Waiting for your coronation: a career-limiting trap.

Women are often reluctant to apply for promotions even when they are well deserved, simply believing good job performance will naturally lead to rewards. This phenomenon of advancement reticence has led to such labels as "tiara syndrome," "girl disease", and "imposter syndrome". Women often undervalue their skills and are less effective at self-promotion than their male counterparts. A number of strategies can help battle these "syndromes" and ease the stress of "taking off the tiara".

Could this be the year to claim the corner office?

The health care industry is in the midst of chaos as we navigate through the uncertainty of reform, gridlock in Congress, and the largest change ever contemplated in the delivery of care as the epicenter moves to the community. Yet, history has repeatedly demonstrated that from chaos, opportunity is born. Creative nurse entrepreneurs, intrapreneurs, and innovative leaders have embraced this complexity and are beginning to reinvent their organizations and themselves to meet the challenge. Nurse leaders need to begin to shape the science around this level of sophisticated leadership, building our capacity as nurses and positioning others for inclusion into these unique ranks.

Governing for improved quality and patient safety.

Board members have a critical oversight role to play in monitoring and providing direction to improve health care quality and safety. In the emerging environment of health care reform, the board's role in overseeing quality and safety on behalf of stakeholders will become as or even more important than its financial oversight role. Nurses can expand their impact by joining the ranks of health care organization governing boards to lead and guide the entire health care enterprise to realize the goal of improved care and outcomes for all patients.

Board oversight of executive performance and compensation.

Making sure the relative roles of the board and management are clear and agreed upon is becoming more important as market and regulatory forces compel boards to govern at levels of detail once considered micromanagement, but are now required and necessary in the current environment of heightened governance accountability. A clear understanding of each other's roles and responsibilities is step one in building a solid partnership between the board and chief executive. A second element of building a strong foundation for the board-CEO relationship is taking time early on to establish mutual expectations about working together. The board's responsibilities in CEO performance management and compensation include setting performance expectations and goals that are clear and measurable and coaching and motivating the CEO. When a CEO fails, one of the most important steps for the board to take is to look in the mirror and commit to the rigorous due diligence needed to avoid future mistakes. Boards should always have CEO succession on their agenda.

The board's role in organizational finance.

Health care reform will result in significant changes in reimbursement with much greater emphasis put on primary care, home care, and other types of non-acute care. The changes in reimbursement will necessitate significant changes in organizational structure and operations. It is essential board members keep current in their knowledge of health care finance so they can execute their responsibilities for the financial health of the organization. The board must ensure that the budget is aligned with the organization's financial objectives and monitor the financial performance. It is essential the chief nursing officer (CNO) contributes to the board's understanding of the financial health of the organization. The board of trustees will more effectively execute their financial responsibilities with the input of nurse trustees and the CNO.

Mission, strategy, and stakeholders.

It's important health care organizations and their boards understand who their primary stakeholders are and identify what they most want and need from the organization. Boards play a key role in helping their hospitals understand key stakeholders and focusing action to meet their needs through development of mission, vision, and values statements and obtaining and using stakeholder feedback in managing risk and setting strategy. Nurse leaders who understand these key board roles and responsibilities will be better prepared to confidently and competently seek service on boards and contribute to effective governance.

Expanding the role of nursing in health care governance.

Nurses are an untapped resource for health care governing boards. It is essential to help nurses fulfill their potential to competently and confidently participate in the governance of our nation's health care organizations. Understanding the health care governance landscape is an important first step for nurses to take on the path to pursuing board service. Like other professionals who seek to more fully prepare themselves to take on the unique challenges of governance, nurses also have access to a range of resources such as Best On Board, a new education, testing, and certification program. Best On Board offers a continuum of courses designed to help both new and seasoned trustees demonstrate their understanding of board issues and responsibilities, enabling them to quickly and confidently contribute in their governance role.

Quality, patient safety, and the board.

It is now broadly recognized that good outcomes for patients depend on more than a clinician's knowledge and skills and use of proven, effective practices or evidence-based medicine. Good outcomes also depend on the organization's culture, which affects how well providers and patients work together. Boards play a key role in helping their hospitals improve the quality and safety of the care they deliver--a governance imperative to ensure hospitals meet the needs of key stakeholders and perform effectively in an environment of reform. Nurse leaders who understand this key board responsibility will be better prepared to serve on boards and contribute to effective governance.

Enhancing board effectiveness.

Like any other job, board work is associated with specific competencies. Competencies are the combination of knowledge, skills, personal characteristics, and behaviors needed to perform a job or task effectively. Boards are only as strong as their weakest member. Board education should focus on improving the knowledge and skills of the board and individual members and on overall board performance. Assessment of individual board member performance is designed to evaluate the trustee's knowledge of board roles and responsibilities and the expectations of board members. Board effectiveness is built through competency-based board member recruitment and selection; board member education and development; and evaluation of board, board member, and meeting performance.