PNP 6023 Module 1 Board Roles and Responsibilities Paper Example

Care, Loyalty and Obedience in a Rural Hospice: What Board Members Owe the Organization and How Three Theories Explain What They Actually Do

Student Name

American College of Education

PNP6023: Organizational Board and Volunteer Development

Module 1 Assignment

Instructor Name

October 12, 2026

Introduction

ACE describes board members as a special type of volunteer who guide an organization's direction, promote it in the community and ensure its mission of service is fulfilled. This paper examines what that means at a nonprofit hospice serving six rural counties in northeast Iowa, where I am director of community relations and staff the board's committees. The hospice is a composite; it blends features of several rural hospices I know, with identifying details altered. The paper sets out the board's legal duties and core responsibilities, uses three theories to explain how the board actually behaves and identifies where its practice falls short.

The Organization and Its Board

The hospice cares for about 140 patients on an average day in their homes and in nursing facilities, with a staff of 85 and roughly 160 volunteers. It is certified by Medicare, which pays for most of its care and sets conditions on how it is governed and staffed. A nine-member volunteer board governs the organization. Its members include a retired family physician, two farmers who are longtime donors, a banker, a pastor, a high school principal, a former hospice nurse, a funeral director and a retired insurance agent. Most have served for more than eight years. The board meets every other month, and an executive committee of three acts between meetings.

Three Fiduciary Duties

Nonprofit board members owe the organization three legal duties under state nonprofit law. The duty of care asks them to give board work the care a careful, well-informed member in that role would give it: to attend meetings, read materials, ask questions and make informed decisions. The duty of loyalty asks members to place the hospice's welfare above any personal gain, which means disclosing conflicts of interest and stepping away from decisions in which they have a stake. The duty of obedience requires them to keep the organization faithful to its mission and compliant with the law and its own bylaws. For a hospice, these duties carry particular weight, because the board answers for an organization that cares for dying patients and spends public money through Medicare.

Core Responsibilities

From those duties follow the board's practical responsibilities: setting mission and strategic direction, hiring, supporting and evaluating the executive director, ensuring financial health and adequate resources, overseeing quality and compliance, representing the organization to the community and governing itself well through recruitment, orientation and evaluation of its own members. In a Medicare-certified hospice, the governing body also carries formal responsibility for the hospice's operations and quality program, so oversight of quality of care is not optional. In practice the hospice board spends most of its meeting time on the inpatient wing campaign and on approving routine reports, leaving little room for the oversight and self-assessment work on this list.

Three Theories of Board Behavior

Miller-Millesen (2003) proposed that three theories explain different parts of what nonprofit boards do. Agency theory sees the board as a monitor protecting the organization's owners, in a nonprofit the public and its donors, from managers who might pursue their own interests; it predicts boards that review finances, set controls and evaluate executives. Resource dependence theory sees the board as a bridge to the outside world, bringing money, information, legitimacy and connections; it predicts boards that fundraise and advocate. Institutional theory sees the board as conforming to expectations about what a proper board looks like; it predicts boards that adopt standard policies and structures because others have them.

Applying the Theories

Each theory explains part of the hospice board's behavior. Resource dependence describes its strongest work: the farmers and the banker have raised most of the funds for a new inpatient wing, the pastor and funeral director connect the hospice to families across six counties and the physician lends credibility with referring doctors. Institutional theory explains why the board has a conflict-of-interest policy, a whistleblower policy and an audit committee, all adopted after a peer hospice's consultant recommended them. Agency theory explains least, because the board's monitoring is weak. Members receive a monthly financial statement but rarely discuss it, the executive director's last formal evaluation was four years ago and the board has never reviewed the hospice's quality data beyond a summary of family satisfaction surveys.

Three Gaps

The analysis exposes three gaps between duty and practice. The first is quality oversight. The duty of care, and the hospice's regulatory obligations, require the board to understand how well patients are cared for, yet it sees almost no clinical quality information. The second is executive evaluation. A board that has not formally evaluated its executive in four years cannot claim to be exercising informed oversight. The third is loyalty in practice. The banker's institution holds the hospice's accounts and the line of credit for the new wing; he disclosed the relationship and abstained from the vote, as the policy requires, but the board has never asked whether banking terms are competitive. None of these gaps reflects bad faith. Each reflects a board whose strengths lie in connection and fundraising and whose habits never developed around monitoring.

Why the Gaps Matter

It might be argued that a board strong in fundraising and community ties is doing its job, and that monitoring can be left to managers and regulators. Research on nonprofit boards suggests otherwise. Brown (2005) found that boards rated as more competent, for example in strategic and analytical work, were associated with stronger organizational performance, though the association does not prove the board caused it. For the hospice, the risks of weak monitoring are concrete. Medicare surveyors review quality and compliance, and a serious finding would land on a board that had not been watching. The new inpatient wing raises the organization's debt and operating costs, which a board that rarely discusses finances may not fully grasp. And an executive who receives no formal evaluation has no structured feedback, which makes succession planning harder if the current director, now in her late sixties, retires.

Implications for Development

The gaps suggest the direction for the rest of this course. Recruitment should add members with financial oversight and clinical quality expertise. Orientation should teach every member what the duty of care requires in a hospice, including how to read quality data. The board-executive relationship needs a regular evaluation cycle that the executive director welcomes rather than fears. And the board should consider term limits, so that its composition can change as the hospice's needs change. Cornforth (2012) cautioned that governance involves more than the board alone and changes over time; the hospice's board was well suited to its founding era of community fundraising and now needs to grow into an era of regulation, data and larger budgets.

Conclusion

The hospice board owes duties of care, loyalty and obedience and carries responsibilities from strategy to self-governance. Resource dependence and institutional theory explain its strengths in fundraising, connection and formal policy, while agency theory highlights weak monitoring of quality, finances and the executive. Closing those gaps, through recruitment, orientation, evaluation and term limits, is the agenda for the modules ahead.

References

Brown, W. A. (2005). Exploring the association between board and organizational performance in nonprofit organizations. Nonprofit Management and Leadership, 15(3), 317-339. https://doi.org/10.1002/nml.71

Cornforth, C. (2012). Nonprofit governance research: Limitations of the focus on boards and suggestions for new directions. Nonprofit and Voluntary Sector Quarterly, 41(6), 1116-1135. https://doi.org/10.1177/0899764011427959

Miller-Millesen, J. L. (2003). Understanding the behavior of nonprofit boards of directors: A theory-based approach. Nonprofit and Voluntary Sector Quarterly, 32(4), 521-547. https://doi.org/10.1177/0899764003257463