1. Section Editor(s): Johnson, Joyce A. PhD, RN-BC

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Several times in the past month, I have heard someone say, "If you're not at the table, you're on the menu." This quote is believed to have originated around 2000 in Washington, DC, and is of unknown origin. Basically, it means that if you are not represented at the decision-making table, you are in a financially vulnerable position, you get left out, or, worse yet, you are on the menu. This quote certainly applies to both nursing as a profession, and specifically to nursing professional development (NPD). So often, NPD practitioners' knowledge and interests are not part of leadership's consideration as they make plans and decisions. And even if we have a seat at the table, it doesn't mean that we have a voice that is heard and considered. All too often, new projects, processes, policies, and procedures are developed without input from NPD. Major initiatives are advanced without thought and preplanning for professional development. Something as significant as planning for the opening of a new facility may not take into account the time and resources needed to prepare the staff until it's almost too late. This type of planning that does not include NPD would generally not take place in businesses outside of the healthcare arena. In addition, in financially tough times, NPD is often the first to be cut from the menu, because it is frequently considered a nonessential function in the healthcare setting.


Many organizations have a Chief Learning Officer (CLO) who reports directly to the President/CEO, serves as a member of senior management, and is the key staff member who develops plans for the education department, which mirror the objectives of the organization. In fact, in most industries other than healthcare, there is a CLO sitting at the table. "At organizations like WalMart, Caterpillar, GE, EMC, IBM, Heidrick and Struggles Ingersoll-Rand, and many more, the CLO is the business executive who owns the corporation's learning and development strategy, programs, and systems. The most effective CLOs tend to be business people first, and then learning experts second." (Bersin, 2007, p. 1)


In Nursing Professional Development: Roles and Accountabilities, Diana Swihart states that


Nursing professional development specialists are the keys to successful succession planning, managing competing priorities, and effecting cost avoidance. These practitioners are more than educators. They emphasize safety, quality, efficiency, and effectiveness of practice while rapidly transitioning diverse generations of nurses into practice. They understand adult learning principles, career development in healthcare and communities of practice, continuing education program development and management, transformational/servant leadership systems redesign, complex implementation, and strategic planning. (Swihart, 2009, p. 1)


According to Wick,


[horizontal ellipsis]human capital is the single most important source of competitive advantage in today's increasingly knowledge-based economy.[horizontal ellipsis]Maintaining competitive advantage through human capital requires ongoing investment in employees' development, both so that they stay current in a rapidly changing world and so that they stay with company.[horizontal ellipsis]This means that all company-funded learning, opportunities-ultimately serve a business purpose. (Wick, Pollock, & Jefferson, 2010, p. 3)


The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health calls for transformation of the nursing profession.


During the course of this study, the committee formulated four key messages it believes must guide that transformation: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; (3) nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States; and (4) effective workforce planning and policy making require better data collection and an improved information infrastructure. (Institute of Medicine, 2010, p. I-12).


This clearly represents a call for nurses to sit at the table with other health professionals.


Often in our facilities, there is no representation on the leadership group by NPD. Recently, in one of our local hospitals, the nursing leader was taken off the leadership group. Now, there is not only no NPD representation but also no nursing representation in that facility. So often we are not represented on the right groups and not part of the decision-making process, but are asked to participate once everything has been decided.


In addition, if you are not at the table, you miss a sense of the culture of the leadership group, 100% of the conversation, and 80-90% of the information. If you are able to hear from your representative, you hear the information through their perspective and filters. You miss the whole picture as well as many of its individual parts which then guide your perspective, participation, and performance. You may follow through with an incomplete picture and may be less effective at your efforts than you might have been had you been at the table. The larger and/or the more hierarchical the organization, the more pervasive the issue.


What can we do to improve our chances of being asked to the table?


[white square] First, we have to believe that we deserve a place at the table. I know that we do, but there are many who don't agree, especially in healthcare. We need to believe we have a unique contribution to make.


[white square] Use the Six Disciplines of Breakthrough Learning (the 6Ds) approach (Pollock, Jefferson, & Wick, 2015) as you plan programs, showing that you are meeting organization needs as well as NPD needs. Help your facility maximize profitability, growth, and value. This has not traditionally been the focus of NPD, which emphasizes helping people grow, develop, and perform their jobs in a competent manner. But we need to remember that the purpose of this growth and development is not an end in itself but serves the end goal of maximizing business results. Organizational goals and results need to be the focus of the director of the department in order to guide the staff to view what they do in that light.


[white square] Be sure your own goals are aligned with the company goals and that your department's goals are directed at achieving the overall business goals as well.


[white square] Run your own department like a business. Meet with your staff members regularly so they too are focused on the overall business goals.


[white square] Hone your listening skills so that you understand the issues clearly.


[white square] Know what's going on in our industry in general. Stay curious and open to new ideas and new ways of thinking and doing things.


[white square] Know the key issues challenging your organization and your discipline. Ask lots of questions especially about finances, objectives, and desired business results. Be able to talk the talk.


[white square] Develop a reputation for being an expert in your aspect of the business. Learn and grow every day through all the methods available to you and take advantage of every opportunity to serve on committees and boards.


[white square] Know what's going on in your facility with emphasis on the financials.


[white square] Ask others for their ideas and thoughts, creating trust and rapport. Show a genuine interest in others in your organization.


[white square] Study the leaders who are at the table-their communication strategies and people skills; then apply what you see. Seek a mentor to help guide your path to the table. Find out what you need to do to get to the table in your organization. Ask yourself if you simply want to be at the table like a diner, if you just want to participate in the process, or if you really want to make decisions? What role do you want to play?


[white square] Consistently report your department's data with emphasis on results and not on efforts. It's not how much you do but the results you get. Measure outcomes and goal achievement, not work processes.


[white square] Recommend programs for staff that will contribute toward improving the business.


[white square] Be accountable for your own work and own mistakes.


[white square] Be passionate about what you do and show it. Step up and volunteer locally and nationally; serve on boards of professional organizations.


[white square] There may be several "tables" in your organization, start with being at one of the tables.


[white square] Become more media savvy. We need a greater presence in newspapers and magazines. We should be publishing articles in all kinds of journals, both professional journals and general interest family and home-oriented magazines you see at the check-out stand in the grocery store. That would go a long way toward getting us noticed.


[white square] Be direct. State your position and the reasoning behind it. Back it up with data. Say what you have to say succinctly and professionally but not abruptly. Stand up for issues that are important to the organization and support other's ideas, which contribute to organizational success.


[white square] Stand up for what you believe in, for issues that are important to you. You are paid to do your job and improve your job. So take risks to improve your organization. Speak up and voice your opinion, offering alternate solutions to suggestions you disagree with.



The road to a seat at the table may be a winding and complicated road, but not one that is impossible to travel. Let some of these suggestions start you on the path to a "seat at the table." But remember that to have a seat at the table isn't enough. You need to be involved and respected, which will lead to a true voice at the table.




Bersin J. ( 2007). The new chief learning officer: 2008 and beyond. Retrieved from[Context Link]


Institute of Medicine. ( 2010). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. [Context Link]


Pollock R. V. H., Jefferson A. M., & Wick C. W. ( 2015). The six disciplines of breakthrough learning. Hoboken, NJ: Wiley. [Context Link]


Swihart D. ( 2009). Nursing professional development: Roles and accountabilities. Medscape. Retrieved from[Context Link]


Wick C., Pollock R., & Jefferson A. ( 2010). The six disciplines of breakthrough learning. San Francisco, CA: John Wiley and Sons. [Context Link]