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Career Spotlight: How to Become a Chief Nursing Officer

April 30, 2020  |  Category: Nursing

Chief nursing officer leads a staff meeting.

As our nation faces unprecedented difficulties in the wake of rising pandemics and other health challenges, patients, doctors, and the health system at large rely on the critical services nurses deliver. Whether providing patient care such as vaccinations, rehabilitation, and health education or advocating for patients’ needs, nurses play an essential role in disease prevention, health promotion, and patient recovery.

The Current State of Nursing

Medical facilities ranging from clinics to hospitals to nursing homes depend on nurses who specialize in every area of healthcare, including urgent care, psychiatry, hospice, labor and delivery, geriatrics, and pediatrics. However, the American Association of Colleges of Nurses projects a nursing shortage in coming years. The U.S. Bureau of Labor Statistics (BLS) expects that the U.S. will need more than 200,000 additional nurses each year through 2026. Several factors are contributing to this shortfall.

The U.S. Census Bureau reports that between 2012 and 2050 the number of Americans aged 65 and older will nearly double. This rapidly growing segment of the population will greatly intensify the demands on the healthcare system. At the same time, large numbers of nurses are reaching retirement age, with more than 50 percent of the nurse workforce 50 years of age and older, according to a 2018 survey.

In addition to the demand for nurses, the effectiveness of healthcare organizations depends on skilled management. Chief nursing officers (CNOs) fill important leadership roles when it comes to ensuring the efficiency and effectiveness of nursing departments. As strategic leaders overseeing operations, they can have a significant impact on patient outcomes and experiences. Their work positions them beside other C-suite leaders, making the CNO a vital link between nursing departments and executive teams in medical organizations.

Reaching high-level leadership positions in healthcare requires the right experience and education. Aspiring CNOs can propel their careers forward by earning a Master of Science in Nursing to cultivate the expertise needed to lead in the field.

What Is a Chief Nursing Officer?

Nurses often specialize, allowing them to offer expert care to patients with respiratory diseases, substance abuse issues, cardiovascular conditions, and other health concerns. In each of these areas, CNOs, who may not directly provide patient care, work behind the scenes coordinating the day-to-day operations that empower nurses to deliver high-quality care.

Chief nursing officers are sometimes called chief nurse executives, vice presidents of nursing, or head nurses. Whatever their title, these professionals are responsible for making sure nursing departments of medical facilities run smoothly.

A chief nursing officer heads a nursing department as the most senior member. As such, CNOs handle issues that greatly affect the quality of nursing care and make key decisions regarding:

  • Budgets
  • Managing staff
  • Complying with regulations

While overseeing a nursing staff, chief nursing officers report to chief executive officers (CEOs), acting as representatives of the nursing departments they head. This allows for communication and representation at the highest level of the organization about patients’ needs and how nursing departments can meet those needs.

CNOs also provide leadership to their departments, providing direction regarding policies and practices to nurses and nurse managers. Chief nursing officers set the tone that shapes their staff’s work environment, which can affect turnover rates and job satisfaction. Like any effective leader, they find ways to listen to the ideas and opinions of their staff to help improve how their departments are run.

Administratively, chief nursing officers help manage the business aspects of medical facilities. This involves organizing medical services and sometimes setting prices. In a nursing capacity, these leaders monitor for best practices and coordinate patient care. They also ensure nurses and nurse managers carry out a facility’s policies consistently.

The overall duty and goal of chief nursing officers is to deliver excellent patient care. They accomplish this by:

  • Collaborating with other hospital leaders to ensure strong communication between the administrative and medical sides of a healthcare facility
  • Seeking out opportunities to offer educational and orientation programs to their staff
  • Looking for ways to improve nursing procedures

Medical facilities hold chief nursing officers accountable for patient outcomes and the medical care the nurses in their departments deliver. They also expect chief nursing officers to be accountable for how their departments affect a facility’s bottom line.

Necessary Education and Training for Becoming a Chief Nursing Officer

Those wondering how to become a chief nursing officer should consider the required educational path.

Step One: Earn a Bachelor of Science in Nursing

All chief nursing officers must be registered nurses (RNs). Most CNOs begin this process by earning a Bachelor of Science in Nursing (BSN) degree from a program accredited by the Commission on Collegiate Nursing Education (CCNE) or Accreditation Commission for Education In Nursing (ACEN).

BSN degree programs cover key topics such as anatomy, physiology, and microbiology. Courses also teach students about health assessment, emergency care, and public health, while building the critical thinking and communication skills core to succeeding as a nurse. Clinical rotations under the supervision of a registered nurse also help students gain hands-on experience with patient care. Students hoping to cultivate their competencies in leadership and finance may elect to minor in business administration.

Step Two: Get a Nursing License

After earning a BSN or an associate’s degree in nursing, aspiring nurses can become licensed registered nurses (RNs) by successfully passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam.

Other requirements for an RN license vary by state. For example, some states require background checks. RNs may also opt to get specialty licenses in areas such as gerontology or ambulatory care, among many others, to gain expertise and give themselves a competitive edge in the job market.

Step Three: Build On-the-Job Experience

After licensing, RNs must apply and hone their skills in the real world. By working in either clinical or medical environments such as hospitals, doctors’ offices, or nursing homes, RNs expand their knowledge and develop a deeper knowledge of how to care for patients and how nursing departments run. This work experience can prepare RNs to move into leadership roles later in their careers. Most medical facilities expect nursing leadership job candidates to have at least five years of experience as RNs.

Step Four: Earn a Master of Science in Nursing or a Master of Health Administration

A Master of Science in Nursing (MSN) degree or a Master of Health Administration (MHA) degree can provide the deeper knowledge nursing leaders need to make critical decisions that shape nursing departments and patient care. Almost all CNO positions require an advanced degree.

MSN degrees often offer concentrations in nursing administration and leadership. The curricula are designed to cultivate knowledge in human resources, finance, healthcare systems, and governance, as well as deepen expertise in evidence-based nursing practices. MHA degrees focus exclusively on administrative management in healthcare, covering topics such as health informatics and managerial accounting.

To further prepare for leadership roles, some nurses earn a Doctor of Nursing Practice. However, not all C-suite medical positions require this level of education.

Chief Nursing Officer Responsibilities

Leadership positions in nursing offer dynamic and demanding work. The chief nursing officer job description encompasses administrative, medical, and leadership tasks that require advanced knowledge and understanding of nursing practice.

On a daily basis, chief nursing officers can find themselves engaged in any of the following:

  • Designing patient care strategies
  • Budgeting and financing
  • Setting quality and safety goals
  • Maintaining staffing levels
  • Creating policies for best practices
  • Hiring and training nursing staff
  • Developing and implementing strategic departmental goals
  • Maintaining nursing care supply inventories
  • Planning for and developing strategies to manage emergencies
  • Managing certifications
  • Reviewing regulations
  • Creating reports for improvement
  • Promoting patient health and wellness

Although CNOs do not work directly with patients, their responsibilities empower them to shape the care of patients systemwide. As the top leaders in nursing departments, CNOs are in charge of overseeing nursing managers, creating patient care strategies, and assessing nurse performance.

CNOs often collaborate with other executives in the C-suite. These executives rely on CNOs to use their expertise to advise and provide feedback about policies and procedures.

Together, CNOs and other executives tackle the challenge of balancing financial constraints while still delivering quality care. They may also collaborate to establish effective hiring processes or develop plans to improve nurse retention. Additionally, chief nursing officers help others in leadership positions stay abreast of the latest research on how medical facilities can best streamline operations.

Skills Chief Nursing Officers Need

Chief nursing officer positions require a range of skills, from leadership and mentoring to organization and communication. Chief nursing offers apply these essential skills on a regular basis:

  • Relationship building: To effectively lead their departments, CNOs must earn the trust and confidence of both their department members and their fellow executives.
  • Organization: To manage operations and nursing teams, CNOs must capably coordinate multiple tasks at once.
  • Mentorship: To build strong nursing staffs, CNOs must provide guidance, support, and opportunities to grow.
  • Communication: To serve as a liaison between top administrators and nursing departments, CNOs must communicate clearly and effectively.
  • Critical thinking: To tackle challenges and innovate strategies for delivering quality care, CNOs must think creatively and analytically.
  • Decision making: To problem solve and successfully manage patient care, CNOs must take corrective actions and think on their feet.

Where Do Chief Nursing Officers Work?

Chief nursing officers serve as a bridge between key decision-makers in healthcare facilities. They not only coordinate with C-suite level executives, they also collaborate with physicians and administrators throughout an organization to ensure patient care. This helps align the goals of the nursing department with those of the organization as a whole, while improving patient safety and the efficiency of care delivery.

Chief nursing officers work in a variety of settings including:

  • Hospitals
  • Government agencies
  • Clinics
  • Outpatient facilities
  • Primary care practices
  • Rehabilitation facilities
  • Group physician practices
  • Healthcare system offices
  • Nursing homes

Different job settings can influence the nature of a CNO’s position. Some settings require a CNO to work with large teams, while others call for specialized knowledge or interest in a particular area of nursing. Still other settings may call for more extensive leadership and executive experience.

CNOs working for large organizations such as hospitals or healthcare systems tend to manage large numbers of staff and coordinate patient care for a wide range of medical issues. Hospitals house various medical departments, and each department employs nursing staff directed by their own respective nursing managers. Hospital CNOs oversee all of these nursing managers. This demands considerable coordination and requires CNOs to manage patient care in many areas, ranging from cancer treatment to behavioral health.

Healthcare systems that govern several facilities also hire CNOs who create strategies for nursing care that reach across an entire healthcare system. They may also provide direction and support to different divisions within the system, including executive management groups and medical staff.

CNOs working for clinics, outpatient facilities, primary care practices, group physician practices, and the like tend to oversee smaller teams, which may offer opportunities to deal more closely with nursing staff. Additionally, CNOs in these positions may need experience in a specific area. For instance, a nursing home may want a CNO with extensive knowledge of geriatric nursing, while a rehabilitation facility may prefer CNOs with backgrounds in rehabilitation.

Salary of Chief Nursing Officers

Chief nursing officers face many challenges in demanding work environments, and they are well compensated. However, a chief nursing officer salary can vary according to a job candidate’s experience, certifications, and education.


Chief nursing officers with more experience in leadership positions can command higher salaries. PayScale data from March 2020 reports the following:

  • Chief nursing officers with less than five years’ experience earned annual incomes between $111,000 and $118,000.
  • Chief nursing officers with five to nine years’ experience earned annual incomes between $119,000 and $128,000.
  • Chief nursing officers with 10 to 19 years’ experience earned annual incomes between $129,000 and $143,000.


Although not all positions require certifications, CNOs who hold them often have a competitive edge when it comes to securing prestigious and well-paid positions. Relevant certifications for chief nursing officers include:

  • The Nurse Executive Certification and the Nurse Executive Advanced Certification, both offered by the American Nurses Credentialing Center
  • The Certified in Nurse Manager and Leader Certification and the Certified in Executive Nursing Practice Certification, both offered by the American Organization for Nursing Leadership

These certifications require candidates to hold at least a bachelor’s degree and sometimes a master’s degree, in addition to having an active RN license.


Almost all chief nursing officer positions call for advanced degrees. Nursing leaders holding a Master of Science in Nursing or another relevant advanced degree have a decided advantage over those holding only a bachelor’s degree, both in terms of improved job options and better salaries.

The median salary of chief nursing officers is about $128,000 a year, according to March 2020 PayScale data. However, along with experience level, geographic location can play a role in how much CNOs earn. For example, CNO salaries in Los Angeles, California, are markedly higher than those in Dallas, Texas. Chicago, Illinois, Miami, Florida, Las Vegas, Nevada, and Houston, Texas, also offer higher than average salaries, according to PayScale.

Pursue an MSN Degree and Become a Chief Nursing Officer

CNO careers offer exciting challenges and rewards to those devoted to delivering quality care. However, securing a position requires the right preparation and experience. Earning a Master of Science in Nursing can prove crucial to achieving this high-level professional goal.

AdventHealth University Online offers a Master of Science in Nursing degree designed to prepare students for successful careers in nursing leadership. The program offers two tracks that cultivate critical knowledge and skills in nursing administration and nursing practice. By selecting the program’s Administration and Leadership track nurses not only improve their skills, they also develop a competitive edge in the field.

Those inspired by the opportunity to improve the work environment of nurses, bring nursing issues into the boardroom, and innovate methods that improve clinical outcomes should consider becoming a chief nursing officer. Explore the benefits of earning an online Master of Science in Nursing from AdventHealth University Online and make a difference in healthcare.


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Indeed, Chief Nursing Officer and VP of Resident Care

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