In 2017, the Nurses on Boards Coalition (NOBC) was
founded with the mission “to improve health in communities across the nation
through the service of nurses on all types of boards.
Laurie Benson, BSN, Executive Director of NOBC says that “The
vision of NOBC was created in direct response to The Institute of Medicine’s
2011 landmark report, ‘The Future of Nursing: Leading Change, Advancing Health,’
which called for nurses to play a more pivotal decision-making role on boards
and commissions. NOBC represents national nursing and other organizations
working to build healthier communities in America by increasing the presence of
nurses on corporate, health-related, and other boards, panels, and commissions.”
Benson answered some questions about NOBC.
Why is it important for nurses to
be a part of boards? What do they bring to the table that other health care workers
All boards can benefit from the nursing perspective. Nurses possess a wide
range of skills including strategic planning, critical thinking, quality and
process improvement, communications, human resources, finance, and complex
problem solving. Accustomed to working
in teams, nurses fit naturally into the boardroom environment. Always connected
to the mission, they understand the challenges, opportunities, and implications
of decisions on many levels. Other
health care workers certainly make important contributions to the boardroom as
well. Nurses welcome the opportunity to serve alongside colleagues and other
leaders to make a collective impact.
With 3.6 million nurses in
our country, nurses represent the largest segment of our health care
workforce. It simply makes good business sense to have the nursing
perspective representedin all
placeswhere decisions and policies affecting health are
made including corporate, governmental, nonprofit, advisory,
governance boards, commissions, and panels or task forces that have fiduciary
or strategic responsibility.
Is this just to encourage
NPs to be on boards or nurses of any rank and experience level? Why?
There is a place in the boardroom for nurses across the continuum. While certain boards require specific rank and experience, many seek candidates at a variety of levels of experience and practice, especially with the increased emphasis on bringing diverse perspectives into the boardroom. Boards are most interested in how a candidate will contribute and bring value to discussions in the boardroom. With each board opportunity, NOBC makes sure we understand the profile of the ideal candidate and then match the opportunity with the skills, experience, qualifications, and interests of those registered in the NOBC database as interested in serving.
A few recent examples include a doctoral graduate who was invited
to serve on a nonprofit board for an organization that provides respite care for parents and families of children with
daily medical needs; another nurse (BSN,
less than 5 years of experience was invited to serve on an advisory board for a
national company who was seeking wider generational representation; and a
faculty member (DNP, RN, CNE, NEA-BC), who will soon
be retiring, was selected to serve on the board of a national health care start
up organization focused on care of the aging. There are unprecedented opportunities for
nurses to serve on boards in every community across our nation!
Has this been started
more because nurses weren’t seeking board positions, boards weren’t seeking
nurses as members, or both? Please explain.
NOBC wasn’t started for nursing, it was started by nursing. National nursing association leaders came together with one purpose in mind—to work together to improve health for all. However, not all boards are necessarily aware of the growing interest, demand, and impact of nurses serving on boards. NOBC members, partners, sponsors, state contacts, and others are doing a great job in increasing the awareness and visibility of the expansive and exceptional nurse candidate pool that is available to all boards.
What are nurses’
roles on boards?
Board governance is an extension of leadership. As leaders, nurses can serve effectively in all types of governance roles based on the structure and specific needs of each board. Nurses serve as Board Chairs, Board Committee Chairs, Committee members or at-large members—wherever the need matches with their skills, interests, and their ability to contribute value. The varied roles for nurses on boards are the same as for others serving on the boards. Boards contribute collectively, not based on the individual board members. Nurses especially thrive when serving on high performance boards, serving as a contributor toward the good of the whole.
Suppose a nurse
would like to join a particular board. What should he or she do to pursue it?
Nurses who are interested in serving on a board should
start with your passion! Next, conduct a self-assessment and prepare a one-page
board biography. Build your skills through nursing leadership resources and
talk to other nurse leaders to learn from their experience. Let others know of
your interest in serving on a board and contact an organization whose mission aligns
with your interests. Register on the NOBC website at www.nursesonboardscoalition.org
to be included in the database for consideration for future board opportunities
and to access many resources to support you on your board journey.
Be bold! You don’t need to wait until you have all the
answers to pursue a board opportunity. Remember, there will be others on the
board who have complementary skills and experience to round out the board composition.
While you will be providing a valuable contribution through your board service,
nurses always tell us they get so much more from the experience than they could
ever hope to give. Create an action plan
today to raise your voice in a boardroom that is right for you!
What else is important
about the Coalition and its mission that is important for our readers to know?
We are experiencing great momentum and success! The NOBC
current thermometer count is at 5,724 board seats toward our key strategy of
10,000 by 2020. I invite you to join us in this important work. Please contact me at [email protected]
to explore how we can collaborate to make a significant impact, together, where
you live and work.
Lastly, if you serve on a board, please consider a nurse as
a candidate for your next board seat!
Nursing education is the foundational pillar that enables future nurses to become competent and knowledgeable in their respective practices. This education was normally provided to nursing students through various didactic theoretical lectures and practical clinical training but recently, the use of advanced simulation technology as an adjunct educational tool has slowly become a significant addition to student centric learning.
History of Simulation
The concept of simulation practice can be traced back to the fields of military, aviation, and nuclear power (with military having used simulation the longest), dating back to the 18th century. Simulation was initially created as a cost-effective strategy for training professionals because it was considered exorbitant to train in these areas in the real world. As the years progressed however, the healthcare profession realized the practicality and usefulness of incorporating advanced simulation technology into educational practice and as a result, spurred the growing movement of simulation in healthcare training settings and educational establishments around the world.
The Impact of Simulation on Nursing Students
The emergence of computer technology has led to the development of innovative tools for healthcare professionals such as simulation technology and patient simulators Simulation technologies have had a profound effect on the nursing profession because it allows nursing students to apply their recently learned skills and knowledge to solve real life scenarios in a safe and structured setting.
In a typical simulation session, two students are often asked to participate and mimic the roles of a registered nurse or a certified nurse assistant (CNA). The rest of the remaining students are then asked to go to a separate room and observe the scenario through a one-way mirror and a live video stream. At the start of the session, the facilitator usually gives report on the patient, which allows the students to familiarize themselves with the patient’s situation, history, charts, and medications in order to successfully manage and implement high quality nursing care for the patient. As the simulation progresses, the facilitator controls the patient’s prognosis and provides cues to the team to enhance the realism of the situation. Once the simulation is completed, the students are then asked to head back to the debriefing room to discuss their experiences.
During the debriefing session, the students learn through self-reflection, group interaction, and questions asked by the facilitator. The use of group discussion engages students in reflective learning and enables the group members to consider a situation from multiple perspectives and consider other alternatives in order to broaden their scope of practice and clinical understanding. By performing simulation scenarios on a regular basis, students are able to develop better critical thinking skills, decision-making abilities, and application of theoretical knowledge in real-life situations.
Facilitating Simulation into Nursing Practice
According to the Institute of Medicine (IOM), approximately 98,000 people die every year from medical errors in U.S. hospitals, and a significant number of those deaths are associated with medication errors. This means that adverse events affect nearly 1 of 10 patients in the hospital setting. Based on this staggering number, the IOM called for a systematic change in healthcare practices and identified simulation practice as a resource to address the needed reform. By fostering experiential learning, simulation ingrains good nursing habits early, while discouraging bad nursing habits from forming before it becomes second nature.
In addition to allowing individuals to hone their nursing skills, simulation has also proven to increase student confidence and self-efficacy once they transition into the clinical setting. Nursing efficacy is an important aspect in nursing practice because it gives the students the confidence required to provide excellent nursing care to their patients. By incorporating what they have learned in simulation, more students are self-reliant in their capabilities, which are invaluable in ensuring that patient safety is implemented in the hospital setting.
Implications for Future Nursing Practice and Further Study
The shortage of availability of clinical sites is quickly becoming the norm for many nursing schools due to changing healthcare reform and the struggling economic crisis. One solution to combat the shortage of clinical sites however is to utilize simulation practice to replicate essential aspects of clinical situations for beginning nursing students. The National Council of State Boards of Nursing is currently conducting a landmark, longitudinal study to examine the knowledge and clinical competency outcomes of students when simulation technology is used in the place of actual clinical experiences. Although calls for additional research in these areas need to be performed, simulation is still quickly gaining momentum as the gold standard for effective learning practice in nursing education.
As you know, health care is opening to a world of opportunities, as we’ve seen sweeping changes unlike any other in the last five decades. Social, political, economic, and technological trends form a “perfect storm.” Today’s nurses are trailblazing new roads in the profession, as they adopt different roles and operate in nontraditional workplace settings.
Nurses today still care for patients, but they must also provide it in the right manner, at the right time, and in the right place. Health care organizations still seek to provide the best patient experience, but they also must cut costs, boost outcomes, and ensure safety. There is growing demand for registered nurses, both in and outside hospital doors, that demands caretakers develop a new skillset and a new mindset. Below are five ways that demonstrate how nursing has morphed and shape-shifted recently, and how nurses can make the most of tomorrow’s opportunities.
Trend #1: Jobs are moving outside of hospitals.
Inpatient units—and sometimes whole hospitals—are being closed and patients are being moved into alternative settings, such as long-term care, rehab, and subacute care facilities. Case in point: Experts estimate that today 65% of health care services are delivered in ambulatory settings, rather than hospitals. That transition from inpatient to ambulatory care settings occurred slowly over the past decade.
Why the switch? The Patient Protection and Affordable Care Act of 2010 was a major factor that hastened what hospitals were already doing: offering services outside their doors. Health care organizations want to cut down on admissions (and re-admissions), and they seek to do that by pumping up preventive care and caring for patients at home, or on an outpatient and community basis.
Andrea Higham leads Johnson & Johnson’s Campaign for Nursing’s Future, launched in 2002 to recruit and retain more nurses and nursing faculty, including minority, male, and other underrepresented groups. “Nursing is at a very exciting time, and nurses are on the frontline of health care, providing delivery of care across the board,” says Higham. “So many people are entering health care because of a confluence of so many forces, such as the Affordable Care Act and an aging population. Nurses are working not just in hospitals, but also in home health care, at clinics, as advanced practice nurses, and managing the entire health care journey. There’s a strong need for nurses in many places outside of the traditional health care setting.”
Think about opportunities outside of the hospital. For example, if you’re interested in pediatrics or working with adolescents, consider openings in pediatric long-term care, pediatric home care, pediatric rehab, or at group homes for children or teens.
According to Phyllis Quinlan, PhD, RN-BC, president of MFW Consultants to Professionals and a nursing coach, nontraditional settings, such as subacute care, are fine places to practice if applicants can overcome their preconceptions. “Long ago and far away, it was considered grandma’s nursing home, but now it’s a combination of residential care and short-term rehabilitation. It could even include pediatric or non-geriatric care,” she explains. “Hospitals are shutting down med-surg floors, and shifting patients to other, lower-cost venues for treatment. Say someone falls and breaks a hip—now they have to learn how to walk with that new hip. That’s when they need bridge care—skilled care, rehabilitation, nursing care—until they can go back home. It’s not about disease care anymore, but about preventative care and home care for managing diseases today. Hospitals soon will be only for emergency care, cardiac care, burns, traumatic injury, [and] cancer centers.”
In addition, health care organizations within the private, government, and nonprofit sectors also need qualified registered nurse candidates to fill the high demand for traditional and alternative roles.
Trend #2: New or returning nurses must develop job-search savvy and resolve to land coveted hospital positions.
“For those new graduates hoping for good med-surg experience after nursing school but can’t get a job in a hospital, don’t despair,” says Quinlan, even though hospitals have adopted stringent nurse recruiting requirements and sought to cut costs in every way without compromising care.
“Most urban area hospitals aren’t hiring, but in other areas, that’s not the case,” she explains, suggesting that new grads and nurses with some experience apply for residency or internship programs to “fast track” their careers with intensive preparation for 12 to 18 months.
“Some health care systems are rich with nursing training resources, others do it but in a more conventional way,” she adds. Another way to get your foot in the door at a hospital: “Move to [an] area where they are hiring. The State of Texas is hiring new nurses, and other states are recruiting nurses to serve a special need or a growing population.”
Nurses who are open to filling short-term temp assignments also have a leg up on other candidates; hospitals are offering six-month contracts rather than making long-term commitments they may not be able to honor.
Trend #3: Nurses must further education, clinical skills, and knowledge to keep up with complexities.
Once, a two-year associate’s program could prepare a nurse for a secure and fulfilling career. Not anymore. “Most places now will hire a nurse with an associate’s degree but ask that she sign a hiring agreement to get a baccalaureate within five years or so,” says Quinlan. “Across the 50 states, the culture varies, but independent facilities and major health systems tell me ‘we’ll only hire baccalaureate-trained nurses,’ so you need to make your peace with the fact that the minimum preparation for practice is now a bachelor’s in nursing.”
The other source of tidal change is digital technology and big data, which make it possible for nurses to do more with their expertise and deliver care from practically any corner of the world, while enjoying the advantages of telecommuting, like other professions.
“Technology allows nurses to practice off the beaten path in more ways than ever before,” says Brittney Wilson, RN, BSN, also known as The Nerdy Nurse. “With jobs like remote case management, telephone triage, and even informatics consulting, nurses can use the clinical knowledge and technical skills to help patients from the comfort of their home.
“Opportunities to work from home and attend to patient care needs virtually do come with a price,” adds Wilson, who is a nurse expert with experience as a clinical informatics nurse. “You have to have above-average computer skills and must be able to learn new software quickly.”
There’s a big need for nurses who have a business background. Traditional nursing programs do not address business aspects of health care. Nurses who go on for a master’s degree in business administration or health administration will understand policies and procedures that are governing health care now.
Trend #4: Nurses must focus on their own personal and career development to progress in the profession.
Clinical and other technical skills are important for any nurse to develop, but so are “soft skills”—for example, effective communication and problem-solving know-how.
“New to nursing? Maybe you have great ideas, but maybe you’re missing skills in how to talk to a patient or family members or how to collaborate with others,” says Higham. “You can always access our avatar-based online program, Your Future in Nursing, on the Campaign’s website.” The cutting-edge format, a game-like simulation environment for practicing key on-the-job concepts and skills, helps a student nurse prepare to make the often tough transition to practicing nurse.
Accelerating change in the health care workplace may require that new and seasoned nurses adjust their attitude and become more flexible about new ways of doing things. According to Quinlan, author of the recently published Rediscover the Joy of Being A Nurse: A Holistic Approach to Recovery from Compassion Fatigue, there’s no point in lamenting the good old days. “Nurses are some of the most creative people on the planet; they’ll make something out of nothing on a daily basis,” she says. “Some feel that they’re expected to adjust instantly to changing conditions and expectations, and they resent it. Those nurses must make peace with the new health care environment, themselves, and their profession.”
Until then, “they’re at a crossroads, and risk starting to swing to the dark side, having lost connection with the joy of practicing,” Quinlan adds.
Trend #5: Nurses will take on expanded and pivotal roles as part of tomorrow’s health care team.
How will we prepare nurses to transition to these advanced practice roles? That question has long been central for Donna Tanzi, MPS, RN-BC, NE-BC, director of nursing education and innovation at North Shore-LIJ Huntington Hospital in New York. “Nurses are going into master’s programs early on in their careers—after getting a baccalaureate, they’re going straight into a master’s or even doctoral degrees,” she says. “They have less clinical experience prior to getting an advanced degree, so we have an obligation as a profession to support them. Entry to DNP takes seven years from entry to graduation, similar to the medical model.”
Tanzi recommends nurse residency programs or fellowship programs for an extensive, tiered approach as students make the transition into their complex new roles.
“Nurses were tending to leave a job in the first year, or to leave nursing totally, because they weren’t prepared for the demands of the role,” she explains. “The bottom line and the message that I want to get out there is go into nursing for the right reasons. Recognize it’s an art and a science and we have the ability to impact people’s lives every day. Continue learning—there [are] always new directions and avenues to explore. There’s no reason to ever become stagnate or get bored in nursing; there are too many opportunities.”
There are many areas where advanced practice nurses apply their expertise gained through a master’s (or increasingly, a doctorate) in nursing or a related field. Clinical nurse practitioners are opening independent practices, or working with an academic affiliation in hospitals, or affiliated with physicians in their practices. Administrative leadership roles usually call for an MBA or MHA. Demand for nurses continues, so we need nurses to teach in nursing schools. At a minimum, instructors must have a master’s in nursing or in nursing education. Entrepreneurship, consulting, and research and development are also growth areas for advanced practice nurses.
Everywhere we look, nurses are being called on to surf the tidal waves of a changing health care environment and the emerging opportunities that come forth from it. Tomorrow’s nurses, with the right technical skills and personal qualities, can look forward to a rewarding career where they can deliver even greater value to their patients and communities.
Photo courtesy of Johnson & Johnson
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