A chief nursing officer (CNO) is a registered nurse who sits at the very top of the executive chain of command in a medical center or another healthcare system. The role of CNO is complex, requiring several years of nursing and leadership experience.

If you’re thinking about becoming a CNO or if you think this is a career path you’d like to take in the future, this career guide will provide you with all of the information you’ll need to make that decision.

Table of Contents

• What is a Chief Nursing Officer?
• What Does a Chief Nursing Officer Do?
• How to Become a Chief Nursing Officer
• Where can a Chief Nursing Officer Work?
• Chief Nursing Officer Salary
• What Skills Does a Chief Nursing Officer Need?
• Pros and Cons of Being a Chief Nursing Officer
• Schools that offer Master of Science in Nursing (MSN) Programs
• Chief Nursing Officer Career Outlook
• FAQs About Chief Nursing Officers

What is a Chief Nursing Officer?

Any healthcare organization requires a Chief Nursing Officer (CNO). It is a non-clinical administrative position that is common in hospitals across the United States. They are the highest-ranking nurse in an organization, and they supervise other nurses as well as the delivery of patient care.

The CNO is the voice of the nurses in an organization, and they must collaborate with the staff to deliver the healthcare organization’s mission, values, and vision. This non-clinical administrative position does not work directly with patients but supervises those who do.

What Does a Chief Nursing Officer Do?

Chief nursing officers, like other high-ranking executives within a healthcare organization, are responsible for developing and implementing policies that will help ensure the organization’s success. 

Though the title “chief nursing officer” does not refer to a clinical position, CNOs must have prior hands-on patient care experience to be successful in this role because they are frequently asked to assess the efficacy of various clinical interventions. 

Duties and Responsibilities

A chief nursing officer’s responsibilities include the following:

Improving nursing efficiency throughout the healthcare organization

A good CNO advocates for nurses and promotes a workplace characterized by efficient communication, interdisciplinary cooperation, and responsible resource deployment.

Budgeting and financial asset management

CNOs are in charge of budgeting for all nursing departments and nursing services in the organization that employs them. Nursing salaries alone account for 40% of the routine costs associated with every hospital, so the CNO’s impact on the overall budget of a facility can be significant.

Creating departmental metrics and conducting departmental audits

Chief nursing officers approve quantifiable measures, known as metrics, that are used in nursing departments to ensure quality patient care. They also participate in the process of determining how each nursing department meets its benchmarks.

Managing a team of direct reports

The chief nursing officer typically supervises a facility’s director of nursing as well as the nurse managers who oversee the various types of specialized patient care and services provided by that facility.

Ensuring compliance with government regulations and best nursing practices

Because healthcare is one of the most heavily regulated industries, one of the major responsibilities of a CNO is making sure that all nurses in an organization follow legal mandates designed to protect patients’ rights, safeguard privacy, and combat abuse and fraud. CNOs also promote evidence-based nursing practices.

Making plans for new patient services

CNOs are in charge of implementing measures to improve healthcare quality as well as coordinating the implementation of new nursing strategies.

Keeping patients safe

Patient safety is required by both government agencies and hospital administrators, and CNOs must ensure that nursing procedures, staff rules, and patient policies prioritize patient safety.

Implementing new technologies:

Chief nursing officers are constantly assessing and assisting in the implementation of new medical technologies that have the potential to improve nursing operations and patient outcomes.

Recruiting and firing:

Nurse managers are typically in charge of hiring and terminating staff nurses. All hires and firings, however, must be approved by the CNO.

Developing retention strategies:

RN turnover has increased dramatically since 2020. Designing effective nurse retention programs is one of the CNO’s most important tasks.

Contacting senior administrators:

Nurses are represented at administrative meetings by CNOs. They provide regular updates to hospital CEOs and executive board members on developments affecting the hospital’s nursing services and nursing staff.

Optimal nurse-physician collaboration:

Positive patient outcomes in a hospital setting require collaborative efforts between nurses and physicians. CNOs set the tone by encouraging trusting and mutually respectful interaction.

How to Become a Chief Nursing Officer

Despite the fact that 26% of chief nursing officers have associate degrees from community colleges or hospital diploma programs, these CNOs are typically on the older end of the nurse leadership spectrum and are planning to retire in the next few years. Approximately 71% of CNOs have BSNs, and 24% have advanced their education to the MSN level. 

It’s safe to say that if you want to be a chief nursing officer today, you’ll need at least a BSN. That means you’ll need to have a diploma from high school. Because admission to college and university nursing programs is competitive, your high school transcript should have included chemistry, biology, and math classes.

The following are the things you must have in order to become one:

Nursing School

You must attend nursing school. To take the first steps toward becoming a registered nurse, you must first obtain an ADN or a BSN from an accredited nursing program.

NCLEX-RN

The second step is to prepare for and pass the NCLEX examination in order to become a registered nurse.

Gain Experience or Continue Your Education

Depending on their circumstances, nurses can choose to gain nursing experience before returning to school or to enroll directly in an MSN program. ADN-prepared nurses will need to take an additional step, either finishing their BSN degree or enrolling in an accelerated RN to MSN program, which will allow them to earn their BSN and MSN simultaneously.

MSN Degree

A master’s degree, typically in healthcare administration or nursing leadership, is usually required to become a CNO. Currently, less than 25% of all CNOs have an MSN, but that percentage is expected to rise dramatically in the coming years. MSN nursing programs specialize in specific areas of expertise, and MSN nursing administration programs best prepare RNs to assume leadership roles. 

Certification

The next step is to obtain certification in nursing management, leadership, and/or administration. There are numerous credentialing centers that provide certification options to supplement a Chief Nursing Officer’s degree education and professional experience.

Job Experience

Aspiring CNOs will want to work in management to gain the necessary experience. This could be a nurse manager, clinical leader, or department manager.

Doctoral Nursing Program or Administrative Experience

A doctorate is not required for chief nursing officers, but it is preferred. Administrative positions can also help you gain experience. If you want to be a chief nursing officer, you should think about taking this final step.

Where Can a Chief Nursing Officer Work?

Chief Nursing Officers typically oversee nursing departments and represent nurses to other healthcare and business administrative professionals in boardrooms. They generally work full-time, but their hours can be irregular (such as 12-hour shifts), in the evenings, overnight, or on weekends, depending on the employer and situation.

Because a chief nursing officer must maintain constant communication with the nursing staff he or she supervises, the country’s nearly 37,500 CNOs typically work from onsite offices at their employers. CNOs work for 84 percent of organizations that provide direct patient care. Another 6% work for government agencies, while 3% work in private industries such as insurance or pharmaceutical firms.

Chief nursing officers may work in the following settings:

• Hospitals
• Outpatient clinics
• Healthcare system corporate office
• Insurance corporate office
• Outpatient surgery centers
• Group physician practices
• Group Nurse Practitioner practices
• Government agencies
• Rehabilitation facilities

Chief Nursing Officer Salary

A chief nursing officer’s starting salary is $47.46 per hour, $8,230 per month, or $98,710 per year. Executive employees in hospital settings, like chief nursing officers, are typically compensated using step rates; this guarantees that executives are paid equitably based on their job duties and seniority.

The average salary for a chief nursing officer is $65.50 per hour, $11,350 per month, or $136,250 per year. CNOs typically reach this milestone after five years of continuous employment. 

The salary of the Chief Nursing Officer is determined by several factors, the two most important of which are the cost of living in the location where the CNO works and the volume of patients that the healthcare facility where they work sees on a regular basis.

CNOs with one to four years of experience earn an average of $112,910 per year, which is 14% higher than the average CNO entry-level salary. Chief nursing officers with five to nine years of experience earn an average annual salary of $132,880, which is 35% higher than the average CNO entry-level salary. 

A chief nursing officer with at least two decades of experience is likely to earn $185,810 per year, or 88 percent more than the average entry-level CNO. If you’ve previously worked as a high-performing CNO at a healthcare facility, your starting salary as a chief nursing officer can be quite high.

What Skills Does a Chief Nursing Officer Need?

A chief nursing officer must be able to balance his or her role as a nurse and patient advocate while also understanding the importance of healthcare business. This necessitates a highly specialized skill set. The following are the most important qualities of a chief nursing officer:

Time administration:

Managing multiple concurrent projects within a given timeframe is no easy task. As a chief nursing officer, you must understand how to organize your time and divide it among competing priorities as effectively as possible.

Problem-solving:

Patients in the facility where you work as a CNO may face a variety of barriers to receiving quality healthcare, and you must be able to identify and address those barriers effectively. The nurses you supervise may also encounter problems that you must resolve.

Manipulation of data:

Chief nursing officers must have advanced computational skills in order to analyze and report data in formats that nurses and healthcare executives can comprehend.

Expertise in technology:

CNOs must be familiar with all standard electronic medical record (EMR) software, as well as the other technology and tools used to provide quality patient care in a rapidly changing hospital setting.

Risk management:

As a CNO, you will be responsible for ensuring regulatory compliance, which means you must have a thorough knowledge of the legal obligations that your nurses and other staff members face, along with extensive knowledge of nursing best practices.

Pros and Cons of Being a Chief Nursing Officer

The higher ranks of nurse management are viewed negatively by the majority of registered nurses. Only 11% of registered nurses want to be nurse managers of any kind. Here are the top 5 pros and cons of being a chief nursing officer.

Pros

You’ll have a lot of freedom.

Chief nursing officers have a lot of say over how their jobs are structured. The facility’s CEO and board of directors may set goals for them, but how those goals are met is often entirely up to the CNO. This provides chief nursing officers with numerous opportunities to implement their own independent vision of nurse excellence.

You will set your own hours.

You’ll never have to punch a time clock as a chief nursing officer. You can come to work whenever you want and leave whenever you want, as long as you complete everything your CEO expects of you. You’ll probably end up working far more than 40 hours per week, but on your own terms.

There will be plenty of opportunities for networking.

As a chief nursing officer, you will have the opportunity to meet other healthcare professionals who can provide you with new perspectives and ideas to help you in your professional role.

You’ll make a good amount of money.

One of the top benefits of being a chief nursing officer is the high pay. The average starting salary for this position is just under $100,000 per year, while CNOs with a decade of experience earn nearly $155,000 per year, which is more than 50% higher than the entry-level CNO salary. The average salary for a CNO is $136,250 per year, which is 81% higher than the average salary for all nurses ($75,330).

You’ll have the chance to learn new skills.

The CNO is in charge of overseeing all nursing operations in a medical facility. Chief nursing officers must, however, understand business administration and finance in today’s highly complicated healthcare delivery structure.

Cons

You will require additional education.

While 26 percent of working chief nurse officers are graduates of associate nursing or hospital diploma programs, those nurses have either gone on to earn BSNs and MSNs or are approaching retirement age. If you’re a young RN looking for a CNO position, you’ll almost certainly need a BSN and an MSN.

There will be paperwork and more paperwork.

Paperwork is required for executive positions such as chief nursing officer. As a chief nursing officer, you’ll be inundated with forms, memos, white papers, studies, executive summaries, reports, and other paperwork. If you dislike paperwork, becoming a CNO might not be the job for you.

You’ll be working more hours.

Another disadvantage of being a chief nursing officer is that CNOs typically work far more than 40 hours per week, making it difficult to maintain a fulfilling personal life. Despite the fact that CNOs work in an office, they frequently work past 5 p.m.

Unpopular decisions may have to be made.

Chief nurse officers are frequently forced to make decisions that are unpopular with the nursing staff as a whole. Another significant disadvantage of being a chief nursing officer is the requirement to travel frequently.

You will not be providing direct patient care.

The reason why the majority of nurses enter the nursing profession is that they enjoy the opportunity to provide hands-on services that have a genuine impact on people’s lives. In fact, more than twice as many nurses who want to advance in their careers hope to do so by expanding their clinical skills.

Schools That Offer Master of Science in Nursing (MSN) Programs

The University of Nevada–Las Vegas does not require applicants to submit GRE scores. Prospective students must submit three letters of recommendation, and international students must submit TOEFL scores. Students accepted to this program last year had an average undergraduate GPA of 3.62. In 2021, the program’s retention rate was 89.4%.

The Ohio State University does not require applicants to submit GRE scores. Prospective students must submit three letters of recommendation, and international applicants must submit TOEFL scores. Last year, students accepted to this program had an average undergraduate GPA of 3.5. In 2021, the program’s retention rate was 95%, and students needed 42 credit hours to graduate.

Georgetown University does not require GRE scores from applicants for its online master’s degree in nursing program. Prospective students must provide three letters of recommendation. Students accepted to this program last year had an average undergraduate GPA of 3.43. In 2021, the program’s retention rate was 85%.

Duquesne University does not require GRE scores from applicants for its online master’s degree in nursing program. Prospective students must submit two letters of recommendation, and international students must submit TOEFL scores. Students accepted to this program last year had an average undergraduate GPA of 3.53. In 2021, the program’s retention rate was 99%.

Texas Tech University does not require GRE scores from applicants for its online master’s degree in nursing program. Prospective students must submit two letters of recommendation, and international students must submit TOEFL scores. Students accepted to this program last year had an average undergraduate GPA of 3.51. In 2021, the program’s retention rate was 92.91%.

Chief Nursing Officer Career Outlook

According to the United States Bureau of Labor Statistics, CNOs are classified as “top executives.” Unfortunately, there is no current breakdown of a CNO’s specific career outlook; instead, they are lumped in with other top executives.

There were 2,639,500 top executives in the United States in 2018, and there will be a need for 2,790,200 by 2028, a 6% increase. CNO positions typically fill quickly and are not always available. Interested individuals are frequently required to relocate in order to find available positions.

FAQs About Chief Nursing Officers

How long does it take to become a Chief Nursing Officer?

How long does it take to advance to the position of chief nursing officer? It can take years of hard work and dedication, as well as additional schooling beyond a traditional BSN, to become a CNO. Obtaining a CNO position within a company or healthcare system can often take 10 to 15 years.

What qualities should a Chief Nursing Officer possess?

A chief nursing officer frequently possesses the following abilities:

• Interpersonal abilities
• Multitasking
• Leadership abilities
• Clinical and medical knowledge
• Understanding of healthcare technology
• Organizational abilities
• Detail-oriented
• Skills in observation and reporting
• Knowledge of policy and regulation in the industry

How much does a Chief Nursing Officer make?

The average starting salary for this position is just under $100,000 per year, while CNOs with a decade of experience earn nearly $155,000 per year, which is more than 50% higher than the entry-level CNO salary. The average salary for a CNO is $136,250 per year, which is 81% higher than the average salary for all nurses ($75,330).

If you’re seeking new challenge in the nursing field, consider exploring opportunities as an ER Nurse, Flight Nurse, Postpartum Nurse, or Utilization Nurse.