Taking Action
A Nurse in the Boardroom
Marilyn Waugh Bouldin
“What I want in my life is compassion, a flow between myself and others based on a mutual giving from the heart.”
Marshall B. Rosenberg
One evening in February 2012, I sat in the audience at a hospital board meeting in rural Colorado wondering how I could convince five board members to support the local clinic for uninsured patients. As president of the independent nonprofit clinic board of directors and a past public health director and nurse, I was concerned about meeting this population’s needs. When the discussion began about the election of new hospital board members, a light bulb came on. I thought, “I could do that!”
This is the story of my campaign to become a member of the Board of Directors of the hospital in my community, the factors leading to my decision to run for the board, the campaign I launched, its success and challenges, and my experience serving as a board member.
I have always believed nurses should be full partners with other health care professionals in designing health care systems, as the Institute of Medicine’s (IOM) report on The Future of Nursing recommended (IOM, 2011). Here was my opportunity! I knew it would be a challenge, and I would be stretching my comfort zone. Historically, nurses have not been welcomed into the boardroom (Hassmiller & Combes, 2012); nor have many sought out board membership. However, with nurses’ broad holistic perspective of patient care, knowledge of quality and safety issues, and understanding of concepts such as team leadership, accountability, professionalism and relationship building, nurses are, in fact, perfect for the job.
At a very young age, as I helped my mother care for younger siblings, I decided to become a nurse. Raising a family, returning to school, and becoming aware of the feminist movement, I enjoyed learning new things, meeting new people, and accepting challenges. Sometimes I failed. The infant-toddler childcare center I started went bankrupt, and once I was fired for insubordination. But I learned that failure wasn’t the end of the world, and I always maintained my passion for taking care of people and my community.
I have been a risk taker ever since I left my promising career at a major urban hospital and moved by myself to a small town in Colorado. When I began developing a new Associate Degree nursing program at our local community college, I was not afraid to ask for help. Fellow nursing directors across the state were a tremendous source of information and support as I tackled this major project. I learned that positive relationships and collaborations were critical to any accomplishment.
FIGURE 52-1 Hospital Board candidate Marilyn Bouldin talking to two constituents during her campaign.
My Political Career
Friends have been key assets on my journey. I met a friend in my rural community (where everyone knows everyone!) who was extremely politically active. One day, she told me about an opening on the state board of health and encouraged me to apply, as they needed representation from my geographic area. I still remember a comment made during my interview with the State Senate Confirmation Committee almost 40 years ago: I was “good looking enough to be appointed.” I felt humiliated
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but was too intimidated to reply. My term in office was a time of tremendous learning and growth, as I was young and very inexperienced. My fellow board members treated me with respect, and I enjoyed discussing state health issues.
Throughout my public health career I learned the importance of developing positive and diverse relationships through my involvement with many community projects. I participated in assessing my community’s health needs and developing new programs to meet those needs. I served on several not-for-profit boards and learned how to be an effective board member. Professionalism and respectful communication were key characteristics being an effective board member. My job required I make periodic presentations to the county commissioners about our work, so I learned how to speak clearly, concisely, and in a politically correct manner, speaking within my time allotment and answering questions truthfully but sensitively.
My Campaign
When I became aware of the upcoming election for hospital board members, I decided this would be an interesting and valuable board to serve on. I had something to offer, and I could influence the board’s direction; also I was retired and had the time to serve. Because of our hospital’s quasi-governmental designation as a “special hospital district,” the board members must be elected by the voters who reside within the hospital district. (Special districts are described in Box 52-1.) However, I had no experience in running a campaign or giving political speeches. I thought I did not have much to lose by trying. Over the years I had developed a tough skin and had learned I could never please all the people all the time. Many professionals in the community assured me that I was very competent to do the job and supported me.
Box 52-1
Special Hospital Districts of Colorado
Special Districts in Colorado are local governments (political subdivisions of the state). Local governments include counties, municipalities (cities and towns), school districts, and other types of government entities such as authorities and special districts.
Colorado law limits the types of services that county governments can provide to residents. Districts are created to fill the gaps that may exist in the services that counties provide and the services that the residents may want. Examples include ambulance, fire, water, sanitation, park and recreation, libraries, and health services.
Upon incorporation as a special district, bylaws are written which describe the election process for the board of directors in accordance with state statutes.
My friends volunteered to help. A nurse friend who was a retired Lt. Colonel decided to be my informal campaign manager. Another friend who was a graphic designer developed the campaign materials. Others offered to support me financially and introduce me to their friends.
The relationships I developed were extensive and varied, even though I had only lived in this community for 5 years. My membership in Rotary International, a service club with weekly meetings, provided me with many networking opportunities. I also belonged to a quilt guild, a church group, and a hiking group for women, all of which provided me with access to people who could be mobilized to support my candidacy and vote in the election.
Campaign Preparation
My campaign was 2 months long. There were nine candidates, two women and seven men, running for two seats. I decided to commit time, energy, and money to run an active, high-profile campaign.
My first job was to learn about the hospital so I could speak knowledgeably. I studied its website, read the bylaws, learned about the services offered, reviewed the latest strategic plan and interviewed existing board members. I also met with people in the C-Suite, a term I learned referred to all the executive chiefs: the Chief Executive Officer (CEO), Chief Operating Officer (COO), Chief Nursing Officer (CNO), and Chief Financial Officer (CFO). Understanding the management of a multimillion-dollar budget was one of my biggest challenges. I had to be willing to ask a lot of questions.
I became familiar with the characteristics of my hospital district (three rural counties with a population of 20,000) to learn about the demographics, the health issues, and other characteristics. I talked
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to health professionals to learn about their concerns, and to people in the district about their experiences and perceptions of the hospital.
Next, I learned about the Secretary of State’s office and campaign laws and regulations. I sought advice from friends who had run campaigns and stayed in close communication with the designated election official at the hospital. She kept me informed about campaign law, election timelines, and report deadlines.
Then I determined my campaign platform. I felt strongly that the hospital (the second largest employer in the region) was essential to having a healthy and economically viable community. I believed the hospital should also be a community health partner and should extend services beyond their walls. The Affordable Care Act (ACA) had recently passed and I decided to use my campaign to increase awareness of this significant legislation. I am a firm believer in an integrated approach to health care using the triple aim model, and wanted to explain this concept to the community. This model promotes a three-pronged approach to developing an effective health care delivery system for the future: improving the experience of care by providing effective, safe, and reliable care; improving the health of the population by focusing on prevention, wellness, and managing chronic conditions; and decreasing per capita health care costs (Bisognano, 2012).I thought there should be more diversity on the board as most of the directors had a financial or business background and all had limited health care experience.
Developing campaign materials was critical. Wherever I went, I wore a nametag that read “Marilyn Bouldin, RN, Hospital Board Candidate.” I had business cards printed and used my personal phone number and e-mail address, as I believed accessibility was important. I developed fliers and newspaper ads, and a friend created a website about me, at the urging of my marketer sister.
Launching the Campaign
I believe that most people are interested in their local hospital. If they haven’t used it themselves, they know someone who has. Many people had stories to tell me about their experiences and I made a point to listen. If someone had a complaint I helped them contact the appropriate person. I empathized with them and sometimes gave health advice. I invited them to contact me anytime if they had concerns about the hospital and told them I hoped to represent them on the board.
I contacted community leaders to identify opportunities to speak to groups. One night I drove 30 miles out into the countryside to attend a community potluck dinner. Another time I drove to the other end of the district to speak at a women’s luncheon. I was a guest speaker at a local political party meeting and a radio talk show, to discuss the ACA and the hospital board election process. I went to my favorite coffee shop and hung out all morning to engage people in informal conversations. I went to Business After Hours where local businesses network over appetizers, and attended Chamber of Commerce events. I talked with my friends as we hiked in the Rocky Mountains, and they in turn talked to their friends.
One effective strategy was having a letter-to-the-editor writing party. A friend hosted this in her home, complete with wine and cheese. We helped people compose letters of support and submit them to the newspapers. (See Box 52-2 for one of the letters that was submitted.) We had fun doing it! I
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had an extensive e-mail list and composed a message about who I was, what I believed and why I wanted to be on the hospital board. I then sent this out to everyone I knew asking for their vote.
Box 52-2
Letter to the Editor
April 26, 2012
Dear Editor,
I want to recommend Marilyn Bouldin to your community. It is logical and fortunate that she has offered herself to serve as an elected member of your HRRMC Hospital Board. As my clinical colleague, former boss, and years-long friend, I am familiar with her broad knowledge of health care, her respect for those who work in this field and of her advocacy for consumers who present for its services.
Marilyn is known for her fairness and ability to listen and intelligently weigh out multiple sides of the issues she tackles. Her enthusiasm and commitment to follow-up is legendary. Should I ever require such health-care decisions in my own behalf, Marilyn heads my list of go-to consultants. Though not a member of your community, I would confidently cast my vote for her in your upcoming election for HRRMC Hospital Board membership. It is my opinion that your community could do no better.
Sincerely,
Marilyn Russell, RN, MSN
One of my most nerve-racking experiences was participating in the League of Women Voters candidate forum. Each candidate was given 3 minutes to talk, followed by questions from the audience. The forum was videotaped to play in the library, and the a newspaper reporter was there to cover the story (the editor did not endorse me because he thought other candidates had a better financial background). I was worried I would make mistakes or not know all the answers, and had a sleepless night before the event, which, of course went fine!
I decided that, regardless of the outcome on election night, I wanted to celebrate with all the people who had helped me. We had a pizza party at a local restaurant and it was a truly wonderful time, especially when I got the news that, not only had I won a seat, but I had also received the most votes!
The following week I wrote by hand many personal thank-you notes to people who had helped me. I also sent flowers to my informal campaign manager and graphic designer. I put one last ad in the paper expressing my appreciation to the people who had voted for me and invited them to contact me with any comments or concerns.
Lessons Learned
Although I have had many professional successes and received many awards over the years, what mattered most in my election were my relationships with people. My ability to listen, to be genuinely interested and compassionate, and to follow through with people’s questions and concerns served me well. Once people found out I was a nurse they trusted and confided in me.
I was pleased overall with my campaign strategies. I decided early on not to accept monetary donations for my expenses. I was intimidated by the additional requirements and documentation required by the Secretary of State’s office for campaign donations. I was also bothered by the thought that I might be beholden to the people who contributed. Next time I will accept contributions! I did not develop a budget at the start and did not realize how much it would cost me to run a campaign, which turned out to be over $600.
I did have one negative experience. After going around town on a windy day to place fliers on windshields, a stranger came to my house to tell me he did not appreciate me polluting the streets with my papers. In hindsight, I think he had a good point!
During my first year on the board I spent a lot of time listening, reading, learning about the culture of the board, and building trust with my fellow board members. Even though I had served on many boards in the past and had spent decades working in health care, I was surprised at the steep learning curve necessary for me to understand how a hospital functions. Being the new kid on the block gave me permission to ask lots of questions. I had several one-on-one sessions with the board chair to learn more. I met with key nurses in the organization to hear their concerns and learn how I could be supportive. I read my board packet thoroughly in preparation for meetings. I was appointed to the
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performance improvement committee as the board representative and actively participated. Refreshing my knowledge of good communication skills was also helpful to me, and I attempted to use nonviolent communication (NVC) as much as possible. The objective of NVC is to establish relationships based on honesty and empathy that will fulfill everyone’s needs (Rosenberg, 2003). I attended a national hospital conference, which I found enlightening and informative. I have also tried to take the initiative when appropriate. For example, I worked on developing a new board member orientation manual, compiling all the information that would have been helpful to me during my first month in office (such as an explanation of the bylaws of the foundation board to which I was automatically appointed when I was elected to the hospital board).
I learned quickly that serving on the board requires much more time than just attending monthly meetings! Although being a board member is a volunteer position, as an elected official I felt obligated to do the best job I could and to represent the hospital’s interests and those of our constituents, the taxpayers in the district who legally own the hospital. Consequently, I committed a significant amount of time to reviewing policies, attending hospital-sponsored events and employee-recognition ceremonies, meeting physician candidates, supporting the volunteer auxiliary, serving on the hospital foundation board, and responding to feedback from community members. I also spent time reading publications related to hospital administration.
I have learned to pick my battles and to ask myself “How important is it?” There are times when I choose to remain silent. There are times when significant informal communication happens outside of board meetings, and I make sure to participate in hallway talks. I learned that maintaining positive relationships is of the utmost importance. Nothing happens through divisiveness. I try hard to keep an open mind and to be willing to compromise.
Even after 2 years, I continue to ask a lot of questions, which I find is very helpful to everyone during a meeting. The responsibilities I have in my position continue to be daunting to me and I take them very seriously, especially in the areas of credentialing physicians, overseeing a very large budget, and evaluating the CEO.
I have become skilled at answering the question I get from community members, “How’s it going on the board?” Some people are just making polite conversation and don’t need an in depth answer. I try to be honest yet tactful and am careful not to undermine anyone or gossip. I constantly need to determine what I can share and what I cannot, and am always aware of the language I use. Once the board has made a decision, we must all present a united opinion, whether we agreed personally with the decision or not. This is sometimes challenging.
The Future
The way we deliver health care and medical services is changing rapidly and represents a paradigm shift. Leaders need to have vision, health care knowledge, critical thinking skills, and collaborative expertise, all of which nurses possess. I look forward to a time when nurses are seen as essential participants in every boardroom in every hospital, and they see themselves that same way.
References
Bisognano M, Kenney C. Pursuing the triple aim: seven innovators show the way to better care, better health, and lower costs. 1st ed. John Wiley and Sons Inc: San Francisco; 2012.
Hassmiller S, Combes J. Nurse leaders in the board room: A fitting choice. Journal of Healthcare Management. 2012;57(1):8–11.
Institute of Medicine [IOM]. The future of nursing: leading change, advancing health. National Academies Press.: Washington, DC; 2011 [Retrieved from] www.iom.edu/nursing.
Rosenberg MB. Nonviolent communication—A language of life. 2nd ed. PuddleDancer Press: Encinitas, CA; 2003.
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