Why Nurses on Your Board Matter

00;00;42;20 - 00;01;08;23
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA Communications. Ellen Brzytwa was recruited as a hospital trustee 45 years ago. The first nurse trustee for a hospital in the greater Cleveland area. Her own experience has shown her that more hospital boards should have nurses as members. People who understand firsthand the complexity of patient care and issues of quality and safety.

00;01;08;26 - 00;01;23;02
Tom Haederle
In today's podcast, hosted by Sue Ellen Wagner, vice president of Trustee Services at AHA , Brzytwa discusses her mission of bringing more nurses into board positions. All of the benefits they bring and what boards should be focusing on now.

00;01;23;05 - 00;01;43;15
Sue-Ellen Wagner
Hi, this is Sue Ellen Wagner, vice president of Trustee Services with the American Hospital Association. I want to introduce Ellen Brzytwa, a trustee of the Cleveland Clinic, who's here with me today. Thank you, Ellen, for being here with me. Ellen, in addition to being a board member, has a nursing background. Ellen, can you talk to us a little bit about your background?

00;01;43;17 - 00;02;07;07
Ellen Brzytwa, RN
Yes. I have been very fortunate to have a nursing background and also be a hospital trustee. My clinical work and my academic work early on in my career were in psychiatry. Now, behavioral health and public health. And I was recruited to be a hospital trustee 45 years ago.

00;02;07;08 - 00;02;07;18
Sue-Ellen Wagner
Wow.

00;02;07;18 - 00;02;12;27
Ellen Brzytwa, RN
I was the very first nurse trustee for a hospital in the greater Cleveland area.

00;02;12;29 - 00;02;47;01
Ellen Brzytwa, RN
And it was a very exciting time to be a trustee. I was really unaware that this was so unusual. And as I grew in my role of being a hospital trustee, I came to understand the value of what I was doing in terms of my own work in enhancing and promoting my hospital and all the good things that it did, but also my relationships with other trustees at that time that none of them had any kind of health care background, mostly all male.

00;02;47;09 - 00;03;15;16
Ellen Brzytwa, RN
And also from the local community, well-meaning. I found I was acting as a translator and helping them to understand what it was we were talking about because they were all male at the time. They often were hesitant to ask questions, and I came to understand this and people would approach me after the meetings for clarification. Eventually I would just ask right in the meeting.

00;03;15;19 - 00;03;51;20
Ellen Brzytwa, RN
That's another acronym. What does that mean? I can't remember. And then after a while, everybody got comfortable with that. Quality and safety issues were there from the very beginning. Fast forward, I've now served in hospitals and hospitals that are merged into large systems and have been very privileged to be part of the AHA effort to involve trustees in a more meaningful and ongoing way, which I think over my career, 45 years as a trustee is new, and I think it's coming into its own.

00;03;51;23 - 00;04;26;27
Ellen Brzytwa, RN
I think trustees bring a huge insight to the very hard working staff of AHA at all levels of the hospital associations, too. They have relationships they can use effectively to advance and also educate all kinds of people that need to understand how hospitals work and why there are over 45 years always continuing crises. Although in my lifetime doing this, I do think we are at a very, very critical, very, very uncomfortable place.

00;04;26;29 - 00;05;04;12
Ellen Brzytwa, RN
And the role of the trustee to be helpful to the executive staff and to their communities, I don't think has ever been more important. One of the things that I've grown to understand is the need for perhaps more trustees that are nurses. And about ten or 15 years ago I was involved with the Robert Wood Johnson Foundation series of investments trying to deal with the nursing shortage, advance the public's understanding of the role of the nurse, but also to move more nurses onto the boards of trustees.

00;05;04;14 - 00;05;38;01
Ellen Brzytwa, RN
This has become a passion for me. That's great. It has been rewarding. And now I'm seeing more interest in this than I have ever. It was always just a hard sell. The other CEOs and the trustees and say, we have, you know, the chief nursing officer saying, no, no, no, I'm talking about an independent outside expert on the field of nursing that will bring you more vision and understanding about the complexities of patient care, about the huge nursing workforce.

00;05;38;03 - 00;05;59;19
Ellen Brzytwa, RN
And all these things are now coming to the fore, especially the issues of quality and safety and nursing practice. So I'm hoping that by my activities with AHA and the people that I work with, that are the staff and other trustees that are starting to think this way, that I can advance that agenda of getting more nurses on boards.

00;05;59;25 - 00;06;23;23
Sue-Ellen Wagner
I think you are. I just want to mention you are on the Committee on Governance with AHA and you've contributed a lot of valuable insight on workforce challenges to that group. So I do think you're increasing awareness. To talk a little bit about - so with all the workforce challenges that our hospitals and health systems are facing, what shape boards be focusing on with those workforce challenges?

00;06;23;23 - 00;06;33;11
Sue-Ellen Wagner
And if you could also address as part of that discussion and the value that a nurse will bring and how can folks find a nurse, that independent nurse.

00;06;33;18 - 00;07;18;05
Ellen Brzytwa, RN
To be on a board? Yeah. Well, let's talk about that. As long as we've been talking about nurses on boards. Any hospital that's interested in this can reach me through Sue Ellen to talk about it, because sometimes people have to get comfortable with the idea, and I'm always available to do that. But there is a terrific organization called Nurses on Boards,  and go online, nursesonboards.com, and there's a whole structure in place to be either a partner with nurses on boards, to get more information on this, or to ask their help in terms of finding an outside nurse that could be a trustee for their organization.

00;07;18;05 - 00;07;49;27
Ellen Brzytwa, RN
And yesterday I was in a trustee meeting here at the AHA Leadership Summit in Seattle, and one of the gentleman who was presenting offered himself as an example and said, I live in Chicago, but I'm the chairman of the board of a hospital in Bend, Oregon. So even if you're a remote hospital or you're from a geographic area in which you're having a difficulty finding someone, this can be accomplished. And nurses on board

00;07;50;03 - 00;08;17;10
Ellen Brzytwa, RN
and also Sue Ellen Wagner at AHA can help a hospital if they have interest in doing this. The value is, again, in terms of understanding that all of the dimensions of the nursing shortage, I often find that people are just panicked over what's immediately in front of them. And I sure don't blame them because half of my heart is as a trustee, as a nurse

00;08;17;10 - 00;08;51;21
Ellen Brzytwa, RN
also, I see the stress. I see what COVID did to the nurses. I see the expense of dealing with that. And nurses are now being paid for the value they are. But looking at the shortage, there's more dimensions to it than just looking at how many people you need to recruit or your turnover rate. All those things are very important, but I often think that the hospital side focuses on that and has less focus on the education side.

00;08;51;24 - 00;09;14;13
Ellen Brzytwa, RN
And I'm seeing a shift in that to a lot more interest on a sustained level in terms of the pipeline. How do we compete with perceived cool jobs when young people see that nowadays? How do we get them in the pipeline? How do we get a populations that have never been attracted to a profession or a nursing? Get them prepared.

00;09;14;14 - 00;09;39;27
Ellen Brzytwa, RN
You have to start in practically late primary school, early junior year to recruit and get them into science-based thinking and curriculum. And there has to be a cool factor. And we have so many things about health care and hospitals that are so cool. All this superhero stuff, we have it. We checked all the technology, all these things, we have it all.

00;09;39;29 - 00;10;03;17
Ellen Brzytwa, RN
We just don't package it, we don't sell it. And hospitals are really going to have to. And I start to see them putting in pipelines that are addressing the education part of being a nurse and the recruitment part, but also all these other dimensions of the cool factor. We still only have 12% of nurses that are male. We have a huge job to do with those.

00;10;03;18 - 00;10;29;22
Ellen Brzytwa, RN
We've got all kinds of underserved populations. We only have, I think it's now 14% of nurses that are African-American. We have less than that that Asian Pacific, and the worst are our tribal nation nurses. And we have so many places to get people into nursing, but it has to be a sustained evidence-based approach. So that's one thing.

00;10;29;22 - 00;11;09;26
Ellen Brzytwa, RN
But the other side of the hospitals taking more interest is in the nursing education programs that produce or registered nurses. And they really I think most hospitals do not know the ins and outs of how colleges and universities educate nurses and how to support those systems or how to intervene to expand the capacity of schools of nursing. We can look at new models of care on the practice side and the delivery side, but if we don't pay additional intense attention to the schools and colleges of nursing in this country, we will not be helping ourselves.

00;11;09;28 - 00;11;10;14
Ellen Brzytwa, RN
So.

00;11;10;15 - 00;11;34;02
Sue-Ellen Wagner
Oh, and thank you, because you've really outlined what boards should be paying attention and looking at that strategy for the workforce going forward. Getting back to the board's role in terms of governance and recruiting board members who have a nursing clinical background, I'm thinking you'll agree that that should be part of a governance matrix, right? Of skills and competencies that folks should be looking at.

00;11;34;02 - 00;12;03;26
Ellen Brzytwa, RN
Absolutely. AHA did one of the most intense and expansive surveys on what boards of trustees in America need that I've ever seen in my career. And as I say, I've been a hospital trustee for 45 years. In my early career, I created an institute for trustees in Cleveland because I saw such a huge need, and now they are starting to look at people having to and help me here.

00;12;03;27 - 00;12;16;03
Ellen Brzytwa, RN
Sue Ellen Sure. One thing is they're looking for health literacy in new recruits of trustees to a hospital board. Well, automatically, a nurse has

00;12;16;05 - 00;12;17;01
Sue-Ellen Wagner
health, right?

00;12;17;01 - 00;12;57;23
Ellen Brzytwa, RN
Literacy. The second thing they're looking for is expertise. In mission critical areas. Well, what's more, mission critical for a hospital than a sufficient number of well-educated, healthy, vibrant, joyful nurses taking care of patients not only in hospitals, but in all ambulatory settings. And so to me, the case for having a nurse trustee is so powerful. I yesterday spoke briefly at a meeting and I said to the other people in the room, even if you never see me again, you'll be thankful that I pushed you on this to think about this.

00;12;57;25 - 00;13;09;15
Ellen Brzytwa, RN
Because go back to your home base. Go back to your health facility and think about what I'm saying. It's very, very important and it will help the other trustees as well.

00;13;09;17 - 00;13;24;16
Sue-Ellen Wagner
Yes. Well, and also adding that skill set to your metrics if you don't have it already. Yeah. Just one last thing in closing. AHA put out a 2022 governance and survey report identifying all of the trends I think you referenced.

00;13;24;16 - 00;13;25;19
Ellen Brzytwa, RN
That's excellent.

00;13;25;20 - 00;13;48;08
Sue-Ellen Wagner
One of the trends that's not so great is pointing out that boards do not have many of the survey respondents. 18% that we got do not have that nursing skill set on their boards. So that's one of the areas that we need to work on with our hospitals and health systems to help recruit for that key clinical eye and expertise.

00;13;48;08 - 00;14;11;24
Ellen Brzytwa, RN
That's right. And also to piggyback on that same survey, it showed that  - and I'm guilty as charged - there's a lot of us that are old and need to exist stage left off these boards at some point. And looking at adding younger trustees, there's a lot of young nurses that are leaders and would be amazing

00;14;11;24 - 00;14;13;00
Sue-Ellen Wagner
to be on a board. Yes.

00;14;13;00 - 00;14;27;04
Ellen Brzytwa, RN
And they're looking for diversity within nursing. We do have diversity. We've got more diversity than many of the other health professions. So I think it's a double, triple win. Take that trust. A nurse, trustees, your board.

00;14;27;09 - 00;14;35;20
Sue-Ellen Wagner
Well, Ellen, thank you for joining me today. Appreciate your words of wisdom. And hopefully more folks will pay attention to adding nurses on their boards.

00;14;35;21 - 00;14;50;21
Ellen Brzytwa, RN
Well, I thank you for making an arrangement to have me interviewed about this with you, Sue Ellen, and I appreciate AHA's continuing and expanding focus on the nursing profession and the nursing workforce. Thank you.