Nurses keep hospitals running. Now they want to run the country, too

Lauren Underwood always had an interest in politics. But the 31-year-old public health nurse didn’t plan on running for Congress at this point in her life.

In 2017, Underwood’s frustrations with her local Congressman — Rep. Randy Hultgren (R-Illinois), who is up for reelection — hit a breaking point. So, she decided to jump into the fray and join the race. In March, she won the Democratic primary in Illinois' 14th District, and she will face off against Hultgren in November. 

“The idea of being a candidate was something I was more interested in down the line,” Underwood said. “I certainly never expected that I would run now.”

Underwood is part of a growing cohort of nurses who are looking to apply their experience caring for patients to public service and leadership roles in the corporate world. Many are millennials driven by a personal mission to find new ways to serve patients, whether that’s at the bedside or by influencing policy.

And in an era in which traditional healthcare service models are being questioned and replaced, nurses are well positioned to understand how to redesign and then execute care in a way that is better aligned with the health system of the future.

With some exceptions — like former Centers for Medicare and Medicaid Services administrator Marilyn Tavenner, a registered nurse — few nurses have traditionally held roles of this nature. But experts say this has become an increasingly popular professional path for nurses.

“It’s pretty interesting; nurses have not run for elected office,” Underwood said. “It’s not just Congress. Generally, we aren’t candidates even in our local communities.”

There are currently three nurses in Congress: Reps. Karen Bass (D-Calif.), Diane Black (R-Tenn.) and Eddie Bernice Johnson (D-Texas). That's compared to 15 physicians serving in Congress right now. However, there are more than triple the number of registered nurses (3.3 million) compared to physicians (1.1. million) in the U.S.

Nurses are also scarce among the ranks of corporate leadership. As are women and people of color. Only 5% of hospital board seats went to nurses in 2014, according to the Campaign for Action, a nursing advocacy organization backed by the AARP Foundation, AARP and the Robert Wood Johnson Foundation.

A report conducted by the National Academy of Medicine and the RWJ Foundation in 2010 called for organizations to put more nurses in leadership roles, whether that’s service on boards that make health policy decisions or taking positions on how to reform the healthcare system.

Nurses say the report helped push the issue forward, but so has the debate over healthcare reform and costs; the growing tension between physicians and nurse practitioners, who can now practice independently in 23 states; and the broader #MeToo movement. All of those factors have encouraged nurses to seek positions on county boards and on hospital committees, according to Andrea Uitti, associate director of programs and grants for the Florida Center for Nursing. 

“Running for office is another ballgame,” she said. “You have to have a certain amount of money … It takes a certain amount of knowledge and savvy. You need money, and you need people to give you donations, and help you campaign.”

The most common occupations for lawmakers at the federal level are in business, education and public office. For example, in the 113th Congress, there were 19 physicians, two dentists, two veterinarians, one psychiatrist, three psychologists, one optometrist — and 5 nurses.

“We go into nursing because we want to help people,” said Maryjoan Ladden, a nurse practitioner and RWJ program officer. “Many nurses see that as their mission. Perhaps they haven’t seen that, ‘Wow, I could be the CEO of my organization. I could be in Congress. I could be surgeon general.’”

What’s holding nurses back

“This is a female-dominated profession,” said Erin Murphy, a registered nurse who is vying to be the Democratic nominee for Minnesota's gubernatorial race. “Ninety percent of nurses are women, and women often have to be asked more than once [to run for office]. The stat is seven times. So, one of the barriers that we’ve had to overcome is stepping into public leadership spaces.”

The structure of the profession also poses obstacles to taking on leadership roles. Many nurses are paid hourly and work in shifts, which can make it challenging to pursue external career-related activities. This is different than it is for doctors, who often begin participating in advocacy days as medical students, according to Underwood. And nursing schools have only recently placed greater emphasis on advocacy and health policy courses.

Then there’s the sticky perception that the sole job of a nurse is to provide patient care. Anything that takes them away from that core activity can feel like a departure from their professional identity.

In a traditional nursing role, RNs take orders from physicians, a structure that teaches nurses to get things done but can also hone soft skills like how to negotiate. Learning and recognizing the value of other soft skills like networking can be challenging for nurses, said Christine Matoski, a nurse in Valparaiso, Ind., who sits on a board, served as a state convention delegate and plans to run for public office in the future. A nurse might ask him or herself: “‘If I network, what’s that going to do?’” Matoski said. “‘How’s that going to help me? There’s a job to do.’”

“If someone is not taught to do it, and professionally there is a more limited ability to engage, for me it’s not a stretch to see why we don’t become candidates,” Underwood said.

Still, many of the skills that Murphy said she acquired as a nurse — problem-solving on a deadline, persistence — have carried over into her work as a lobbyist for the nursing industry and, later, as a state senator. If she wins in November, Murphy will be the first nurse to serve as a governor in the U.S.

What’s changing

For both Underwood and Murphy, the decision to run for office stems from their personal experiences with the healthcare system. Murphy, who is a proponent of a single-payer healthcare system, grew frustrated with health insurers while caring for her mother before she passed away. “My perspective is deeply rooted in my experience as a nurse,” she said. “When you are sick, you should get care. Period.”

Underwood was diagnosed at age 8 with supraventricular tachycardia, a heart condition that would be classified as a pre-existing medical condition. “It was personal for me,” she said. “Under the [Affordable Care Act] repeal bills, I wouldn’t be able to afford coverage.”

Even though nurses are passionate patient advocates, some have been hesitant to move into leadership or public-facing roles. Lissette Altreche, a 26-year-old emergency room nurse at NYU Langone Medical Center in New York City, was first invited to sit on the board of the National Association of Hispanic Nurses in 2016. At the time, she wondered what she would be able to offer. Now? “If we’re not sitting at the table, things aren’t going to change in healthcare,” she said. “Many nurses have decided to fight for nursing and also for the patients.”

That’s evident in the level of support that nurses interested in this path now have available to them. There are high-ranking executives and political leaders who can serve as role models. There are organizations like Campaign for Action and the Nurses on Boards Coalition that advocate for nurses, in part through mentorship and by helping them gain leadership and public facing skills. And while all of the nurses interviewed for this story say changes are needed to fix the American healthcare system, that perspective is shared by both Republican and Democrat nurses, each with different ideas how to do it.

Nurses have “scientific curiosity” and empathy; they are natural managers, with “boundless energy,” said Lynn O’Connor Vos, a nurse who made the move to corporate healthcare in the 1980s. She’s worked for Johnson & Johnson and Novo Nordisk, led WPP’s ghg healthcare advertising agency and currently serves as the CEO of the Muscular Dystrophy Association.

Right now, the association is hiring a leader to run its care-center strategy. She wants a nurse to fill that role. “The majority of care can really be executed by nurses,” Vos said. But “you have to be comfortable reinventing yourself. That’s probably the group of nurses who will do better and thrive when they jump into these spaces.”

What's your view? What role can nurses play in public service or as corporate leaders?

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