By Susan B. Hassmiller

and Susan Reinhard

Some of the largest health-care systems in America do not have any nurses serving on their boards of directors. That is a huge oversight, especially in a time of rapid change in health-care delivery. Consumers and providers would benefit from having nurses' front-line perspective present as policy decisions are made.

Last month, nurse leaders from 21 national nursing and other health-related organizations came together to change that. They launched the national Nurses on Boards Coalition, which has a goal of putting 10,000 nurses on boards of corporate and nonprofit health-care organizations by 2020.

The effort is a direct response to the Institute of Medicine's 2010 call for nurses to play more pivotal decision-making roles on boards and commissions to improve the health of all Americans. The institute's landmark report, "The Future of Nursing: Leading Change, Advancing Health," established that strong leadership from nurses is an essential element in transforming health-care delivery and improving patient care.

It seems the institute's call has not reached much of America.

The American Hospital Association's Trustee Magazine summed it up in September: "Without a nurse trustee, boards lack an authority on the patient experience, quality, and safety, and perspective from the largest part of the hospital workforce."

The absence of nurses in leadership positions comes as hospitals, medical groups, and insurance companies claim they've become more patient-friendly in a health-care system that is putting more emphasis on prevention.

While doctors fill 20 percent of hospital board seats, nurses make up just 6 percent, reported Trustee Magazine, which cited the hospital group's most recent governance survey.

The dearth of nurses serving on boards stands in stark contrast to the fact that nurses are the largest segment of the U.S. health-care workforce at three million strong. More than any other health-care providers, nurses bring the perspective of the patient.

Consider that nursing practice covers health promotion, disease prevention, coordination of care, cures, and palliative care when cures are not possible. Nurses provide the majority of care in hospitals, nursing homes, clinics, and outpatient settings. They are on the front lines in making sure care is delivered safely, effectively, and compassionately. And nurses are the ones who not only tend to patients' physical health needs, but also respond to their social, mental, and spiritual needs.

Due to federal health-care reform, providers are in the midst of reworking care delivery to make it more accessible, accountable, and affordable, while putting an emphasis on prevention and primary care. Nurses already play a huge role in care. It's time they begin playing a role in the boardroom too, bringing their practical sensibilities and views of patient care experiences to the table.

The nation's largest health care philanthropy, the Robert Wood Johnson Foundation and the 38 million-member AARP, believe nurses must have a voice in the boardrooms of the health-care organizations we trust to care for us. Backed by the foundation and AARP, the Future of Nursing: Campaign for Action is driven by the Institute of Medicine's evidence-based recommendations.

Nurse representation is our best hope of achieving high-quality care that is accessible, affordable, and compassionate.