What Does a Chief Nursing Officer Do?

A chief nursing officer (CNO) doesn’t take blood pressure or test reflexes. In fact, CNOs don’t engage directly in patient care at all; they are high-level managers. A CNO’s responsibilities include:

• Ensuring patient safety
• Improving nursing policies
• Monitoring resource procurement and allocation

It takes decades, and a great deal of effort and accomplishment, to become a CNO. From their beginnings as a registered nurse to earning a graduate degree and eventually leading an entire nursing unit, there are no shortcuts to this leadership role.

Do you feel up to the challenge? In this article addressing the question what does a chief nursing officer do? we cover:

• Job description for a chief nursing officer
• Can a chief nursing officer advance their career?
• Chief nursing officer salary
• Education requirements for being a chief nursing officer
• Top graduate degrees for CNOs

Job description for a chief nursing officer

Chief nursing officers do a little bit of everything, except actually nurse sick patients. Jesus Cepero, RN, NEA-BC (Nursing Executive, Advanced Certification), Ph.D., head nurse at the University of Michigan’s Von Voigtlander Women’s Hospital (C&W), focuses on “leading all aspects of nursing practice to ensure the quality, safety, and successful execution of strategic initiatives across C&W.” It is the same way a general leads their command into battle; they won’t pick up a gun, but instead marshall the ones who do.

To take the metaphor further: a general does not usually make decisions on their own; instead, they work with other ranking officers to create a plan of attack. In the same way, Cepero works with the hospital’s chief clinical officer, executive director, and other stakeholders to “review and champion quality, safety, and operational initiatives to meet the needs of our patients, families, staff, and community.”

Though Cepero is (jointly) responsible for patient outcomes in his hospitals, there is no way he can interact with every patient or nurse each day. Instead, he continually evaluates how the nursing staff operates within the established hospital framework and seeks to improve patient outcomes.

Day-to day-duties of a CNO

Other head nurse job duties include:

• Speaking for all the nurses during executive meetings
• Providing nurses with continuing education opportunities
• Recruiting and training nurses and other staff
• Retaining top nurses
• Managing human resources
• Improving old services and creating new ones
• Conducting performance reports
• Developing and meeting department goals
• Creating and maintaining department budgets
• Complying with all relevant laws

Who does the chief nursing officer report to?

Though the CNO leads the nursing department, they must report to, and collaborate with, other hospital executives. Each hospital might have a different organizational structure, but some common job titles include:

• President and CEO
• Physician-in-chief
• Chief medical officer
• Chief learning officer
• Business development officer
• Chief operating officer

As the CNO, you might not deal with all (or any) of these people every day. Even so, you will regularly represent the nursing department during meetings with these executives and with the board of trustees.

Can a chief nursing officer advance their career?

CNOs can advance their careers, but there’s not a lot of headroom in nursing; CNO is pretty much the top rung. They might become a hospital CEO or COO, jobs that require at least as much business acumen as medical know-how.

If being a hospital CEO was always your goal, you probably should have stayed out of medicine; many CEOs don’t have a medical background. The most common master’s degree for hospital CEOs is a Master of Healthcare Administration. This degree trains students to create and implement policies on a wide scale, and to manage the complex economics of a healthcare facility. An MHA program covers everything from healthcare law and ethics to operations management to advances in healthcare practice.

Chief nursing officer salary

Chief nursing officers earn an average annual salary of $125,087. This is about one-third of a hospital CEO’s average salary, even without factoring in the stock options and benefits that could send their total compensation package into the millions.

Only eight percent of CNOs earn stock options and only 12 percent earn a fixed bonus. However, when compared to other nurses—and to the rest of the country—head nurses make a lot of money.

To put the numbers in perspective, here are some common nursing jobs and their customary pay:

• Registered nurse (RN) ($71,730)
• Emergency room nurse ($65,870)
• Clinical nurse specialist ($88,228)
• Nurse practitioner ($107,030)

Location is another variable that determines how much money a head nurse earns. For instance, the average CNO in Massachusetts makes $147,874. In Florida, the average is only $114,999.

Education requirements for being a chief nursing officer

It is good to familiarize yourself with how much money an RN earns since you will likely need to work as one for five to ten years. A CNO needs to know the ins and outs of nursing, which is why having practical experience is so important. It is tough to manage others without having performed the job yourself. So, how does one become a registered nurse?

Education requirements for becoming an RN

There are a number of ways to become an RN, but the best one is by earning a Bachelor of Science in Nursing (BSN). This four-year bachelor’s degree helps qualify graduates to take the NCLEX-RN, which all states require for licensure, plus any state-specific exams. Be sure that your undergraduate program is certified by the Commission on Collegiate Nursing Education (CCNE) or Accreditation Commission for Education in Nursing (ACEN). This will be important later on.

You can technically become a registered nurse by earning an two-year Associate Degree in Nursing (ADN), but it’s not recommended. Most nurses have BSNs, and there has been a huge push within the nursing community to make it the recommended degree.

Another benefit of the BSN is that it better prepares you to complete a graduate degree, which nearly all employers will require of their CNO. There are RN to BSN transition programs for nurses with ADNs, but it is a much easier, softer route just to get the preferred degree out of the gate. Once you have the right amount of experience—there is no set number of years, but five to ten is the conventional wisdom—it is time to earn a graduate degree.

Top graduate degrees for CNOs

There are a few ways to enter the world of nursing administration, but four of the best graduate degrees for CNOs are:

• Doctor of Nursing Practice (DNP)
• Doctor of Philosophy in Nursing (PhD)
• Master of Health Administration (MHA)
• Master of Science in Nursing (MSN)

Each degree has a different focus. For instance, an MSN is a more practical nursing specialty degree, though it can lead to nursing management. An MHA is a more management-focused program—the hospital CEO might have this degree as well. The DNP is a lot like the MSN, but it takes longer to complete. And a Ph.D. is often regarded as an academic degree (for those who want to teach nursing), but nurses with management aspirations can still benefit from it. All four degrees can help you develop essential skills for the CNO position.

Additionally, you might be asked to earn a leadership certification in order to become a hospital executive. CNOs often hold some of the following certifications:

• Nurse Executive, Advanced Certification (NEA-BC)
• Nursing Executive Certification (NE-BC)
• Certified Director of Nursing Exam (CDONA)
  Certified Medical Practicum Exam (CMPE)
• Certified Executive in Nursing Practice (CENP)

Not every hospital is going to have the same hiring requirements for its CNO. Some might want to promote an in-house nurse who knows the organization. In contrast, others might value hiring an outside candidate with the very best available qualifications.

The bottom line is this: the responsibility of a chief nursing officer is to improve the safety and functionality of the nursing department. Gaining experience and earning the best qualifications possible will set you up for future success.

Questions or feedback? Email editor@noodle.com