Serving on boards allows nurses to partner with other leaders to promote change and advance health. The Robert Wood Johnson Foundation (RWJF) Future of Nursing Campaign for Action advocates for a nurse in every board room (Campaign for Action, 2015a). The call for nurses to serve on boards is important because nurses provide a unique perspective in the healthcare arena. Serving on boards allows nurses to partner with other leaders to promote change and advance health. However, some nurses may lack the knowledge and experience for successfully serving as a board member (Groysberg & Bell, 2013). The purpose of this article is to describe six competencies that will enhance one’s ability to serve on a board. These competencies can increase one’s ability to participate in and/or conduct a productive meeting so as to obtain planned outcomes. An overarching aim of the article is to provide nurses with sufficient awareness of the basic board rules and standards needed in professional situations to advance a workforce of nursing leaders able to promote health across a variety of interdisciplinary settings.

This article augments several existing web-based resources created for nurses to increase their leadership savvy (RWJF, 2015). Currently, the RWJF and the American Association of Retired Persons (AARP) funded Future of Nursing Campaign for Action website highlights the Nurses on Boards Coalition, which promotes a national goal for 10,000 nurses in leadership positions to serve on governing boards by 2020. The campaign goal will be accomplished by partnering with over 20 national organizations (Campaign for Action, 2015a). The website offers nurses guidelines for collaboratively leading a transformed healthcare system. On the website, nurses have access to a toolkit, as well as several videos, presentations, brochures, webinars, and articles created by national nurse leaders to enhance nurses’ understanding of the skills needed to serve in board rooms. The Campaign for Action website also provides interested readers with dashboard indicators to monitor campaign progress in meeting the Institute of Medicine Report (IOM) (2010) recommendations. The Dashboard Indicator 5 addresses leadership and reports the percent of hospital boards with RN members (Campaign for Action, 2015b). Hassmiller (2012), too, has defined several leadership competencies required to competently serve in board rooms.

The intent of the IOM 2010 recommendation was to have healthcare decision makers ensure that leadership positions be filled by nurses. It is important to recognize that healthcare decisions are not bound solely to hospital board rooms; they can also involve community-based settings. The goal of this article is to enhance leadership competencies for serving in board rooms across the healthcare delivery systems, a goal that is consistent with the theme of using nurses to transform healthcare delivery and advance health.

We begin by describing six competencies nurses need to serve on boards and/or policy-forming committees. Next we discuss strategies for demonstrating these competencies and describe personal responsibilities of board members. We conclude by noting that knowledge of these rules and standards is essential for nurses to assume leadership roles that will enhance the health of today’s and tomorrows’ societies.

Competencies Required During Board Meetings

This section will describe key skills and abilities for nurses to develop as they prepare themselves to serve as members of a professional board. These competencies include a professional commitment to serving on a governing board; knowledge about board types, bylaws, and job descriptions; an understanding of standard business protocols, board member roles and voting processes; a willingness to use principles for managing and leading effective and efficient board meetings; an appreciation for the ethical and legal processes for conducting meetings; and the ability to employ strategies for maintaining control during intense/uncivil situations.

Competency 1: Exercise Professional Commitment to Serve on a Governing Board

Serving as a board member involves providing a professional service related to your specialized education. Whether you have no experience serving a board, are an experienced national nurse leader, or someone in between, you must always consider your own professional nursing goals before you make a commitment to serve. Jafaragaee, Parvizy, Mehrdad, and Rafii (2012) define professional commitment as a “responsibility to professional issues and challenges” (p.473). In exercising professional commitment, determine whether your service to the board will: promote your career; advance the health or the well-being of nurses, patients, or community members; and/or meet the goals of the organization as a whole. Serving as a board member involves providing a professional service related to your specialized education. You hold a license to practice learned skills, and you may advise others about your field of practice/industry (Office of Fair Trade, 2015). Before making the commitment to serve, assess your professional ability to fill the role of a board member by seeking to understand as much as possible about the board you are thinking about serving (Sullivan, 2013).

Competency 2: Be Knowledgeable about Board Types, Bylaws, and Job Description

There are several types of boards to consider. For example, governing boards set directions for organizations and stakeholders; they may also be policy-making panels that establish mandates for a chief executive officer (CEO) to implement and enforce. Advisory boards work to educate those board members who may represent, for example, management teams for a home care agency or a long term care facility. Foundation (fundraising) boards use members to influence and solicit resources for the fiscal growth of the organization (Carver, 2013).

If you are a novice board member, request copies of any handbooks, charter-type documents (bylaws), and/or job descriptions to help you quickly grasp your role as a board member. It is also helpful to determine if the board offers a formal orientation that explains the purpose of the board and the board members’ roles and responsibilities. Preparing yourself before the first meeting will provide you with the knowledge and confidence needed to be a contributing board member.

Competency 3: Know Standard Business Protocols, Board Member Roles, and Voting Processes

Regardless of the board you serve, Robert’s Rules of Order (Robert’s Rules) (Robert, Robert, Evans, & Honemann, 2011) are usually adopted as the standard meeting procedure for maintaining order and following parliamentary procedure. The purpose of having a standard procedure for meetings is to maintain order, create an accurate written record, and achieve meeting objectives. A more detailed account of why such rules are needed can be found in the Robert’s Rules book (Robert, et al., 2011). When Robert’s Rules are applied, you can expect the meeting to proceed in the following manner:

• Determine if a quorum validated by organizational bylaws has been met
• Call to order
• Roll call, or sign in
• Pledge of Allegiance and/or prayer in some settings
• Review of previous minutes
• Adoption of agenda: reports, old business, new business, time limits
• Motion sequencing: motions to accept, discuss, revise, and vote upon
• Announcements
• Adjournment

The use of Robert’s Rules requires that board members prepare by reading documents before the meeting. The use of Robert’s Rules requires that board members prepare by reading documents before the meeting. The reason for preparation is two-fold: (a) to understand the agenda items so that substantive discussion and logical decision making can take place during the meeting; and, (b) to ensure that accurate record keeping has taken place, important because written documents represent legal evidence of board actions (Henkel, 2007). Board members should always pay attention to attendance records, review minutes before the meeting, and revise items as needed for accurate reflection of the decision-making process and actions taken. Take heed that in some states and countries making motions and casting votes are bound to the United States (U.S.) Federal Freedom of Information Act and to state sunshine laws (Moyer, 2003). Federal law may or may not apply internationally. For example, with regard to doing business in another country, over 100 business standards are used across the globe (Baker Tilly International, 2015). In the United States, state sunshine laws require public and government agencies to open meetings and records to the public, upon request (Moyer, 2003).

One can also expect to find participants in a variety of roles in a business meeting. One can also expect to find participants in a variety of roles in a business meeting. Many businesses designate a Parliamentarian to advise the chair so that decisions of the chair are not subject to appeal by the members. Time keepers help limit the time spent discussing any one topic. Voting members should recuse themselves for any issues involving a personal conflict of interest. All persons have equivalent rights—the majority prevail, the minority is heard, and the absent can expect that the rules of order and process will have been followed (Robert, et al., 2011).

As a board member, you should have a general understanding of the types of meetings in which a board member can be asked to participate so that you know what to expect once a meeting begins. Regular meetings are business situations specified according to time, frequency, and duration in the bylaws. They include formal decision making when voting takes place. In contrast, open forums involve discussion or debate on matters of public interest in response to a proposal or problem. Usually, no official actions are taken during public forums. Work sessions are informal pre-meeting situations where staff and board members work to gather information and are legally bound to open forum policy. Special meetings may be held for emergency reasons, to discuss and vote on issues that cannot wait for the next regular meeting, or to ward off a lengthy meeting which might result from lengthy debate.

Executive sessions are special meetings that are closed to public and involve only elected officials and staff members who are needed in the discussion. Executive sessions are special meetings that are closed to public and involve only elected officials and staff members who are needed in the discussion. Executive sessions may take place before, in the middle, or at the end of a regular board meeting; they must follow specific procedures for adjourning and reconvening. That is, if a special meeting occurs during a regular meeting, before it can occur, a motion to adjourn the regular session must be made, seconded, and voted on. Then, the chair dismisses the executive group and establishes when the regular session will reconvene for business.

Parliamentary order during an executive session requires record keeping and voting. Minutes are taken in executive session which are read and approved only in executive session (Robert, et al., 2011). Final votes are not usually taken during an executive session; these sessions are designed to maintain confidentiality and to allow for robust discussion (BoardSource, 2007). Final votes are taken and outcomes are recorded in official meetings as passed, defeated, or tabled. Executive sessions are subject to state sunshine laws, which means documentation of executive session are public record (Loversidge, 2014).

Executive sessions can be held with or without the presence of the CEO. Executive sessions held with the CEO are for the purpose of privately discussing a suspect or inappropriate activity (unless the activity has been perpetrated by the CEO). Examples include a lawsuit; business transactions; crisis management; and reprimands or verbal warnings directed to a board member, board president, and/or CEO. Executive sessions held without the CEO are for the purpose of human resource management; they may address CEO performance evaluation and/or compensation; succession planning; litigation involving the CEO; board actions; member actions, and/or a financial disclosure if an objective auditor is present in the executive session (Cordes & Engle, 2014; Robert et al., 2011).

The exception to using Robert’s Rules occurs when employing Consensus Decision Making, a group decision-making process... The exception to using Robert’s Rules occurs when employing Consensus Decision Making, a group decision-making process involving specific steps toward total group consent (Bressen, 2007). Several consensus decision-making models can be applied. In general, most consensus-oriented, decision-making models involve seven basic steps and identify four basic leader associated roles (Hartnett, 2011) (See Table 1). The Empath, or Vibe Watch, is a person responsible for monitoring the verbal cues of participants and maintaining a climate that is free of intimidation or bias (Verma, 2009).

Table 1. Summary of Consensus Decision Making: Basic Steps and Leader Associated Roles.

Table developed by authors based on Hartnett (2011).

Competency 4: Use Principles for Managing Effective and Efficient Board Meetings

When you decide to serve as a board member, be prepared to clear your calendar for the meetings... your presence at meetings is very important. When you decide to serve as a board member, be prepared to clear your calendar for the meetings. Usually, boards meet once a month, on a specified day, and at a specific time and place; however, occasionally additional meetings may be called. Although it can be a challenge to manage a full professional docket and to maintain a sense of control over your life, the temptation of being absent for meetings must be avoided. Because a board member’s voice and vote is always important to the stakeholders being represented, your presence at meetings is very important. Absenteeism complicates the decision-making process because in most boards a quorum of members must be present for voting. Refer to the board’s absentee policy or the board’s bylaws before making the decision to forgo the meeting. Standard practice is for the President of the Board to survey all members prior to setting an additional meeting date, so that a quorum is assured.

The manner in which meetings are managed and rules are enforced or suspended reflects the culture of the board. Boards with experienced members can progress through standard procedures at a fairly rapid pace. Many experienced members employ five simple principles to run efficient and effective meetings. These principles are discussed below and presented in Table 2 (Lipman, 2013).

...efficient and effective meetings are planned with the meeting outcomes in mind. Lipman proposes that efficient and effective meetings are planned with the meeting outcomes in mind. The agenda serves as the guide for achieving successful meeting outcomes. In order for agenda items to result in outcome-based solutions, he recommends that experts be called upon to present information about agenda items. Lipman also proposes a half-time rule to promote efficiency. The idea of the half-time rule is that the total expected meeting time should be set by dividing the time the leader estimates it will take to complete the agenda by two. He explains that if you set a meeting time for an hour, the meeting will last one hour. Lipman suggests that you set a 30-minute time period for a meeting you expect to end up taking 60 minutes because discussion doubles the minimum amount of time it takes to complete the agenda. In essence, participants work more efficiently to accomplish the goals of the meeting when time is limited. Lipman also suggests keeping a rapid pace to the meeting by disregarding late arrivals and by having participants stand, rather than sit.

Table 2. Summary of Lipman’s Principles for Efficient and Effective Meetings.

Table developed by authors based on Lipman (2013).

Competency 5: Understand Ethical and Legal Processes for Conducting Board Meetings

Multiple situations could occur to exemplify ethical and legal implications of serving on a board. It is important that the chairperson be able to address these situations. Imagine that you are serving on a Public Health Council for a State Health Department and the council is taking public comment on new rules regarding partner notification of sexually transmitted infections (STIs). In a classic paper written by Meiklejohn (1961), the fundamental tenet of debate in open forum is that the First Amendment (Freedom of Speech) of the U.S. Constitution is upheld. That is, all participants in a public meeting are protected by the right to speak without censorship or restraint by the government. It is the role of board president to maintain public order; however, all board members are also responsible to understand, and be ready to facilitate, the process of maintaining order (Smith, 2012). Following are recommendations for the chairperson/leader to use so as to maintain order:

• Begin with the assumption that the public is ignorant of Robert’s Rules or Consensus Decision Making and of the business meeting process
• Behave and communicate as if the television news camera is rolling or a reporter is in the room Behave and communicate as if the television news camera is rolling or a reporter is in the room
• Explain, immediately after the meeting has been called to order, the procedure and rules for public expression of thoughts
• Note that consequences of not following the rules will be enforced, and persons causing disruptions, using profanity, or engaging in name calling may be asked to leave
• Require all citizens to sign in and provide their address
• Remind participants that there should be no deviation from the approved agenda
• Give guests listed on the agenda the courtesy to present first
• Give the board the opportunity to ask questions after presenters have shared their proposed ideas
• Invite the public to speak after the board has asked questions
• Encouraged the public to stand before the board and to direct thoughts and opinions for consideration to the board
• Allow board members to ask members of the audience to clarify an idea with the presenter
• Reassure citizens that their comments and opinions will be considered when an official decision is made
• Remind citizens that that the roles and responsibilities of the board are to represent, and make decisions, in the best interests of all stakeholders: the involved majority, the non-present citizens, and those supporting the opponents

Competency 6: Employ Strategies to Maintain Control in Intense or Uncivil Situations

...maintaining control of the agenda is of utmost importance. Whether you are serving the board as the chair or as a member, maintaining control of the agenda is of utmost importance. Sometimes, after the meeting is called to order, members deviate from the agenda and disrupt the flow of the meeting. When this happens, if it is allowed to continue, there may not be time for scheduled agenda items to be addressed. Such situations require deliberate leadership. These simple strategies can be used to maintain order: (a) setting limits by allowing a final comment; (b) re-orienting the group to the agenda; and (c) objecting to any unrelated line(s) of discussion.

The following is a listing of the steps generally used by the chair during a business or professional meeting. The chair begins by announcing each agenda item and identifying the subject. Next, the chair invites reports from the responsible parties and leads a discussion clarifying technical items that may seem erroneous, lacking in data, or ambiguous. The chair then invites members to make motions, repeats the motion, and acknowledges the person who presented the motion. Then, the chair accepts seconds to the motion, a step which is usually not recorded or repeated. Finally, the chair clarifies the motion, moderates discussion, and manages the voting process. A time keeper and parliamentarian can assist the chair as needed to maintain pace and order (Robert et al., 2011).

Discussion

The leader or chair of the group needs to assure balanced participation among members during their discussions. The tasks associated with Competencies 1-4 focus on building an effective group, which is the responsibility of every board member. To establish cohesiveness within the group, each member must take the group’s work seriously, and establish and maintain a feeling of shared responsibility among members for group outcomes. The leader or chair of the group needs to assure balanced participation among members during their discussions. Effective groups are able to match individual needs to group goals and change group goals when appropriate. Groups that experience open, direct, and clear communication, both horizontally and vertically, are more productive. They are also groups in which power and leadership is shared by all members (Griffin & Moorehead, 2011).

As suggested in the discussion of effective and efficient meetings (Competency 4), board members need to demonstrate effective communication skills in group discussions. They must understand that every member participates as both a transmitter and receiver of information. When making a point, members need to remember to address the group, rather than an individual within the group. Group discussions generally demonstrate cycles of continuous progress toward the goal alternating with movement away from the goal. This occurs as members work to reduce the tension that arises when people attempt to have their individual needs/preferences met, yet also engage in group interactions, working to find consensus while discussing group tasks. This phenomenon is defined as the essence of group process (Littlejohn & Foss, 2010).

It is important that nurses who agree to serve on boards and advisory groups understand how politics, power, and influence affect group process, and ultimately the outcomes of group goals. Understanding ethical and legal processes (Competency 5) addresses policy, politics, and influence, as well as the ethical-legal processes involved when serving on a governing board. It is important that nurses who agree to serve on boards and advisory groups understand how politics, power, and influence affect group process, and ultimately the outcomes of group goals. In any group, committee, and/or advisory board, politics, power, and influence will be at play. Issues as to who will be the leader, and who will have control of the meeting will underlie most meetings. Understanding the definitions of politics, power, and influence can help the nurse analyze the hidden agenda of board members. For example, Sullivan (2004, p. 67) has defined politics as “… a neutral word meaning the art of influencing others to achieve a desirable goal, usually by acquiring resources,” while power is simply the potential ability to influence. One is influential to the extent that he or she is able to communicate ideas to others and gain their support through acceptance of participation (Sullivan, 2004, p. 3).

Be alert for strategies such as monopolizing the conversation, scapegoating other members, and continually disrupting meetings... Finally, consistent with Competency 6, which addresses maintaining control during difficult situations, the board membership focuses on maintaining control at meetings and protecting members from episodes of incivility. Although any board member can demonstrate power and influence over decisions made during board meetings, much of the decision making occurs when board members politic behind the scenes. This politicking often occurs during interactions between a few influential group members before and/or after the actual board meeting. Be alert for strategies such as monopolizing the conversation, scapegoating other members, and continually disrupting meetings; these strategies are used to influence group members during meetings. Groups using these strategies are motivated by a pursuit of high status and powerful positions among peer groups. When observed, this behavior should not be tolerated because it is indicative of incivility, bullying, and/or mobbing behavior (Salmivalli, 2010; Wachs, 2009).

...nurses need to become effective at dealing with conflict in board meetings. While these strategies may not be used in all board meetings, it is critical that nurses understand the group process and the role politics, power, and influence play in board decision because they may be called upon to play these games. To deal with these situations, nurses need to become effective at dealing with conflict in board meetings. Strategies that nurses can employ include: supporting legitimate conflict, clarifying ideas, identifying commonalities, setting limits, and helping to establish a sense of trust within the group (Deutsch, Coleman & Marcus, 2011). In the case of incivility, bullying, and/or mobbing, Lowenstein (2012) has recommended zero tolerance, and Salmivalli (2010) has advised direct confrontation with the ring leader and "wannabe" members of the group. McCarthy (2001) has provided clear direction on how to break bullying cycles before the point of escalation. These approaches include diffusing those who dominate discussions and redirecting those who detract from the agenda. Time limits can be established that give each member a chance to speak once before a member can respond to a topic the second time.

...if there is an amendment on the floor and no discussion is taking place for or against it, the implication is that the amendment is endorsed. Conversely, Roberts Rules of Order (Robert et. al., 2011) requires that chairs must recognize that silence is the equivalent of consent. Recognizing silence is important because silence provides you with an opportunity to advance your stance if you are not being heard. This means if you can break silence, majority consent is unendorsed. For example, if there is an amendment on the floor and no discussion is taking place for or against it, the implication is that the amendment is endorsed. In such instances, the nurse leader has the opportunity to influence the discussion by suggesting alternative solutions to the motion. Make sure, though, that what you say is pertinent and relevant to the topic of conversation. If it is pertinent and the majority is swayed to your way of thinking, you give evidence of being a credible and contributing member. The likelihood that you will be acknowledged in future meetings is heightened.

Personal Responsibilities

The need for you to be a respected, credible and contributing member of a board is two-fold. First, the nursing workforce must be present where decisions are being made so that they can lead the healthcare delivery system (Campaign for Action, 2015a). Second, the Institute of Medicine Report (2010), The Future of Nursing: Leading Change, Advancing Health, has recommended that all nurses (especially practicing RNs) lead the American public to higher levels of health. By participating in board room discussions, you can gain political advantage, thus increasing nursing’s power, and influencing society’s health and well-being across a variety of interdisciplinary settings.

If you have an opposing view, come with credible evidence to support your position. In order to succeed, you must make the commitment to be an active and knowledgeable participant. This means that when the board agenda is sent to you, you review it and identify any question(s), so that you can provide a fresh perspective on the matter(s) to be addressed. If you have an opposing view, come with credible evidence to support your position. We authors recommend following the basic tenants of productive communication which include listening, reflecting, clarifying, and validating others’ views.

Remember why you were asked to serve on the board. If you are an expert in your area, remember to represent your constituents. Also you always represent the profession of nursing. Reflect the values of the group(s) you represent. Just as it is your personal responsibility to be ethical and legal in all transactions, so it is your responsibility to be clear about your comfort level with the decisions being made and action(s) being taken by the board.

Conclusion

In response to the RWJF Future of Nursing Campaign for Action, which has advocated that nurses serve in board rooms, this article has discussed reality-oriented nursing competencies that can enable nurses to enhance their abilities to lead and serve in formal meetings. These approaches can help nurses to increase their leadership savvy. Competencies required for leadership and managing dysfunction in formal meetings were discussed in alignment with Robert’s Rules (Robert et al., 2011). Competency 1 reminds nurses that serving on boards is a professional commitment. Competencies 2 and 3 reinforce the belief that nurses need to be knowledgeable about how boards are structured and function. Competency 4 capitalizes on nurses’ management skills when participating in board decisions. Competency 5 reminds nurses that acting ethically and legally is paramount when serving on boards; and Competency 6 provides nurses with strategies to maintain control during intense discussions.

As the article has noted, it is important to maintain professional behaviors; follow professional and organizational etiquette; use the consensus-decision-making process; draw upon principles that promote efficiency and effectiveness; attend to legalities; and maintain order. Group process; understanding politics, power and influence; and managing bullying, incivility and mobbing are also essential. Nurses can utilize this information to heighten awareness of basic rules and standards for policy-related meetings, in which the professional nursing workforce can expect to be called upon to lead in the board room and beyond to promote the health and wellness of society.

Authors

Ann M. Stalter, PhD, RN
Email: Ann.Stalter@wright.edu

Dr. Stalter currently serves as an Associate Professor and the former Director of the RN-BSN Program at Wright State University College of Nursing and Health in Dayton, OH. Her area of nursing focus is public/community health and her clinical expertise is in home health nursing. She has previously served as a consultant to the Chief Nurse of the American Red Cross, Governing Board Member of the Ohio Public Health Association, and Chair of the Public Health Section of the Midwest Nursing Research symposium. Dr. Stalter wrote this article because she recognized, while working with RN completion students, that the knowledge they were gaining about the process would position them for leadership participation in health-related boardrooms.

Deborah Arms, PhD, RN
Email: Deborah.arms@wright.edu

Dr. Arms is an Assistant Professor at Wright State University College of Nursing and Health in Dayton, OH. She has served as the Chief of the Division of Prevention for the Ohio Department of Health and as Chief of the Bureau of Community Health Services in the Ohio Department of Health, Division of Family and Community Health Services. She has also worked as a Clinical Nurse Specialist at the Nisonger Center for the Mentally Retarded and Developmentally Disabled and as a Director of Program Services for the Ohio Nurses Association. Dr. Arms is nearing retirement and wanted to share her lived managerial experiences with practicing nurses, so that they can be more confident when serving on boards.