1. Carlson, Elizabeth A.

Article Content

This month's books are quite different one from the other, but I recommend both of them. Nurse On Board: Planning Your Path to the Boardroom is a great book for anyone interested in serving on a board. Being Mortal is a more universal book with a message that all healthcare providers should hear.


The Institute of Medicine's (IOM's) 2011 report, The Future of Nursing, called for nurses to assume increased leadership roles in healthcare to help improve America's health and the healthcare system. One such leadership role cited was serving on boards. It certainly makes sense that healthcare systems or organizations would benefit from the knowledge that nurses have about patients/clients based on the knowledge nurses have from regular contact with patients and the system.


As with any endeavor, being asked and serving as a board member are facilitated by knowledge of what being a board member entails. An excellent and easily understandable book on this topic is Nurse On Board: Planning Your Path to the Boardroom by Connie Curran. This 162-page book published in 2016 by Sigma Theta Tau International costs U.S. $39.95.


This book begins with Acknowledgements, About the Author, and Foreword. Immediately prior to the Introduction is a brief piece "Institute of Medicine Calls for Nurses to Serve on Boards," written by Hassmiller. Hassmiller describes some of the thinking that resulted in the strong IOM statement on nurses needed on boards. In addition, she cites two statistics: In 2012, American Hospital Association (AHA) reported that only 5% of hospital board seats were occupied by nurses, whereas in 2014, the AHA reported that physicians occupied 20% of board seats. Thus, in 2014, the Nurses on Boards Coalition formed with the goal of placing 10,000 nurses on corporate and nonprofit health-related boards by 2020 (p. xxix).


The purpose of this book is clearly stated as an "explanation of what boards are and what they do, takes a look at the skills and characteristics required of effective board members (and how to develop these skills), and offers a description of what and who nurses need to know" (p. xxi). There are seven chapters and an index. Each chapter provides content and links it to a highlighted section, Health Trends. There are small clipboard icons that further define concepts in the text. Lightbulb icons offer additional tips related to the topic, and triangular icons containing an exclamation point highlight topics or content requiring caution. Case studies that exemplify the content are presented.


The first chapter, "Board Basics," provides an overview of types of boards and a board member's role and expected duties. The second chapter, "Hospital Governance Trends," looks at current changes impacting healthcare now and in the future and the board's role in governing the organization. After discussing what boards are, the next chapter discusses "What Nurses Need to Know to Get on Board(s)." Governing versus doing is discussed, as well as why this is a key concept. The how and why board members are recruited are discussed, along with common expectations. Orientation, education, and development should occur to improve the skills of board members. Interactions with the CEO are discussed. And, the fact that board members are evaluated is presented. Chapter 4, "Top Competencies for Successful Board Service," offers a clear, comprehensive discussion of skills needed such as finance, strategy, and risk taking.


The remainder of the book focuses on what you can do to become a board member. In the fifth chapter, the readers are given the tools to determine if serving on a board is a commitment they want to make. The next chapter, "Serving as a Productive Board Member," suggests how new board members can best use their talents to advance the organization. The final chapter, "What's Holding You Back?" presents the reader a challenge to become a board member and what to do when the plans do not go as hoped.


I really enjoyed this book because it offers excellent content, is easy to understand, offers doable ideas, and sheds light on the working of a board. I have and do serve on a few boards and found valuable, useable information throughout this book. I highly recommend it even if you do not think you may want to serve on a "big" board. Information in this book can help you be effective in any board-type situation you may encounter.


The second book is Being Mortal: Medicine and What Matters in the End by Atul Gawande, MD. This 282-page book was published in 2014 by Metropolitan Books and costs U.S. $26.00. Dr. Gawande is a surgeon in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and Harvard School of Public Health. This book has been widely read, having been on the New York Times best-seller list for more than 23 weeks, some of the time in the number one spot. Through a series of stories about people he has interacted with and research findings, Dr. Gawande paints a compelling picture of what exists now in most cases and what can exist going forward to make the end of life a good part of life.


In the Introduction, Dr. Gawande lays the groundwork for the premise of the book; mortality and how we experience it today both as receivers of and as deliverers of care. He posits that medicine fails the elderly or terminally ill even as it is supposed to be in the process of helping. He states, "Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need" (p. 9). As a writer and scientist, Dr. Gawande believes that by looking closely at something that is "confusing or strange or disturbing," one can make sense of it.


This book has eight chapters. The first chapter is "The Independent Self." Dr. Gawande introduces the reader to himself, his father, and grandmother-in-law, who readers continue to follow throughout the book. He also discusses how the process of aging has changed over the years, from occurring at home with family members to our current approach. The second chapter is "Things Fall Apart" and presents how healthcare today keeps us alive while declining and how this is different from that during our grandfather's or early generation. He also talks about how we age and why we age. He looks at the trajectory of aging and its impact on society. He tells stories about people that exemplify this decline. He talks about geriatric providers and support systems.


The third chapter is about "Dependence" and what occurs prior to death. As Dr. Gawande states, "It is not death that the very old tell me they fear. It is what happens short of death-losing their hearing, their memory, their best friends, their way of life" (p. 55). The reader learns about two more people and their "crossroads." He presents both good and bad elderly living arrangements and looks at the issue of the elderly having control over themselves and their living arrangements. Chapter 4 is "Assistance" and presents different living arrangements available to the elderly. In Chapter 5, "A Better Life," Dr. Gawande gives examples of living arrangements that give control to the residents. He talks about assisted living and the true concept behind that idea. He presents the delightful story about Bill Thomas and his approach to nursing home residents and the idea of the residents having maximum independence as a foundation to the good life no matter where on the spectrum of life the person was at that time. (Hint: it involves dogs, cats, and birds....)


In Chapter 6, "Letting Go," Dr. Gawande discusses the question: "When should we try to fix and when should we not?" (p. 149). He explores what is it patients want the doctor to do if they have a diagnosis of and advanced and incurable disease? Dr. Gawande relates his patient rounds with a nurse on the hospice service and the insights he gleaned from the nurse. From the nurse and how she interacted with the patients receiving hospice care, he developed insights and tools to use with other patients as well as his father. This chapter contains example after example of ways to determine what the patient's desires are and how to help the patient realize those desires. Dr. Gawande discusses choices that need to be made and how these choices can be framed to achieve what the patient desires.


In Chapter 7, there are "Hard Conversations." Dr. Gawande discusses how conversations about the quality of life must include death. He cites that scholars posit there are three stages of medical development that countries go through that parallel their economic development. In extreme poverty (Stage 1), most deaths occur at home because most people do not have access to medical care. Stage 2 occurs as the economy develops and more people have access to medical care as the medical capabilities advance. The people then turn to medical care when they are ill and at end of life. At this stage, most people die in the hospital. In Stage 3, income levels have risen to the point where people are able to be concerned about the quality of their life, including during illness and death, and the number of people who die at home once again rises. He uses examples to illustrate these ideas and discuss the role healthcare providers have in the process of death.


Dr. Gawande concludes with Chapter 8, titled "Courage." His states that there are two kinds of courage required in aging and sickness: the courage to confront the reality of mortality and the courage to act on the truth that is found. He details his and his mother's struggles when his father is in his final days. In the "Epilogue," he identifies what he has learned-that the job of healthcare providers is not to ensure health and survival but is broader and is to enable well-being.


This is an excellent and compelling book. As stated previously, it was on the best-seller list for more than 23 weeks and, as such, has been read by many people outside of healthcare. I suggest that it is incumbent on healthcare providers to understand what our patients and families may have read and how they view our role. This would be an excellent book to discuss as part of continuing education or in a classroom setting. I highly recommend it.


Although these are two very different books, they each offer substance and very useable information. I highly recommend both books and suggest the second book would be an excellent springboard for discussion.