How to Become a Chief Nursing Officer


    Doctor sitting at desk in office on computer

    By: Kathleen Gaines, RN, BSN, MSN, BA, CBC

    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.

    Part One What is a Chief Nursing Officer?

    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 the top-level nurse within an organization and they oversee other nurses and the implementation of patient care.

    The CNO is the voice for 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 that 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. 

    Find Nursing Programs

    Part Two Chief Nursing Officer Salary

    According to payscale.com, as of May 2020, Chief Nursing Officers earn an average salary of $128,031 per year or $53.54 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 $111,381
    • 5-9 years of experience earns an average salary of $118,087
    • 10-19 years of experience earns an average salary of $119,348
    • 20 years+ of experience earns an average salary of $143,984

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

    • Los Angeles, California - $178,206 per year
    • Chicago, Illinois - $157,642 per year
    • Miami, Florida - $152,577 per year
    • Las Vegas, Nevada - $144,519 per year
    • Houston, Texas - $141,190 per year

    Salary.com reports much higher average salaries for CNOs. As of April 2020, they reported that the average yearly salary for a CNO in the United States was $232,500 with the range typically falling between $198,750 and $270,380

    Show Me All Specialized MSN Programs

    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. CNO’s 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. 

    Part Three What Do Chief Nursing Officers Do?

    A CNO can run a single hospital within a healthcare system or multiple hospitals 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. 

    Show Me All Specialized MSN Programs

    Part Four Where Do Chief Nursing Officers Work?

    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

    Part Five How Do You Become A Chief Nursing Officer?

    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, 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. 

    Show Me All Specialized MSN Programs

    Part Six CNO Certification

    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.   

    Graph depicting routes to becoming a CNL

    Eligible CNL Programs

    Test Information

    • 140 questions (130 scored and 10 pre-test) 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). 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 the 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

    Part Seven What is the Career Outlook for a Chief Nursing Officer?

    According to the U.S. Bureau of Labor Statistics, CNOs fall under the Top Executives category. Unfortunately, there is not a current breakdown of the specific career outlook for a CNO -- rather they are lumped together with other top executives. 

    As of 2018, there were 2,639,500 top executives in the U.S. and by 2028 there will be a need for 2,790,200 which is a 6% 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.

    Part Eight What are the Continuing Education Requirements for Chief Nursing Officers?

    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.

    Show Me All Specialized MSN Programs

    Part Nine Where Can I Learn More about Chief Nursing Officers?

    Becoming a CNO requires hard work, dedication, and determination. CNOs need to be able to multitask, have strong leadership skills, 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. 

    Find Nursing Programs

    FAQs

    • 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 $128,031 per year or $53.54 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:
        • Strong and direct vision
        • Powerful communication skills
        • Results-oriented approach
        • Integrity
        • Professional Growth
        • Emotional Intelligence
        • Compassionate
        • Decision-Making Skills
        • Strong clinical thinking skills
        • Goal-setting behavior
        • Flexibility and adaptability
        • Ready to Lead
        • Business Minded

    Nursing Scholarship
    Email Signup

    Nurse.org

    Find a job, learn, connect and laugh.

    Try us out.

    Join our newsletter