Rising to the Top of the Unit: How to Become a Chief Nursing Officer

Nursing executives affect patient outcomes and work to improve the patient experience and yet, paradoxically, do little to no direct patient care. As the highest-ranking member of their department, a chief nursing officer (CNO) oversees operations that impact the quality of nursing, from budget development to staff management to regulatory compliance. In a pinch, they might even do clinical rounds.

The chief nursing officer reports directly to a facility’s chief executive officer or chief operating officer and oversees hundreds of nurses and other workers. They are the bridge between the executive team and the nursing department. Part of a CNO’s job is to understand the needs of patients and staff and then communicate those needs to their fellow executives and the board.

Does becoming the highest-ranking administrative nurse in your organization sound like your dream career? In this article, you’ll learn how to become a chief nursing officer. It covers:

• What does the chief nursing officer do?
• Top chief nursing officer skills
• Steps to become a chief nursing officer
• Certifications for chief nursing officers
• Additional steps you can take to become a chief nursing officer
• Is becoming a chief nursing officer right for you?

What does a chief nursing officer do?

Most patients in doctor’s offices and hospitals interact with nurses more than with any other medical professional. What they don’t see are the many nurse administrators who work behind the scenes to coordinate that care. Nonetheless, CNOs (and other nurse administrators) are essential to every patient care team.

When you become a chief nursing officer, your day-to-day duties will involve:

• Recruiting, training, and monitoring nursing staff (and in some cases, non-nursing staff)
• Developing and managing departmental budgets
• Designing and implementing strategic goals for the department
• Creating and overseeing patient care and education initiatives
• Developing best practice guidelines for nurses at your organization
• Managing human resources
• Managing departmental finances
• Coordinating daily nursing operations
• Creating staff retention programs
• Conducting performance assessments
• Planning new patient services
• Working closely with the board of directors and other executives
• Representing the nursing department at board meetings
• Ensuring that the department complies with regulations

A CNO is responsible for creating an environment that empowers nurses to offer patients the best possible clinical care. As CNO, you will be held accountable for patient outcomes and for the quality of medical and bedside care your nurses provide. You’ll also be responsible for the nursing department’s impact on your employer’s bottom line.

CNO Wilhelmina Manzano of New York’s Presbyterian Hospital told Healthcare Innovations that the key things she focuses on in her role as a CNO are “maintaining a healthy, competent, robust nursing workforce; aligning nursing’s goals with the hospital’s so I can better support the organizational initiatives; improving the work environment of the nursing staff; leadership development… efficiency and patient safety; and of course, how healthcare reform will impact healthcare organizations and hospitals, including nursing.”

It’s a challenging job. You will be under a lot of pressure whether you work at a hospital, outpatient care center, outpatient surgery center, urgent care clinic, group practice, rehabilitation facility, or other healthcare facility. In return, you’ll be well compensated: the average CNO salary is about $125,000 per year, though chief nursing officers in large hospitals or healthcare systems may make much more.

Top chief nursing officer skills

Becoming a chief nursing officer takes more than nursing skills. You may spend anywhere from three years to a decade working with patients before moving into an administrative or managerial role, so you do need clinical skills. But to make it to the top of the nursing ladder, you’ll also need:

• Business skills
• Communication skills
• Interpersonal skills
• Leadership skills
• Problem-solving skills

That’s because CNOs are executives, and the role itself is a leadership position.

Chief nursing officers need to be able to assess the strengths and weaknesses of entire departments and then make strategic decisions that result in better patient care—without burning through available resources. As CNO, you will have to weigh the needs of patients and nurses against the business needs of your employer. That won’t always be easy, and you’ll likely always wish you had more (funds, staff, etc.) to work with. The ability to compromise and to get creative will serve you well in this role.

Steps to become a chief nursing officer

As in most professions, a chief nursing officer’s preparation begins with education.

Most CNOs start out by earning a bachelor’s degree in nursing (BSN). Some begin by completing an associate’s degree in nursing (ADN) to become an RN, but if you’re starting from scratch, it makes more sense to start with the BSN, which you will ultimately need. Make sure to study at a school accredited by the American Association of Colleges of Nursing (AACN) or the National League for Nursing(NLN). MSN programs require that your BSN come from an accredited program.

As you study for your bachelor’s degree, you’ll take courses in:

• Anatomy
• Emergency care
• Health assessment
• Nutrition
• Pathophysiology
• Physiology
• Public health

Depending on where you study, you may have the option to choose a minor. Business administration is an excellent minor option for aspiring CNOs because coursework will touch on leadership, finance, and communications. Once you earn your BSN, you can take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam to receive your RN license and begin working in medical and clinical settings, including doctor’s offices, hospitals, surgical centers, long-term care facilities, and the ER. This is important because many employers will only employ nursing administrators with at least five years of patient care experience.

If you’ve already earned an ADN and are working as a registered nurse, there are RN-to-BSN programs that take just one or two years to complete at:

• Sacred Heart University
• University of Louisiana at Lafayette
• University of Oklahoma – Health Sciences Center
• University of South Alabama
• The University of Texas at Arlington
• The University of West Florida

After graduating with a BSN, you’ll need to earn a master’s degree. Many aspiring chief nursing officers opt for Master of Science in Nursing degrees with a concentration in nursing administration or nursing leadership, though some choose the Master of Health Administration or even dual MHA/MBA or MSN/MBA degrees instead. The important thing is to make sure that the master’s degree program you choose includes coursework covering relevant topics like:

• Healthcare administration
• Healthcare human resources management
• Healthcare quality and safety
• Leadership development in healthcare
• Economics in healthcare
• Translating research to practice
• Financial management
• Nursing informatics

There are RN-to-MSN programs that can help you earn a master’s degree in less time—usually in four years instead of the six years it would take to earn a BSN plus an MSN. If you’ve already completed a BSN program, you should also look into online and hybrid MSN programs at schools like:

• Duke University
• Georgetown University
• Ohio State University

Once you’ve earned your MSN or another nursing administration-focused master’s degree, advancing to CNO is typically all about work experience. However, some aspiring CNOs do choose to go on to earn a doctoral degree in nursing practice (DNP) with a concentration in executive administration.

Certifications for chief nursing officers

Earning professional nursing administration certifications may not be necessary to land a CNO position, but it does demonstrate your commitment to continuing education and best practices.

Relevant certifications include:

• Certified in Executive Nursing Practice (CENP) – granted by the American Organization for Nurse Executives (AONE)
• Nurse Executive (NE-BC) – granted by the Amernican Nurses Credentialing Center (ANCC)
• Nurse Executive, Advanced (NEA-BC) – granted by the ANCC
• Fellow of the American College of Healthcare Executives (FACHE) – granted by the American College of Healthcare Executives (ACMPE)
• Certified Medical Practice Executive (CMPE) – granted by the ACMPE

Additional steps you can take to become a chief nursing officer

You can start taking steps to make yourself a more attractive candidate for CNO positions while you’re still in nursing school and at the start of your career. During your undergraduate and master’s degree years, look for a mentor who is in a healthcare leadership position. When you’re working as a clinical nurse after graduation, make sure your supervisors and managers know that you’re interested in advancing to supervisory roles (because not everyone is). After you land your first administrative role, get your Nurse Executive (NE-BC) certification through the American Nurses Credentialing Center.

The typical advancement path CNOs follow takes them from nurse to assistant nurse manager to nurse manager to nurse director. At each stage, they have increasing responsibilities and influence. Advancing from one position to another is sometimes a matter of moving from one organization to another, but it’s also possible to advance in the same organization. If your long-term goal involves staying at your current place of employment, it’s worth letting your employer know that you’re looking to advance in your career.

Is becoming a chief nursing officer right for you?

If your goal is to make the most significant impact on patient outcomes, chief nursing officer is a great way to accomplish it. That said, there are pros and cons to becoming a chief nursing officer that you need to consider. Let’s look at the potential cons first.

Cons of becoming a chief nursing officer

• You’ll do little to no clinical care. If what attracted you to nursing in the first place was the opportunity to interface with patients, you probably won’t thrive in the CNO position. Becoming a nurse practitioner may be a better option.
• You’ll need to go back to school if you don’t have a master’s degree in nursing. Not everyone can afford to take the time off or handle the stress of working plus going to school.
• Stepping into an executive role involves taking on more stress. The lives of patients and the careers of nurses will be in your hands. You’ll work long hours and have a lot of responsibility resting on your shoulders.

Depending on what you’re looking for in your career, the pros of becoming a chief nursing officer may overshadow the cons.

Pros of becoming a chief nursing officer

• The high salary is a definite pro, but more important may be the fact qualifying to be a CNO will open lots of other opportunities as well. The job outlook for medical and health services managers (a category that includes CNOs) is good. The Bureau of Labor Statistics predicts that employment opportunities will grow much faster than the average for all occupations. The competition for CNO spots may end up being fierce (as each organization usually only has one CNO), but you’ll also be qualified to step into nurse manager and other well-paying nurse executive roles, where you’ll have almost as big of an impact on patient outcomes.
• You’ll be in a position to have a meaningful impact on outcomes for many patients. Your decisions will affect hundreds, not just those patients you’d treat daily as a clinical nurse. If you relish responsibility and take satisfaction in positively impacting processes and outcomes, it’s hard to beat the chief nursing officer role. You’ll be doing those things all day, every day.

(Last Updated on February 26, 2024)

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