Nurses are being held back in the boardroom by insufficient skills and the attitudes of senior managers, the Royal College of Nursing has claimed.
RCN executive director of nursing Professor Alison Kitson said that not all trust boards recognise the value of nurses' experiences.
She told HSJ: 'The really high-performing trusts absolutely understand the contribution that nurses make to the strategic health of the organisation, but it's not true across the board. We've got to get our chief executives as passionate and excited about nutrition and keeping hospitals clean as about finance.
'There are some really successful nurses in acute trusts, but it's up to the attitude of the chief executive and whether they see the nurse as an integral part of the team.'
Her comments follow health minister Lord Hunt's remark at a nursing conference last week that nursing leaders need to do more to make their voices heard.
Professor Kitson thought he was 'laying down a challenge'.
'If he's willing to listen, we're willing to talk, but we always have been,' she responded.
'Nurses are driving innovation and change. It doesn't make sense not to have that in the boardroom.'
All the new strategic health authorities have mandatory nursing directors but in primary care trusts there is a danger of nurses being overlooked, she said.
'We need a perspective on how we can develop patient-focused care, tackle MRSA and treat people with dignity.
'Each chair needs to think who's able to give direct evidence-based information to the boardroom.
'It makes sense this comes from someone in nursing, which is the largest workforce. When it goes well, we're going to be achieving the targets.'
Another obstacle is that nursing managers often lack the skills to participate in top-level discussions, she felt.
The RCN is working with the Department of Health to build nurses' commissioning skills.
She said: 'We can't expect people to perform to their best if they're not prepared and don't connect with the team they're working with.
'We've moved from the polemic about whether nurses are in the boardroom to how we can best harness their contributions,' added Ms Kitson.