional issues involving quality and patient safety, to build on limited existing information on procedures for regulating medical professionals in Europe. DESIGN: Twelve vignettes describing scenarios of concerns about standards of physicians were developed, covering clinical, criminal and administrative matters. Medical regulatory bodies in nine European countries were asked what action they would normally take in each situation. Their responses were related to their regulatory mandate. RESULTS: Responses varied greatly across participating countries. Regulators are always involved where patients are at risk or where a criminal offence is committed within the clinical setting. Non-criminal medical issues were generally handled by the employer, if any, at their discretion. Countries varied in the use of punitive measures, the extent to which they took an interest in issues arising outside professional activities, and whether they dealt with issues themselves or referred cases to another regulatory authority or took no action at all. CONCLUSIONS: There is little consistency across Europe on the regulation of medical professionals. There is considerable diversity in the range of topics that regulatory bodies oversee, with almost all covering health care quality and safety and others encompassing issues related to reputation, respect and trust. These inconsistencies have significant implications for professional mobility, patient safety and quality of care.

Learn to lead in the boardroom.

Nurses, positioned as members of one of the most highly trusted professions, are called to meet the health needs of patients and communities in a variety of ways. The Institute of Medicine calls nurses to partner with physicians and other professionals to redesign health care in the United States. One way that nurses can answer the call is by serving in the boardroom, where decisions regarding health and health care are made. Identified competencies for board leadership include (a) open communication, (b) planning, (c) active engagement, (d) collaboration, (e) decision-making skills, (f) financial stewardship, (g) organizational skills, (h) advocacy, and (i) visionary skills. Board competency development begins in nursing school and continues throughout one's professional career. A board leadership self-assessment tool is provided as a guide for personal and professional growth. Continuing education professionals play an important role in development of boardroom competency.

A matter of perspective. The best boards respect the line between governing and managing.

Is your board governing or managing? Learn how to spot the difference.