How to Become a Chief Nursing Officer

A Chief Nursing Officer (CNO) is a top-level, nonclinical, administrative position within a healthcare system. While CNOs no longer work at the bedside, those interested in management but still looking to work within a medical facility may find that a CNO is the perfect position for them. If you are considering becoming a CNO or think this is a path you might want to take in the future, this career guide will give you all of the information you need to make that decision.

A Chief Nursing Officer (CNO) is essential to any healthcare organization. It is a non-clinical administrative position, most commonly seen in hospitals throughout the United States. They are considered top-level nurses within an organization, and they oversee other nurses and the implementation of patient care.

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

They have demanding and complex roles that require accountability, leadership, and strong communication skills to lead the nurses in the organization to achieve quality patient outcomes. 

According to payscale.com, as of June 2022, Chief Nursing Officers earn an average salary of $134,414 per year or $60.62 per hour.

Specifically, the Chief Nursing Officer can earn a higher annual salary with increased years of experience. As per payscale.com, 

• 1-4 years of experience earn an average salary of $121,597
• 5-9 years of experience earns an average salary of $120,887
• 10-19 years of experience earns an average salary of $134,972
• 20+ years of experience earns an average salary of $148,732

Currently, the highest paying states for Chief Nursing Officers that have reported salaries, according to ziprecruiter.com, are as follows:

• Hawaii - $156,907 per year
• Massachusetts - $156,356 per year
• Connecticut - $155,351 per year
• Nevada - $155,264 per year
• Rhode Island - $151,609 per year

Salary.com reports much higher average salaries for CNOs. As of June 2022, they reported that the average yearly salary for a CNO in the United States was $245,280, with the range typically falling between $209,670 and $285,250. 

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Regardless of workplace settings, CNOs enjoy similar benefits. While actual benefits may vary depending on the institution, most include the following:

• Health insurance
• Certification Reimbursement
• Retirement Options
• Family Leave of Absence
• Maternity Leave
• Dental Insurance
• Dependent health insurance coverage
• Life Insurance
• Paid time off
• Relocation assistance
• Childcare
• Bereavement leave
• Vision Insurance
• Discounts
• Education Reimbursement
• Attendance at nursing conferences
• Conference Travel Expenses
• Relocation packages
• Other work-related travel

How to Earn More Money as a CNO

The salary for a CNO is often related to their experience and where they work. CNOs working in larger hospitals (299 beds or more) will typically earn more than small hospitals. Furthermore, depending on the hospital's performance, they may be eligible for bonuses. 

A CNO can run a single hospital or multiple hospitals within a healthcare system, depending on the size. This position is essential to the success of an organization and is generally considered a top-priority job.

A Chief Nursing Officer’s day-to-day duties will involve:

• Staff development
• Sharing responsibility for employee engagement, recruitment, and retention
• Implementing company standards of care, policies, and procedures
• Creating and implementing a schedule for safe staffing
• Delegating jobs to lower-level administrators in the nursing department
• Recruiting, training, and monitoring nursing staff and nursing ancillary 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
• Managing human resources
• Coordinating daily nursing operations
• Planning new patient services
• Working closely with the board of directors and other executives
• Ensuring that the department complies with regulations
• Fundraising on behalf of the nursing department
• Maintaining compliance approvals and accreditations
• Cultivating relationships across all departments and jobs
• Partnering with physicians to develop strategic plans

Chief Nursing Officers work to create an environment that empowers their nursing staff and allows them to provide the best possible patient care with the appropriate resources and support. They are held accountable for patient outcomes and the quality of bedside nursing care throughout an organization. Even though a CNO is not working at the bedside, they still oversee every aspect of the nursing department. 

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As an essential position in any healthcare organization, CNOs can work in a variety of settings. Some of the most popular are:  

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

To become a Chief Nursing Officer, you must first become a registered nurse and complete the following steps.

Step 1: Attend Nursing School

You’ll need to earn either an ADN or a BSN from an accredited nursing program in order to take the first steps to becoming a registered nurse. 

Step 2: Pass the NCLEX-RN

Study for and pass the NCLEX examination to become a registered nurse.

Step 3: Gain Experience or Continue Your Education

Nurses can choose to gain some nursing experience before going back to school or go directly into an MSN program, depending on their unique situation. ADN-prepared nurses will need to complete an additional step of either completing their BSN degree or entering into an accelerated RN to MSN program which will let them earn their BSN and MSN at the same time.

Step 4: Graduate with an MSN degree

In order to become a CNO, you’ll usually need at least a Master’s degree in nursing, typically in healthcare administration or nursing leadership. 

Step 5: Get Certified

Become certified in nursing management, leadership, and/or administration. See more on certification options in the next section. 

Step 6: Get a Job

Aspiring CNOs will want to obtain a job in management to get the experience they need. This can be something like a nurse manager, clinical leader or department manager.

Step 7: Enroll in a Doctoral Nursing Program or Gain Administrative Experience

This is not required but it is preferred for Chief Nursing Officers to earn a doctoral degree. You can also gain experience by working in administrative roles 

Step 8: Obtain a Position as a Chief Nursing Officer

You did it! It was a long road, but now you can start working as a CNO. 

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While there is no specific certification for a CNO, there are numerous certifications related to healthcare administration, leadership, and management. These include Nurse Executive, Certification (NE-BC), Executive Nursing Practice Certification (CENP), Nurse Manager and Leader Certification (CNML), Clinical Nurse Leader (CNL), and Nurse Executive, Advanced Certification (NEA-BC). We’ll dig into each of these below. 

Nurse Executive, Certification (NE-BC)

Eligibility Requirements

• Hold a current, active RN license
• Hold a bachelor's or higher degree in nursing
• Have held a mid-level administrative or higher position (e.g., nurse manager, supervisor, director, assistant director) OR a faculty position teaching graduate students nursing administration OR nursing management or executive consultation position full-time for at least 24 months (or the equivalent) in the last 5 years.
• Have completed 30 hours of continuing education in nursing administration within the last 3 years. This requirement is waived if you have a master's degree in nursing administration.

Test Information

• 175 questions (150 scored and 25 pre-test) multiple-choice examination
• 3.5 hours to complete
• ANA members: $295
• Non-members: $395

Certification Renewal:

• Every 5 years
• ANA members: $250
• Non-members: $350

Executive Nursing Practice Certification (CENP)

The Certification in Executive Nursing Practice (CENP) is for nurse leaders who are engaged in executive nursing practice.

Eligibility Requirements

• Hold a current, active RN license
• Hold a bachelor's degree in nursing + four years of experience in an executive nursing role
• Hold a Master’s degree or higher + two years of experience in an executive nursing role

Test Information

• 175 questions (150 scored and 25 pre-test) multiple-choice examination
• 3.5 hours to complete
• AONL members: $325
• Non-members: $450

Certification Renewal

• Every 3 years
• 45 contact hours of continuing professional education related to healthcare administration and leadership
• AONL members: $200
• Non-members: $275

Nurse Manager and Leader Certification (CNML)

The Certified Nurse Manager and Leader (CNML) credential is designed exclusively for nurse leaders in the nurse manager role.

Eligibility Requirements

• A valid and unrestricted license as a Registered Nurse; and
• Baccalaureate in nursing degree or higher plus 2080 hours of experience in a nurse manager role

OR

• A valid and unrestricted license as a Registered Nurse; and
• A non-nursing baccalaureate degree plus 3120 hours years of experience in a nurse manager role

OR

• A valid and unrestricted license as a Registered Nurse; and
• A Diploma or Associate Degree in Nursing plus 5200 hours of experience as a nurse manager

Test Information

• 175 questions (150 scored and 25 pre-test) multiple-choice examination
• 3.5 hours to complete
• AONL members: $300
• Non-members: $425

Certification Renewal

• Every 3 years
• 45 contact hours of continuing professional education related to healthcare administration and leadership
• AONL members: $200
• Non-members: $275

Clinical Nurse Leader (CNL)

Eligibility Requirements

• Be in their last term or a graduate of a CNL master's or post-master’s program accredited by a nursing accrediting agency recognized by the U.S. Secretary of Education that prepares individuals with the competencies delineated in the AACN white paper CNL Competencies and Curricular Expectations for Education and Practice.
• Registered Nurse licensure
• Submission of the candidates’ Education Documentation Form by the CNL Program Director.   

Eligible CNL Programs

Test Information

• 140 questions (130 scored and 10 pre-tests) multiple-choice examination
• CNL exam is scored on a scale between 150-500
• Must achieve a score of 350 or greater to pass
• Valid for 5 years
• Fee: $425

Exam Content Includes:

• Nursing Leadership (32%)
• Clinical Outcomes Management (23%)
• Care Environment Management (45%)

Certification Renewal

• Provide your current RN License number, state, and expiration date
• Comply with the Standards of Conduct
• List employment history within the 5-year CNL certification period (2,000 hours of professional practice). The job title listed as “Clinical Nurse Leader” is not required to be renewed.
• List 50 contact hours earned within the 5-year CNL certification period.
• Fee: $310

Nurse Executive, Advanced Certification (NEA-BC)

Eligibility Requirements

• Hold a current, active RN license in a state or territory of the United States or hold a professional, legally recognized equivalent in another country.
• Hold a master's or higher degree in nursing, or hold a bachelor's degree in nursing and a master's in another field.
• Have held an administrative position at the nurse executive level or a faculty position teaching graduate students executive-level nursing administration full-time for at least 24 months (or the equivalent) in the last 5 years.
• Have completed 30 hours of continuing education in nursing administration within the last 3 years. This requirement is waived if you hold a master's degree in nursing administration.

Test Information

• 175 questions (150 scored and 25 pre-test) multiple-choice examination
• 3.5 hours to complete
• ANA members: $295
• Non-members: $395

Certification Renewal

• Every 5 years
• ANA members: $250
• Non-members: $350

According to the U.S. Bureau of Labor Statistics, CNOs fall under the Top Executives category. Unfortunately, there is no current breakdown of the specific career outlook for a CNO; rather, they are lumped together with other top executives. 

As of 2022, there were 3,787,800 top executives in the U.S., and by 2032, there will be a need for 124,200 more, which is a 3% increase. Generally, CNO positions fill very quickly and are not always available. Often, interested individuals will have to relocate to find available positions. 

Interested in becoming a Chief Nursing Officer. Check out jobs here.

Chief Nursing Officers have the same continuing education requirements as other RNs. This will vary on a state-by-state basis. There are no specific CEU requirements for Chief Nursing Officers unless they have obtained an advanced certification. Even though CNOs no longer work at the bedside, they must maintain their RN certification. 

All advanced certifications require a minimum number of CEUs to maintain certification. These generally have to be related to administration, leadership, and management. They can also be used for RN licensure renewal. 

Generally, in order for an individual to renew their RN license, they will need to fill out an application, complete a specific number of CEU hours, and pay a nominal fee. Each state has specific requirements, and it is important to check with the board of nursing prior to applying for license renewal.

A detailed look at Continuing Nurse Education hours can be found here.

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• American Organization for Nursing Leadership
• American Hospital Association
• American College of Healthcare Executives
• American Nurses Credentialing Center
• Organization of Nurse Leaders

Becoming a CNO requires hard work, dedication, and determination. CNOs need to be able to multitask and have strong leadership in nursing and communication skills. Becoming a Chief Nursing Officer takes years of dedication and multiple levels of schooling and certification. It is not a quick process, and generally, individuals know they want to take an administrative path vs. bedside nursing path early in their career. 

• What is a Chief Nursing Officer?

  • Chief Nursing Officers (CNOs) are Registered Nurses who work at an administrative level. The individual reports directly to the President or CEO of the hospital and is one of the top management positions within a healthcare organization. A CNO is responsible for overseeing and coordinating all daily activities within the nursing department and is the spokesperson and is a figurehead of the nursing department within the healthcare organization. 

• What Does a Chief Nursing Officer Do?

  • CNOs work within an organization to improve efficiency and quality in delivering healthcare services, develop nursing department goals and objectives, recruit and supervise staff members, manage the finances of the nursing department, prepare and monitor budgets and spending, represent the nursing department and organization at investor meetings and/or on governing boards and communicate with all members of the medical staff and department heads. 

• How Much Do Chief Nursing Officers Make?

  • According to payscale.com, Chief Nursing Officers earn an average salary of $134,414 per year or $60.62 per hour.

• How Long Does it Take to Become a Chief Nursing Officer?

  • Becoming a CNO can take years of hard work and dedication and additional schooling beyond a traditional BSN. Often, it can take 10 to 15 years to obtain a CNO position within a company or healthcare system. Every individual follows a different path to becoming a CNO, but it generally takes many many years.

• What Qualities Should a CNO Possess? 

  • Becoming a CNO is not easy, and not everyone will have the qualities needed to be a strong and effective leader. Ideally, a CNO should have a strong and direct vision, good communication skills, leadership abilities, strong clinical thinking skills as well as flexibility and adaptability.

$100,000+ Doctorate RN Masters Non-Bedside Chief Nursing Officer