Nurses Deserve a Seat at the Table in 2025

Why Frontline Insight Must Shape Healthcare Leadership

In 2025, the call for shared governance is louder than ever: nurses deserve a seat at the table. For too long, nurses have been underrepresented in boardrooms, executive committees, and high-level policy discussions, despite being the largest segment of the healthcare workforce. According to the American Organization for Nursing Leadership, only 6% of hospital board members in the U.S. are nurses. Yet nurses possess a unique systems view informed by thousands of direct patient interactions, interdisciplinary collaboration, and daily operational challenges. At The Healthcare Executive, we’ve written extensively on how servant leadership from the bedside strengthens executive performance. When frontline leaders are excluded from decision-making, health systems risk strategic blind spots in workforce planning, patient experience, and care quality. The absence of the nurse voice in governance contradicts the push toward inclusive, data-informed leadership. Now more than ever, healthcare needs leadership models that mirror the realities of care delivery. For that reason, boards must open the door—and pull up a chair—for the nursing profession.

Health systems such as Intermountain Health and Trinity Health are already demonstrating the benefits of elevating nurses into executive roles. These organizations have appointed Chief Nursing Executives (CNEs) to their governing boards and embedded nurse leaders into major strategic committees. Their rationale is clear: nurses bring clinical realism, workforce insight, and system-wide understanding that few other leaders can replicate. This shift reflects a deeper recognition that nursing leadership is not just operational—it’s strategic. At The Healthcare Executive, our analysis on board diversity reinforces that the most resilient organizations are those that include clinical representation at the top. When boards include CNEs, the result is more balanced budgeting, stronger workforce engagement, and improved alignment with clinical priorities. In these models, the nurse leader helps bridge the clinical-business divide. This integration yields not only smarter decisions but more sustainable outcomes. Therefore, inclusion of nurse executives is more than symbolic—it’s transformational.

Nurse leaders bring more than compassion and care; they bring data, evidence, and actionable insight. From staffing models and patient throughput to infection control and documentation workflows, nurses have operational knowledge that is vital to strategic planning. At UCHealth, nurse-led committees have helped shape hospital expansion projects and care model redesigns based on real-time clinical trends. By grounding executive planning in lived clinical experience, systems gain agility and accuracy in their decisions. This was evident during COVID-19, when nurse leaders played essential roles in crisis response and surge management. Now, the lessons of that era must be institutionalized—not forgotten. Nurses at the table accelerate innovation by grounding strategy in feasibility and frontline relevance. Their expertise contextualizes performance metrics, quality reports, and financial outcomes with on-the-ground logic. Because of this, their presence drives smarter, faster, and more resilient decision-making.

Despite this value, many health systems still operate in siloed structures where administrative leaders are disconnected from clinical realities. This divide contributes to impractical mandates, morale decline, and systemic inefficiencies. As explored in our work on patient experience metrics, disengagement from nursing teams directly correlates with reduced quality scores and staff turnover. Hospitals must confront the structural barriers that prevent nurse participation in governance. At Mass General Brigham, shared governance models empower nurse councils to weigh in on system priorities, creating meaningful collaboration between boardrooms and break rooms. Nurse insight isn’t anecdotal—it’s strategic intelligence backed by clinical hours, pattern recognition, and a holistic view of the patient experience. Inclusion requires intentional design, not just invitation. Boards that fail to integrate nursing voices often replicate the same gaps that nurses are trained to close. In turn, the exclusion of nurses becomes an operational liability rather than a political choice.

Boards benefit most from diversity—not just of demographics, but of perspective. Nurses contribute insights shaped by empathy, real-time problem solving, and interprofessional negotiation. At Rush University Medical Center, nurse executives collaborate with IT, finance, and legal teams on digital integration, workforce policies, and strategic risk management. This cross-functional collaboration helps avoid blind spots and builds trust across departments. As highlighted in our article on executive development, interdisciplinary fluency is the future of healthcare leadership. Nurses are inherently collaborative and communication-focused, making them natural assets in strategic decision-making. Inclusion builds confidence, encourages innovation, and reduces misalignment between policy and practice. By welcoming diverse clinical voices, hospitals create boards that are truly representative of those who serve and those served. Consequently, governance becomes more reflective, inclusive, and results-oriented.

Training nurses for board service requires more than promotion—it requires intentional development. Organizations like the ANA Leadership Institute and AONL offer leadership tracks designed to prepare nurses for executive roles. These programs build strategic thinking, financial literacy, and boardroom communication skills. At The Healthcare Executive, we believe that building the next generation of nurse board members must begin with early exposure to governance frameworks. Hospitals should develop internal pathways that support nurse talent from clinical leadership to system leadership. This creates pipelines of ready candidates for committees, councils, and eventually board seats. Mentorship, sponsorship, and succession planning are essential. When governance includes clinicians prepared to lead, the result is a more dynamic, informed, and future-ready board. For this reason, investment in nurse leadership development should be a board-level priority.

Elevating nurses to board roles is also a matter of equity and visibility. The nursing profession is predominantly female and includes a growing number of BIPOC professionals—yet both groups are underrepresented in healthcare governance. At Kaiser Permanente, diversity in leadership has improved through active recruitment of nurses and women of color for board roles. Representation at the top changes what’s prioritized, what’s funded, and what’s challenged. It signals to frontline staff that their experience is not only valid but vital to system health. As discussed in our servant leadership series, authentic representation drives cultural healing and strategic alignment. Nurses don’t just reflect diversity—they embody it. Including them affirms that leadership is not reserved for administrators but open to the entire workforce. Accordingly, representation is not just a gesture—it’s an operational necessity for inclusive excellence.

When nurses participate in board decisions, the impact extends beyond the hospital. They influence regional partnerships, community health investments, and public policy positions. At Montefiore Medical Center, nurse board members have championed initiatives on home care expansion and neighborhood-based health education. Their voice links the institutional mission to real community needs. As covered in our review of external engagement strategies, clinical leaders shape how hospitals respond to social determinants of health. Nurses bring credibility, trust, and outreach capabilities rooted in their daily work with patients and families. Their governance participation ensures that system strategy is grounded in local relevance. Community-connected leadership leads to better access, stronger alliances, and more responsive care design. Thus, including nurses in strategic roles is also a step toward greater health equity.

To fully integrate nurses into governance, organizations must redefine leadership pipelines. This includes formalizing clinical-to-executive pathways, aligning competencies with strategic goals, and compensating board service as labor—not volunteerism. At Atrium Health, compensation and succession planning are tied directly to nursing-led governance initiatives. This model treats nurse board service as a leadership discipline, not a symbolic act. As emphasized by The Healthcare Executive, organizations that invest in governance infrastructure see better alignment across business units. Nurses who lead gain confidence, influence, and a clearer view of system levers. Their leadership sends a powerful message to staff: your experience matters at every level. With this in mind, leadership equity must be codified, not contingent on goodwill or individual advocacy.

Ultimately, the future of healthcare leadership demands voices from the bedside. Nurses are trusted more than any other profession in America, according to Gallup. They are the backbone of quality care, operational continuity, and relational trust in clinical settings. In 2025, giving them a seat at the table is not just fair—it’s foundational. Systems that integrate nurse leaders into governance benefit from authenticity, accountability, and insight that cannot be outsourced. The boardroom must reflect the realities of the care environment it governs. By including nurses, organizations align mission with mechanism. Nurses have always shaped healthcare at the bedside—now they must help shape it from the boardroom. For that reason, the future of healthcare depends on their formal presence at the highest levels.