Nurses Belong at Every Table Where Decisions Get Made

When Cole Edmonson and Nancy Mannion joined me for our Belonging and Retention season, they came with a simple message: nurses are good for business.

Cole is the CEO of the Nurses on Boards Coalition, and Nancy chairs its board. Cole spent 35 years in hospitals and health systems, 18 of them as a chief nursing officer at three different facilities. Since its founding a little over a decade ago, the coalition has helped place nurses in more than 11,000 board seats. But numbers were not the heart of what they shared. The heart was a way of thinking that most boards are missing.

A discipline built for the boardroom

Nancy walked me through the nursing process: assess, plan, implement and evaluate. Every nurse learns it early and uses it constantly, often under pressure and with incomplete information.

Listen to those four steps again and think about what a board is supposed to do. Assess the situation honestly. Plan a response. Make sure it gets implemented. Evaluate whether it worked. Nurses have been practicing board-level discipline at the bedside for their entire careers. Cole added that the process actually began as a business process before nursing adopted it. As he put it, "when everyone else is playing checkers, nurses are playing 3D chess."

What nurses add is the instinct to start with the person. They think about the sharp end of a decision, where it lands on a patient or a family, not just the blunt end where it is made. Cole gave me examples from his own board service: asking whether an organization was providing trauma-informed care for victims of sexual assault, or what a newly diagnosed diabetic would face returning home to a food desert. Nancy said the last question in every decision is always the same. Is this the right thing to do?

From the unit to the community

Cole's own path started with shared governance inside his hospital, where his executives valued board service and encouraged it. From there he joined local nursing organizations, became an officer, served on a national nursing leadership board and eventually joined the board of an organization in Dallas that works to prevent human trafficking among young girls and women. He was about to become its chair. As an emergency nurse trained to care for victims of sexual assault, he had seen trafficking up close.

Cole also said something I wish more leaders understood about their own people. "You can't get all of the joy you want in life from your job." Board service gave him another place to make a difference. For many nurses it could do the same, and organizations that encourage it keep people who feel more whole.

He was honest that the seat at the table is not enough. "If you're at the table and you only have a voice but you're not listened to, then it's just noise." And his reminder about why it matters: "Nurses are not passive observers. They are active participants when they are all in and when they are at the table."

Why this belongs in a conversation about belonging

Our season was about belonging and retention in healthcare. It might seem like board service is a separate topic. It isn't.

Nurses are often the largest group in a health system and among the least represented where strategy is set. When the people closest to patients never see their perspective reflected in leadership decisions, they draw a conclusion about how much they matter. That conclusion shapes whether they stay.

Nancy reminded me that nurses led us through the pandemic. Nobody planned for it, and yet, in her words, "we pivoted, we made do, we innovated and we held the line." People who can do that at the bedside can certainly do it in a boardroom.

She also offered the most practical advice of the conversation for nurses who think they have no time to serve. It is about priorities. Start small, with Meals on Wheels or a patient and family advisory council, not a Fortune 500 board. Turn off the television. The coalition even offers a course to help nurses learn the language of the boardroom. And watch for the moment someone believes in you before you do. "Sometimes our leadership journey starts with a tap on the shoulder because someone sees in us what we don't see in ourselves."

What leaders and boards can do

• Look at your board and your executive team. Ask whose way of seeing is missing.
• Invite nurse leaders to present strategy, not just report on staffing.
• Be the tap on the shoulder for a nurse in your organization who has never pictured herself in a governance role.
• Ask your nurses what they would change if they had a seat at the table, and act on at least one answer.

You can watch my full conversation with Cole and Nancy in Nurses Are Good for Business, part of the Belonging and Retention season.

Healthcare spends a lot of time asking how to keep nurses. One answer is to give them a voice where it counts, and then to listen.

Want to explore these ideas further? Learn more about my work on leadership, identity and conviction at www.theglennllopis.com.