The chief nursing officer (CNO) role is an executive position that is among the highest nurses can obtain in their careers. A CNO oversees the entirety of nursing operations in a health care facility or network, acts as a representative of the nursing staff with upper management, and often helps shape various health and professional policies.

Fulfilling the obligations of a chief nursing officer requires advanced skills, knowledge, and experience. Aspiring CNOs can hone their expertise by pursuing an advanced education with a focus on nurse leadership. Earning a graduate degree can help nurses ascend the ranks and ultimately command a generous chief nursing officer salary.

A chief nursing officer, sometimes referred to as a chief nursing executive, is often the highest-ranking nurse at a health care facility or health system. They share the same rank as other C-suite executives, such as chief executive officers (CEO) and chief financial officers (CFO).

A CNO’s duties and responsibilities vary depending on the size and structure of the network or facility where they work. For example, a CNO for a single rural hospital will have a different day-to-day than a CNO for a nationwide network of hospitals.

Chief nursing officers work in a variety of settings, including hospitals, emergency medical centers, inpatient and outpatient clinics, medical research facilities, government agencies, nursing homes, and rehabilitation centers.

Regardless of their employment setting, a chief nursing officer’s job description generally includes many of the following duties and responsibilities:

• Budgeting and financial management: While a CFO manages the budget for a facility or network as a whole, the CNO is responsible for creating and adhering to the part of that budget set aside for nursing services and staff.
• Improving nursing efficiency: CNOs serve as advocates for nursing staff, and they often act as liaisons between nursing staff and upper management. They strive to ensure cooperation between various departments and use their resources to improve overall efficiency in nursing operations.
• Auditing and reporting: The CNO audits each nursing department regularly and creates reports based on their findings. Some CNOs are responsible for developing performance metrics that serve as benchmarks.
• Ensuring regulatory compliance: A significant aspect of a CNO’s role involves ensuring that the facility or network’s nursing staff adheres to regulatory and legal mandates.
• Creating and enforcing best practices for nursing: Nursing best practices are designed to improve efficiency, reduce costs, increase revenue, enhance patient satisfaction, and improve patient safety. CNOs often develop and implement these best practices and ensure that nursing staff follow them.
• Implementing new technologies and services: CNOs make important decisions about the various technologies and services used by nursing staff. They are responsible for purchasing technology and offering new services in accordance with their budgets to improve the quality of patient care.
• Improving patient outcomes and safety: Patient safety is always a top priority for health care facilities. CNOs research trends and examine data regularly, leveraging what they learn to implement services, protocols, and technologies that improve patient outcomes, enhance safety, or both.
• Nursing staff recruitment and retention: Though they may employ a nurse recruiter to handle the logistics of hiring, the CNO is ultimately responsible for hiring nursing staff. The CNO is also responsible for overseeing nurse retention and promotion as well as disciplinary measures.

A chief nursing officer’s salary is often affected by the skills they bring to the table, so developing these skills through education and experience is crucial. Relevant skills for CNOs include the following:

• Problem-solving: CNOs make important decisions every day and often face complex challenges. The ability to find solutions despite existing barriers and unforeseen complications is vital.
• Time management: CNOs juggle many responsibilities, so they must be able to divide the time available to them between their various priorities effectively.
• Risk management: Ensuring regulatory compliance and adhering to legal obligations are some of the most important aspects of a CNO’s job. Minimizing risk is essential for maintaining patient safety and facility reputation.
• Communication: CNOs act as liaisons between executive leadership and nursing staff as well as serving as patient advocates. Strong communication skills are essential to their success.

Becoming a chief nursing officer entails pursuing the proper education, obtaining the required credentials, and gaining experience in clinical nursing and nurse leadership positions.

Aspiring CNOs often begin their ascent by earning a Bachelor of Science in Nursing (BSN) degree. Many CNOs go on to earn a Master of Science in Nursing (MSN) as well, which builds on the foundational skills they acquired through their BSN, while also helping them develop leadership competencies.

The Doctor of Nursing Practice (DNP) is a terminal degree that prepares aspiring nurse leaders for successful careers. A DNP program typically includes several concentrations. The Nurse Leadership concentration of Regis College’s MSN to DNP program is ideal for aspiring CNOs.

A registered nurse (RN) license is the basic requirement for becoming a CNO. To obtain it, nurses must pass the NCLEX-RN offered by the National Council of State Boards of Nursing.

Those who want to pursue a CNO role can earn several additional credentials that demonstrate that they have exceptional leadership capabilities. While these credentials are generally not required to become a CNO, they are highly recommended. These include the Certified in Executive Nursing Practice (CENP®) and Certified Nurse Manager and Leader (CNML®) credentials, both from the American Organization for Nursing Leadership, as well as the Nurse Executive Certification (NE-BC®) from the American Nurses Credentialing Center.

Most employers prefer to hire CNOs with several years of clinical experience and multiple years of nurse leadership experience. CNOs are better equipped to act as advocates for patients when they have adequate bedside nursing experience, and serving in lower-level leadership positions helps them hone the necessary skills and expertise to take on an executive role.

Leadership experience includes several nurse management roles, such as:

• Nurse shift leader
• Nurse manager
• Nursing administrator

The median annual salary for a chief nursing officer was about $140,500 as of June 2023, according to Payscale. Some CNOs receive bonuses based on performance that range from $5,000 to as much as $49,000 per year on average.

Several other factors can influence a CNO’s compensation, including the size of the facility, the number of facilities included in the network, and the CNO’s experience. Payscale reports that the lowest-paid CNOs are those working in facilities with smaller budgets or those with less experience, and they earn around $99,000 annually. The highest-paid CNOs are those who have more experience or work for facilities with much larger budgets, and they can earn upward of about $216,000 per year.

According to the U.S. Bureau of Labor Statistics (BLS), the employment outlook for CNOs is exceptional. Employment of medical and health services managers, which includes these nurses, is expected to grow by 28% between 2021 and 2031, adding more than 130,000 new jobs. Additionally, overall employment of nurses is expected to grow tremendously over the next decade, creating a need for nurse administrators and executives to lead them.

A chief nursing officer is not only vital to individual health care facilities and networks but also to the future of health care across the country. As demand for health care services and the clinicians who provide them grows, so too will the need for skilled leaders.

Discover how you can have an impact on the delivery of quality health care by shaping policies and clinical procedures with Regis College’s online MSN to Doctor of Nursing Practice degree program. The program’s Nurse Leadership concentration covers essential topics for aspiring CNOs, including regulatory issues and organizational structures.

Learn more about how the program can help you realize your leadership potential.