Chief nursing officers walk a fine line: They must simultaneously advocate for nurses and for patients, a constant balancing act that brings eventual rewards. As one CNO stated in a study reported in Healthcare, “If my nurses are well taken care of, my patients will be taken care of.” It’s the CNO’s mission to give nursing staff a voice in patient care delivery, to the ultimate benefit of patients themselves.
Nurses interested in a career as a chief nursing officer must learn to manage everything from setting patient staffing levels and lengths of patient stay, to giving nursing staff optimal resources while staying within a strict budget.
What Does a Chief Nursing Officer Do?
A CNO supports their nursing staff with resources and leadership that empower nurses to give the best patient care possible, with an eye to the best possible patient outcomes. In large part, the CNO bears ultimate responsibility for the quality of nursing and, by association, the success of patient care in their organization.
Some specific CNO duties and responsibilities include:
While the chief nursing officer role is nonclinical, its administrative duties require CNOs to be grounded in clinical practices and operations. For instance, a CNO may see that their hospital’s nursing department lacks a specific patient service, such as follow-up care after treatment. They can implement training for their nursing staff on that service. CNOs can also partner with physicians to make decisions about a complicated situation regarding a patient or their family, such as decisions about end-of-life care.
A daily responsibility of CNOs is communication. In the course of a day, a CNO typically communicates with:
- Nurse leaders
- Administrative managers
CNOs ensure that all departments adhere to legal policies and regulations — maintaining a facility’s accreditation is another one of their essential job duties. Nursing administrators typically report to CNOs about retention programs for avoiding nurse turnover. In many situations, CNOs are responsible for recruiting, hiring, and training employees.
Chief nursing officers consult with other leaders and managers to strategize about establishing the best nursing practices, create retention programs, and determine staff salaries. A CNO is an advocate for nurses and physicians when communicating with the hospital chief executive officer (CEO). Determining budgets with the chief financial officer (CFO), particularly for nursing departments and units, is another major responsibility.
CNOs meet with the board of directors to discuss financial goals for meeting their hospital’s operational goals. They also oversee the planning of fundraising events on behalf of their organization to raise money for a specific department or program.
The day-to-day responsibilities of CNOs can vary depending on their healthcare environments. Some work environments include:
- Rehabilitation facilities
- Healthcare corporate offices
- Outpatient clinics
- Private practices with multiple doctors
How to Become a Chief Nursing Officer
While CNOs must understand business administration and finance, many begin their careers as nurses. The steps to becoming a chief nursing officer, including the necessary education and experience, are as follows:
Step 1: Earn a BSN
Individuals should earn a Bachelor of Science in Nursing degree to begin the process of becoming nurses. Typical courses in a BSN program include:
- Nursing Care of Individuals and Families
- Applied Pathophysiology
- Statistical Analysis for Decision Making
- Human Anatomy and Physiology
Step 2: Become a Registered Nurse
After nursing students earn their BSN from an accredited institution, they can qualify to sit for the NCLEX-RN exam; after passing the exam and following state requirements, they can become certified registered nurses. According to the Bureau of Labor Statistics (BLS), about 3.1 million registered nurses currently hold jobs in the U.S. About 60% work in hospitals, while others work in:
- Nursing homes
- Ambulatory healthcare services
- Educational institutions
- Residential care facilities
- Government agencies
Step 3: Earn an MSN
The process of becoming a chief nursing officer can take considerable time and effort. Most Master of Science in Nursing programs require RNs to have one to two years of experience before applying.
Nurses can choose to pursue an MSN degree for a variety of reasons: Some plan to work as nurse practitioners, while others want to serve as nurse educators. Others choose to gain experience in administrative positions, participating in the decision-making processes of their medical facility.
Step 4: Earn a DNP
While Doctor of Nursing Practice programs differ, most applicants should have an MSN degree as well as several years of experience in the field. DNP programs offer different specialties and concentrations for graduate nursing students to help them develop a deeper understanding of business administration, leadership and management, and healthcare informatics.
Job Outlook and Salary of a Chief Nursing Officer
Nursing professionals can take from 10 to 15 years to qualify to become a chief nursing officer. The BLS projects the number of jobs for top executives, including CNOs, will grow by 4% between 2019 and 2029, which is faster than the average growth projected for all careers.
According to the BLS, top executives in healthcare — including CNOs — earn an annual median salary of $166,410. Salaries for top executives can vary based on job location, medical organization size, experience, and education. According to PayScale, CNO salaries range from approximately $94,000 to over $200,000.