Chief Nursing Officer: The Steps to Becoming a Key Health Care Leader

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A smiling chief nursing officer holds a file.In any given health care facility, whether it’s a large hospital or a smaller medical practice, nurses perform an invaluable function. Their role may encompass anything from conducting diagnostic tests to administering key treatments. Furthermore, nurses often serve as liaisons between patients and providers, ensuring clear communication about treatment plans.

For nurses to fulfill their important duties, they need an environment that sets them up for success. That’s where the chief nursing officer, or CNO, comes into play. In many hospitals and even larger practices and clinics, the CNO provides leadership to the entire nursing team, creating a clinical context in which nurses can care for patients as effectively as possible.

The role of the CNO has always been important, and it’s becoming more critical all the time. Health care organizations across the board have warned of a looming nursing shortage as the U.S. population ages, health concerns become more acute and the health care environment becomes more fragmented. As a result, CNOs play an important role in mitigating the impact, both through recruitment and through efficient staffing.

Becoming a chief nursing officer offers ample opportunity to those who wish to make a positive impact on the health care industry and play a direct role in improving patient outcomes. This guide explores the position’s key responsibilities and outlines some preliminary steps that can be taken toward a career as a nurse leader.

The Role of the Chief Nursing Officer

It’s important for aspiring nurse leaders to understand the role the CNO plays in the hospital — one that encompasses key relationships with nurses, providers, patients and board members.

What Is the Role of the Chief Nursing Officer?

At the most basic level, a CNO is tasked with overseeing a nursing team’s day-to-day operations. This job requires the CNO to facilitate relationships between various stakeholders.

For example, the CNO may serve as an intermediary between the nursing staff and hospital administrators. As the spokesperson for all nurses in the facility, the CNO communicates resource allocation and staffing needs to the hospital’s leadership and lets it know how policies or procedures could be amended to allow nurses to more effectively care for patients.

At the same time, the CNO receives administrative ground rules and regulations from the senior leadership. The CNO then communicates these rules to the entire nursing team and holds the nurses accountable for compliance.

The CNO role can also involve furthering relationships with providers. The CNO works with doctors and surgeons to learn what kind of support they need from hospital nurses and to schedule team members accordingly.

Depending on the hospital’s structure and organization, the CNO may also be responsible to the board of directors. In some contexts, the nurse leader must report to the board at regular intervals, providing updates on how nurses are meeting key metrics, such as patient safety, quality and length of stay.

Ultimately, the CNO is most responsible to the patients. Any nurse leader’s overarching goal is to create an environment in which nurses can provide the highest standard of patient care and pursue the best clinical outcomes. This job might include resource allocation and budgeting, proper training and onboarding, effective scheduling, and advocacy for patient-centered hospital policies and procedures.

CNO vs. Other Executive Positions

The CNO is considered an executive-level position, which means it’s situated in the C-suite with other key positions, such as the chief executive officer and chief operations officer. It’s important for aspiring nurse leaders to understand the distinctions between these important leadership roles.

Chief Executive Officer

The hospital CEO is tasked with carrying out both short- and long-term plans and makes many of the key decisions about the hospital’s overall mission. In most hospital settings, the CEO approves the budget and helps manage risk. A successful CEO is aware of all levels of hospital operation and can extend strategic support and guidance to other management team members.

Chief Operations Officer

If the CEO is all about the big-picture strategy, the COO is more in the weeds with day-to-day operations. It falls to the COO to make sure policies and frameworks are in place for the hospital to enjoy sustained growth. Often, COOs are involved with recruiting and hiring new leaders. They may also help lead the organization through clinical accreditation processes.

Chief Nursing Officer

The CNO’s role involves both business efficiency and clinical quality but is particularly focused on members of the nursing team. The CNO often reports to either the CEO or the COO, providing insights into how the nurses are maintaining patient safety, minimizing length of stay, curbing readmissions and ensuring that patients have a satisfying experience.

What Is a Chief Nursing Officer’s Salary?

Those who aspire to become a CNO will naturally want to know about the typical chief nursing officer salary.

According to PayScale data from April 2020, the median annual salary for a CNO is $127,905. CNOs typically have opportunities for bonuses as well as profit sharing in their organizations.

A number of factors can determine the chief nursing officer salary:

  • Education: Nurses with advanced degrees, such as a Doctor of Nursing Practice, typically command higher salaries.
  • Experience: Those who have spent more years in nurse leadership positions usually earn higher salaries.
  • Location: Hospitals in major metropolitan areas often can pay their nurse leaders higher salaries.

What Does a Chief Nursing Officer (CNO) Do?

In preparing for work as a CNO, it’s helpful to consider the scope of the chief nursing officer job description.

At the broadest level, the job description of the CNO is to support the organization’s values and advance its mission through daily management and leadership of the nurses.

The specifics of a chief nursing officer job description can fluctuate according to the facility and the direction given by the board of directors. Some general examples of a CNO’s daily duties include:

Communicating with Nurses and Other Clinical Care Providers

The CNO is tasked with communicating hospital priorities, procedures and objectives to the entire nursing team. They must also entertain any feedback or needs that the nurses have. This may be done through daily huddles, rounding, one-on-one meetings or town halls. Written communication, including email updates, may also be useful.

Maintaining Clinical Care Standards

The CNO is also responsible for leading the team in achieving desirable patient outcomes, including reasonable length of stay, readmission and patient safety ratings. Rounding and spending time on the floor is essential, as it allows nurse leaders to experience firsthand the culture of care at the facility and to identify any roadblocks to efficiency.

Additionally, the CNO can pursue better outcomes by advocating to the C-suite or to the board for positive changes in hospital policy; by budgeting hospital resources more constructively; and by setting rules and strategies for the nursing team, guiding nurses in how to most effectively care for their patients.

Attending to Key Administrative Duties

The CNO also has a number of important administrative functions. One example is staying abreast of government compliance issues and the stipulations made by regulatory and accrediting boards, as well as ensuring that the hospital nurses are upholding the necessary standards. The CNO may also play a direct role in organizing or coordinating different care delivery models, such as directing an outpatient nursing or rehab facility.

Hiring and Training Nurses

The CNO is responsible for maintaining a full staff of qualified and competent nurses. As such, the CNO is likely to be actively involved in recruiting, interviewing and hiring new nurses. This may involve developing relationships with local nursing schools, including internship programs and nurse residencies.

Additionally, the CNO must develop training infrastructures that ensure all members of the nursing team are equipped to make positive outcomes and to do their jobs as effectively as possible.

How to Become a Chief Nursing Officer

As for how to become a chief nursing officer, the process takes time. Nobody begins their career at the CNO level; rather, nurses who begin as registered nurses (RNs) or licensed practical nurses (LPNs) may advance into managerial positions, perhaps becoming nurse leaders for a particular department, service line or shift and eventually taking on CNO responsibilities.

In pursuing this long-term career goal, nurses need to be aware of the educational requirements and essential certifications.

Educational Requirements

While it’s important for nurse leaders to have experience administering patient care, this isn’t the only skill set they need. Leading a team of nurses, answering to a board of directors and managing potentially large budgets requires a broader set of competencies, including critical thinking, problem solving, delegation and communication skills.

To hone these skills and understand how they apply in a health care context, current and aspiring nurse leaders likely want to pursue an advanced degree, potentially a Doctor of Nursing Practice (DNP). A DNP curriculum will provide a formal setting in which nurse leaders can cultivate their administrative skills, such as the following:

  • Working collaboratively with other nurses
  • Applying research to analyze patient care and population health trends
  • Designing care delivery plans that are economically feasible and meet the community’s needs

Completion of a DNP can help nursing professionals develop these skills and become trusted and credible leaders in their field.

Certification

In addition to education, aspiring CNOs should also consider licensing requirements.

The first step in the certification process is simply earning the title of registered nurse (RN). It’s not possible to ascend into nurse leadership positions without first receiving this foundational nursing certification.

The next step is to consider certified nurse manager and leader (CNML) certification. While not all CNO roles require this credential, there are many that do. Even if it isn’t required, certification can provide professionals with a competitive advantage in the job market.

Earning CNML certification requires the completion of a comprehensive exam that touches on many aspects of nurse leadership. This is another area where pursuit of an advanced degree can help. Specifically, DNP programs provide competence in financial management, human resource management and strategic planning — all components of the CNML exam.

Common Chief Nursing Officer Interview Questions

Given the high levels of responsibility that a CNO holds, becoming a CNO can be a rigorous process. Those applying for work in this field can anticipate a series of interviews, potentially with health care recruiters, members of the hospital’s executive team and board members. One way to fare well in this interview process is to consider in advance some of the most common chief nursing officer interview questions.

Preparing for Common Chief Nursing Officer Interview Questions

Interviewers may ask any number of questions to ascertain information about the applicant’s previous work history, knowledge base and leadership approach.

The interviewer will also seek to identify synergies between the applicant’s skill set and past achievements and the current needs of the hospital. For example, if the hospital is preparing for a major construction project, CNO applicants will likely be asked what experience they have planning or managing renovations.

CNO interviews commonly include the following questions:

Why do you want to work in this hospital?

Different hospitals have unique challenges, opportunities and cultures. It’s reasonable for interviewers to wonder why someone would want to work in their particular context. The answer may touch on the hospital’s size, level of independence, reputation in the community or areas of clinical focus.

What is your approach to conflict management?

The CNO must lead a team of nurses in providing exemplary patient care, which is achievable only when the nurses are working together as a team. The ability to manage different personalities and mediate conflicts is key for any CNO.

How will you create an optimal work environment for our nursing team?

Those applying for a CNO role should be prepared to discuss specific ways in which they will create a positive work environment. Answers can highlight anything from employee surveys and daily huddles to effective scheduling and budgeting.

What’s your philosophy in working with physicians?

To promote positive patient outcomes, nurses and physicians must work in tandem, putting clinical care above all else. Part of this responsibility falls to the CNO, who should be prepared to earn physicians’ trust and cultivate collaborative relationships with them.

Ideally, applicants will come prepared to share stories of when they have worked closely with physicians in the past; diffused tense situations; or collaborated with doctors on a successful project, such as the expansion of a service line or the integration of a new clinic.

What are the most important qualities for a nurse to possess?

There’s not necessarily a right or wrong answer to this question, but it may provide the interviewer with a chance to hear applicants speak about their passion for nursing and to compare the applicant’s philosophy of nursing with the hospital’s existing culture and values.

Additional Considerations for a Chief Nursing Officer

It’s customary for CNO interviews to address issues such as salary and benefits expectations. Applicants will want to spend some time preparing for this discussion so they can speak to the general salary range they require in order to take the position.

This preparation must be done with an eye toward the industry median, as well as to such mediating factors as geographic market, experience level and education level. These issues will be addressed in greater detail later in this article.

Becoming a Leader in Health Care

Leadership is an essential component in any successful health care organization. An effective leader facilitates productive, collaborative relationships between nurses, technicians and physicians, with the end goal of promoting positive patient outcomes and making the hospital profitable. CNOs can play a significant role in delivering this level of leadership.

To move into a CNO role, advanced education can be invaluable. University of North Dakota’s online Post-Master’s Doctor of Nursing Practice program provides an environment in which the nurse leaders of tomorrow can hone their skills and develop their capacity to add value to an organization. Learn more about the benefits of enrolling in this DNP program today.

Recommended Readings

BSN vs. MSN: What Are the Benefits of a Master’s in Nursing?

MSN vs. DNP: Comparing Salaries, Job Outlook and More

What Is Health Policy and What Role Does It Play in Nursing?

Sources:

Becker’s Hospital Management, “38 Hospital and Health System Roles, Defined”

Business News Daily, “How to Become a Chief Operating Officer (COO)”

HealthLeaders, “Chief Nursing Officers’ View of Nurse Supply and Demand”

HealthLeaders, “5 Strategies New CNOs Should Know”

Houston Chronicle, “Function & Responsibilities of a Chief Nurse”

Indeed.com, “5 Director of Nursing Interview Questions and Answers”

Investopedia, Chief Executive Officer (CEO)

National Council of State Boards of Nursing, NCLEX & Other Exams

NCBI, “Chief Nursing Officers’ View on Meeting the Needs of the Professional Nurse: How This Can Affect Patient Outcomes”

PayScale, Average Chief Nursing Officer (CNO) Salary