APPLAUSE to Larry Prybil for articulating the need for nurses to participate in governance, presenting research findings of the slow progression of nurses serving on boards, and sharing his personal knowledge of the work and impact nurses have when they are part of health care governance. Prybil not only described the challenges of why nurses are not on health care boards but also gave suggestions about how to overcome those challenges and provided a clear road map of how to get nurses on boards.

It is worth noting another research study that focused on the potential differences of the board chair, chief nursing officer, and chief executive officer in their familiarity with patient quality studies and the comprehensiveness of their hospital quality plans. Study results indicated that the chief nursing officer reported a greater understanding than the chief executive officer or board chairperson. Their conclusion was that nurses have an important role in the boardroom regarding patient safety and quality of care.1

Nurses bring a unique perspective to the boardroom, which includes but is not limited to operational processes about the health care system; communication required for effective care; understanding of care continuum requirements; plans, ideas, and methods to create safe health care environments; capability of identifying capital needs that affect quality and safety; and finally bringing patient safety and quality "alive" and making it meaningful to board members. Nurses understand the patient and family stories behind the graphs on quality, allowing them to make the challenges of providing safe patient care very personal.

Since only 6% of health care institutions have nurse leaders as board members, an increase of 4% since 2007, and despite studies suggesting that this should be best practice in health care governance, strategies are needed to bring nurses into the board decision making. Some strategies include educating board members of the complexity of health care and need to have the right skill sets in the boardroom for decision effectiveness; preparing nurses educationally to be positioned to have board leadership roles; devising a process to discover nurse leaders willing to serve; conducting studies that provide evidence of how nurses in governance affect board discussions, decisions on quality and patient outcomes; and encouraging associations that accredit and recognize health care organizations to support nurses being at the highest level of decision making in the institution, which is governance.

As health care systems are designing models of care that are coordinated across people, functions, activities, processes, and facilities to maximize the value of service, the patient needs to be in the forefront, and quality and safety cannot be compromised but should be enhanced. Nurses are in a position to influence and shape board discussions, keep the patients and their families in the center of board decisions, and educate other board members on quality, safety, and clinical integration. This can only occur if nurses are in the boardroom where the decisions are being made about new models of integrated care that are value based, economically sound, and safe. The evidence of why nurses need to be in governance has been described; now an action plan on implementing nurses on boards needs to occur.

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