The chief nursing officer (CNO) is responsible for nursing leadership, administration and practice at the highest level of provider operations. Employed by all types of health care organizations, CNOs are top executives whose job duties range from overseeing care delivery to managing nursing department finances and developing policies.
Given the variety in professional responsibilities, nurses aspiring to become chief officers need to be as competent in interprofessional collaboration as they are in evidence-based practice. They also need years of clinical and administrative experience, since CNOs are involved in strategic decision-making and board of director relationships.
There are a few fundamental steps you can take to become a chief nursing officer. Education is perhaps the most important requirement, as many employers look for a master’s degree at a minimum. Earning a Doctor of Nursing Practice, however, can help you build a comprehensive skill set and prepare you for the leadership demands of the CNO position.
What is a chief nursing officer?
The chief nursing officer is essentially the chief executive officer (CEO) of the nursing department. For example, the CNO of a hospital system may report to the CEO. Everyone else in the nursing department — including registered nurses (RN), nurse managers, nurse practitioners (NPs) and nurse educators — report to the CNO.
From their seat at the executive table, CNOs impact all areas of the nursing department and the provider’s operations. Broadly, CNO responsibilities fall under one of three categories: leadership, administration and practice.
In terms of nursing administration, CNOs may be involved in everything from medical supplies contracts to organizational expansion. As practicing nurses, CNOs must ensure a high degree of patient care and safety, along with nursing staff support.
Specific job responsibilities will vary with the work environment and size of the organization, but generally a CNO’s core duties include:
- Overseeing and assessing nursing department performance
- Establishing departmental goals, policies and processes
- Monitoring quality of care; developing and implementing improvement plans
- Managing department finances; fundraising and negotiating with vendors
- Managing patient billing and revenue operations
- Investing in new health care technologies
- Recruiting and cultivating new leaders, as well as motivating and engaging current nursing staff
- Acting as a liaison to other health care and nursing institutions or professional organizations
- Ensuring compliance with federal and state laws at a high level
- Advocating for nursing and patient-focused causes to other executives and decision-makers
- Representing nurses and the organization in a professional capacity
- Contributing to strategic organizational vision, culture and decision-making
- Collaborating with physicians and other leaders
- Fostering an inclusive and supportive workplace for nurses
- Lobbying for health care, nursing and patient issues
Though CNOs do not often supervise the minor details of day-to-day operations, they are kept informed and may respond or intervene if and when necessary.
Chief nursing officer salary and job outlook
The American health care industry is growing rapidly, with an aging population creating more demand for care services. As health care organizations and their workforces grow, there will be an even greater need for skilled and experienced professionals to take on executive nurse management positions. The U.S. Bureau of Labor Statistics (BLS) predicts 6% job growth for top executives between 2018 and 2028. The employment of medical and health services managers — which can align with the CNO role — is expected to increase 18% in that same time frame.
Evidence of CNOs being in demand also comes from the competitive salaries they could earn. According to the BLS, top executives made an annual median salary of $104,980 in 2018; but top executives in health care were among the highest paid in the executive cohort, earning a median annual salary of $173,770.
Other salary estimates available from job-posting sites further illustrate the financial potential of becoming a nursing officer. Beyond base salary, CNOs stand to also earn from bonuses, profit-sharing and/or vested stock options (which are commonly included in executive total compensation). According to PayScale, the average CNO salary in 2019 was $127,739, while GlassDoor measured it at $120,005 in 2019. ZipRecruiter ($136,250) and Salary.com ($231,110) reported on the high end for average CNO salaries.
Regarding the work environment, CNOs can be found in all types of health care organizations, from regional or private hospital systems to state and federal public health agencies. Large employers are not the only option. Small and medium-sized providers also need executive nursing talent. CNOs can find work in outpatient centers, community clinics, physicians offices and surgical centers.
How to become a chief nursing officer
The first thing any ambitious student should know about becoming a chief nursing officer is that it takes time. CNOs often work their way up from registered nurse to nurse manager to nurse administrator to nurse director, for example. They must also achieve a high level of education. Many organizations look for candidates who hold a master’s degree, but often prefer nurses with doctorates.
Let’s walk through the fundamental steps to becoming a chief nursing officer, including education, skills and experience:
Earn a bachelor’s or equivalent
The CNO career path starts with earning a bachelor of science in nursing (BSN), or a similar degree like an associate degree of nursing (ADN) or a nursing diploma from an approved program. In a typical undergraduate education, nursing students will gain an introduction to core competencies including:
- Human anatomy and physiology
- Microbiology and chemistry
- Behavioral and life sciences
- Fundamentals of nursing theory and practice
- Basic pharmacology
- Disease prevention and health promotion
- Data management and health care technology
During their studies, nurses will start to build clinical hours and experience, whether through clinicals or another experiential learning opportunity. This is key to testing classroom-taught skills and knowledge in a practical environment.
Become a registered nurse
A main objective of any BSN, ADN or nursing diploma program is to prepare graduates to sit for the National Council Licensure Examination (NCLEX-RN). The exam is the standard for licensing registered nurses and is administered by the National Council of State Boards of Nursing (NCSBN).
It’s highly important to inquire with your state’s board of nursing about eligibility criteria, because each state may have different requirements. Nurses who take the NCLEX-RX must complete a minimum of 75 questions, and can complete a maximum of 265. The content of the exam assesses four areas of nursing practice:
- Physiological Integrity: Basic care, dosage calculations, therapeutic procedures, medical emergencies, illness management
- Safe and Effective Care Environment: Interdisciplinary collaboration, case management, incident prevention, safe use of equipment, ethical practice
- Health Promotion and Maintenance: Health screening, physical assessment, health promotion, disease prevention, lifestyle choices
- Psychosocial Integrity: Mental health concepts, stress management, support systems, family dynamics, grief and loss
The NCLEX-RN is administered in-person and electronically for a fee of $200. You have up to six hours to complete as much of the examination as you can. If you fail, you must wait 45 days until the next attempt and pay $200 for each time you sit for the exam. Nurses get eight attempts per year and there is no maximum lifetime number of attempts, although varying state regulations may apply.
Earn a master’s degree
A graduate degree is crucial to becoming a CNO. Fortunately, there are a number of master of science in nursing (MSN) programs that accept students applying with a BSN, ADN or nursing diploma. Some may also accept bachelor’s degrees in fields other than nursing, while additional accelerated tracks exist for RNs to enter without a bachelor’s and still earn an MSN. Each program will have a different time-to-completion based on the entry, so be sure to research your options.
A graduate education is so important because prospective CNOs start to gain an understanding of operational, managerial and leadership aspects of nursing and health care provider roles. Some of the core subject matters addressed in MSN studies include:
- Principles of advanced nursing practice
- Evidence-based practice
- Health care organizational management and finance
- Statistical procedures and health informatics
- Nurse advocacy and health care policy
- Leadership in health care systems and delivery
In addition to completing coursework, hundreds of clinical hours are required to earn an MSN. Students may complete internships, practicums or seminars to satisfy these requirements — even in online MSN programs, like Bradley’s, which allow students to select approved local sites and preceptors.
Another note about MSN programs is the opportunity for specialization. Earning an MSN with a focus in administration is one option would-be CNOs may want to investigate to gain further operational expertise. Health care organizations may consider candidates who don’t hold an MSN, but earned an MBA.
The next step to becoming a CNO is getting certified by an officially recognized credentialing body and joining a professional nursing organization. Certification is an independent endorsement of a nurse’s skills and knowledge.
There are hundreds of different certifications available — from family nurse practitioner to certified registered nurse anesthetist — and there are certifications designed for nurse executives, including:
- Nurse Executive (NE-BC) and Nurse Executive, Advanced (NEA-BC), offered by the American Nurses Credentialing Center (ANCC)
- Certified in Executive Nursing Practice (CENP), offered by t the American Organization of Nursing Leadership (AONL)
- Certification by the American College of Healthcare Executives (ACHE)
Be sure to research the eligibility criteria for each type of certification, as well as the requirements for continuing education to keep your credentials active and up to date.
Pursue a DNP
Earning a doctor of nursing practice (DNP) represents the ultimate level of preparation for practice-focused nurses. While the doctor of philosophy (PhD) in nursing is research-focused, the DNP is designed for nurses seeking a terminal degree in nursing practice. Thus, it is an ideal degree for top nursing executives to have.
While pursuing a doctorate, nurses will refine their skills, gain new insight, and expand their clinical experience and expertise.
According to the AACN, every accredited DNP program has eight core learning objectives:
- Scientific underpinnings for practice: Integrating nursing science with ethical, psychological, analytical and organizational knowledge
- Organizational and systems leadership for quality improvement and systems thinking: Evaluating care delivery and operational cost-effectiveness, developing and implementing quality or cost initiatives
- Clinical scholarship and analytical methods for evidence-based practice: Using information technology to inform quality of care improvements; tracking, analyzing, interpreting and leveraging data
- Information systems/technology and patient care technology for the improvement and transformation of health care: Designing and maintaining systems that monitor and evaluate care outcomes and patient interactions
- Health care policy for advocacy in health care: Acting as an advocate and providing leadership to all levels of nursing; understanding how policy is made and enacted
- Interprofessional collaboration for improving patient and population health outcomes: Ensuring effective communication and collaboration between departments
- Clinical prevention and population health for improving the nation’s health: Analyzing cultural diversity and epidemiological, environmental and biostatistical records as a function of managing population health
- Advanced nursing practice: Demonstrating advanced knowledge of clinical judgment, accountability, evaluation and improving patient outcomes
Logging clinical hours plays a major role in earning a DNP. For example, Bradley’s online DNP-Leadership program requires 1,000 clinical hours, which includes hours earned in the master’s program. And as the program title indicates, nursing students will have the option to focus their doctorate in an area of practice. Those who focus on leadership are that much more prepared to take on the duties of the nursing executive.
Complete your DNP online at Bradley
For nurses who aspire to become a chief nursing officer, a DNP can offer the highest degree of clinical and organizational preparation. And nurses can build increased leadership capacity by completing the DNP-Leadership online program offered by Bradley.
Earn your degree 100% online in three years, and choose your own local sites and supervisors to complete clinical hours.
Ready to take the next step in your career? Contact an enrollment advisor today.
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National Council of State Boards of Nursing
American Nurses Credentialing Center
American Organization of Nursing Leadership