The 2010 Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health recommended increasing the number of nurse leaders in decision-making roles on boards and commissions to help improve the health of individuals and communities (IOM, 2011). Subsequently, action coalitions were created in all 50 states in the United States (U.S.) to actualize the goals of this report (AARP, AARP Foundation & RWJF, 2018). The Nurses on Boards (NOB) Coalition was then formed as a national effort to collect NOB data and increase leadership skills of nurses to promote nurses serving on boards to help build a culture of health and wellness (Curan, 2016; Mullinex, Walton & Ruiz, 2017; Walton, Lake, Mullinix, Allen, & Mooney, 2015). A Culture of Health is a concept created by the Robert Wood Johnson Foundation (RWJF) to describe a national framework for improving the health, equity and well-being of populations (RWJF, 2018; Storfjel, Winslow & Saunders, 2017).
Purpose
To develop an innovative, evidence-based professional development model that prepares nurses for leadership roles and board service to implement strategies for improving population health.
Methods
Our evidence-based model of NOB education was planned collaboratively, implemented and facilitated by RWJF Culture of Health and Center for Nursing/Action Coalition nurse leaders from three U.S. states. The team developed the 2018 tri-state NOB education intensive through three primary methods: 1) review of the literature, 2) evaluation data from previous NOB training programs, and 3) key informant interviews with national NOB experts and developers of NOB curricula.
Evidence was reviewed from the literature on leadership, NOB, and culture of health to provide a background for model development (McBride, Campbell, Woods, & Manson, 2017; National Academies of Sciences, Engineering, and Medicine, 2015; National Advisory Council on Nurse Education & Practice, 2016; Plough, 2018). In one state, a nurse leaders program was developed to recognize emerging leaders who would serve in various leadership capacities. These leaders were surveyed in 2015 about interest in serving on boards. From the survey results, a NOB education program was offered in 2016 in one state, expanded in 2017 to two states, and in 2018, expanded to three states inviting emerging and seasoned nurse leaders and educators. Post-education debriefing, evaluations, and follow-up surveys were distributed to participants in all three years of programming for feedback on program satisfaction, recommendations to strengthen the program, reports of subsequent service on boards, and further leadership development needs.
Results
In 2016, 25 nurses in one state attended the NOB live, education program that was facilitated by leadership training professionals. Based on survey responses and post-training debriefing, education planners, facilitators and experts in NOB training recommended the following: 1) Strengthen the content about social determinants of health and Culture of Health; 2) Add purposeful mentoring content and one-on-one follow up to support mentor/mentee relationships; 3) Use a strength-based leadership assessment tool to inform participants of personal leadership styles; and 4) Use practical tools to assess readiness and progress in board service.
A year-long collaboration with national experts on NOB curricula provided practical tools and applications to improve the educational program. In 2017, 43 nurses attended the revised two-state NOB education program. Fifty percent of attendees participated in two follow-up training webinars at one and two months. This education program was partially funded through a national RWJF grant and low-cost participant registration fees. Attendees were surveyed at two weeks, six months and 12 months post-education with 100% of respondents reporting they were more motivated to serve on health-promoting boards. Actual health-promoting board service was reported by 44% of respondents at two weeks, 53% at six months and 62% at 12 months. Participant comments and results indicated that the education engendered confidence and motivation to seek and serve on boards and offered new ideas about nursing roles in building a culture of health in their local communities through board service. While satisfaction of participants was high, attendees expressed the need for improvement on basic details about seeking and serving on boards, individual help on how to approach boards, and what boards were available in their specific regions.
In 2018, additional RWJF funding expanded the NOB education to a tri-state regional program. Forty-one participants attended the two-day education conference. Participants reported increased knowledge about social and environmental influences on health, Culture of Health, and how they can impact health through serving on health-promoting boards. Ninety-seven percent of participants reported increased knowledge of their leadership style and how to apply leadership skills to board service. Fifty-one percent said they were interested in serving as training facilitators in future train-the-trainer models of NOB education. Mock board meeting simulation was recommended as an addition to the education program. Six-month post-training follow-up will evaluate participants’ service on health-promoting boards.
Implications for Nursing
Nurses are the largest segment of the healthcare workforce and are uniquely suited to advocate for building a culture of health by serving on health-promoting boards. Based on evidence found in the literature and from research data generated by our surveys, a Nurses on Boards education model was developed that can be replicated and used by other nursing leaders nationally and globally to help develop nurses for board service. Expected outcomes are improvements in population health. This model for improving health can be easily translated to other communities around the globe.