Chief nursing officers (CNOs), sometimes called chief nursing executives, are registered nurses (RNs) with a primary focus on high-level administration. CNOs create policies and processes to maintain compliance, improve patient outcomes, and retain nursing staff. RNs typically need a graduate degree and a few years of supervisory experience before pursuing a CNO position.
This guide explores a CNO’s role, including their daily duties, educational requirements, and salary potential. Learn more about how to become a chief nursing officer.
How Long to Become:
MSN or DNP
28% Growth from 2021-2031
for all medical and health services managers
What is a Chief Nursing Officer?
The chief nursing officer works under the chief executive officer or the president. This executive nursing leadership position manages all operational aspects of a healthcare facility, serving as the link between executive and medical staff. CNOs work in hospitals, outpatient clinics, outpatient surgery centers, and government agencies. They tackle human resource issues and handle fiscal responsibilities. An CNO’s responsibilities include:
- Managing and creating budgets
- Ensuring compliance with state and federal laws
- Strategizing to improve nursing care, patient outcomes, and staffing ratios
- Onboarding new nursing staff and implementing retention programs
- Handling personnel issues and grievances
- Working to control costs and stay on budget
- Consulting with administrative staff to meet goals and objectives
- Maintaining and improving standards of care
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Steps to Becoming a Chief Nursing Officer
Becoming an RN is the first step in pursuing a CNO career, but employers typically require additional educational and credentials. Keep in mind that specific licensing and program requirements for RNs vary by state.
Earn an ADN or BSN Degree From an Accredited Program
You need at least an associate in nursing degree (ADN) to become an RN —the minimum educational requirement to take the NCLEX-RN. Many employers prefer to hire RNs with BSNs to improve quality of care. The average BSN takes about four years, unless you complete a bridge program.
You typically need a BSN degree to apply for a traditional MSN program. However, the RN-to-MSN degree lets RNs with ADN degrees graduate in two years or less. MSN programs also accept non-nursing degree holders, who can use their general education requirements to complete an accelerated BSN program.
Pass the NCLEX Exam to Receive RN Licensure
You need to pass the NCLEX-RN exam to earn your RN license. Most nursing graduates take the exam about one month after earning either an ADN or a BSN degree.
The exam has a minimum of 75 questions and covers four areas: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. You have up to six hours to take the exam with the option to retake it if you fail.
Gain Clinical Nursing Experience:
You typically complete specialized nursing courses and practicum experiences during a BSN program that provides clinical experience.
You can also apply for part-time jobs in the medical field, such as a certified nursing assistant, or find volunteer opportunities to help build experience. Seek out guidance from senior nurses who are willing to mentor less experienced nurses or provide shadowing experiences.
Earn an MSN Degree in Nursing
Many employers prefer to hire RNs with MSN degrees for CNO positions since they have an advanced nursing education. A graduate level degree may be the minimum requirement for larger hospital systems.
An MSN degree also offers the chance to specialize in family nursing, adult-gerontology, nurse midwifery, nurse administration, nursing anesthesia, or nursing informatics, among other specialties.
Even without a BSN, you can pursue a MSN. ADN-to-MSN programs only take 24-36 months, but this rigorous program requires a full-time commitment.
Gain Experience in Leadership and Management in Nursing:
You can get started in nursing administration by specializing in leadership and management as an MSN student.
Nursing students can also gain the work experience for a CNO position by applying for membership in shared governance or policy development committees. Some nurses may pursue a role as a charge nurse, assistant nurse manager, or director of nursing in order to prepare for a more senior role as a CNO.
onsider Becoming Certified in Leadership or Informatics
You do not need certification to become a CNO, but it can set you apart. Earning a certification from the American Organization for Nursing Leadership (AONL) or the American Nurses Credentialing Center (ANCC) demonstrates your proficiency and leadership and informatics experience.
Requirements for certification vary. Generally, you need to have at least an RN license, a BSN degree, and clinical work experience to become eligible for a certification exam.
Chief Nursing Officer Education
As a minimum education requirement, you need a BSN degree to become a CNO. Larger hospital systems typically require an MSN degree.
RNs with a nursing diploma or an ADN can increase their nursing knowledge and advance their career by earning a BSN degree. Some nursing schools offer accelerated ADN-to-BSN programs.
Students may also enroll in a traditional, four-year BSN program, provided they complete the prerequisites and meet other admissions criteria.
First-year and transfer students generally need a 3.0 GPA, high school or college transcripts, and a minimum C grade for prerequisites such as anatomy, biology, and chemistry.
BSN degrees cover human anatomy and physiology, nursing fundamentals and health assessments, pathophysiology, nursing research, and theory and pharmacology. A core element of the BSN educational experience includes a practicum.
Time to Complete
Critical thinking skills, health assessments, clinical reasoning and knowledge, implementation of nursing plans, evaluate patients, patient safety advocacy, and collaboration on a healthcare team.
Employers typically prefer to hire CNOs with an MSN degree. Larger hospital systems typically require CNOs hold an MSN degree as a minimum requirement. You also need an MSN to become an advanced practice registered nurse.
MSN degree holders can specialize in specific areas, such as nursing leadership and management. Many chief nursing officers launch their careers after gaining managerial experience as a nurse practitioner.
A BSN degree with a minimum of a 3.0 GPA. Applicants typically must submit transcripts, an essay, references, and hold a valid RN license.
Advanced nursing education in healthcare policy and advocacy, nursing research and an evidence-based practice, health assessments, clinical pathophysiology, and organization leadership.
Time to Complete
Business skills, communication and team building, executive leadership and management, health systems, health policy, nursing care ethics, patient improvement, and technology and information literacy.
Chief Nursing Officer Licensure and Certification
An RN license serves as the basic requirement needed to become a CNO. RNs need to pass the NCLEX exam to get licensed in their state or hold a Compact license. To maintain their license, RNs need to keep documentation of their clinical hours, with requirements varying by state. For instance, Connecticut requires renewal every year, and Colorado every two years. While you do not need an APRN license, CNOs may hold an NP license.
Certification is optional for CNOs, unless required by a specific employer. CNOs who hold an RN license and a BSN degree can validate their leadership experiences with credentials from professional nursing organizations such as the American Nurses Association.
Available certifications for CNOs include the Certified Nurse Manager and Leader and Certified in Executive Nursing Practice Certification through AONL. RNs also obtain informatics and nurse executive credentials.
Working as a Chief Nursing Officer
CNOs made an annual average salary of $138,260 as of March 2023, according to Payscale. Many factors influence what you can earn as a chief nursing officer like experience and work setting. For instance, CNOs who have more than 20 years of experience make an average of $154,000 a year, and the top 90% of CNOs earn $214,000 a year.
Hospitals, outpatient care centers, clinics, and physician offices need chief nursing officers. Nurses often find CNO positions through their employers, nursing job boards, and professional nursing organizations.
Frequently Asked Questions About Becoming a Chief Nursing Officer
How long does it take to become a chief nursing officer?
Becoming a CNO typically takes 8-10 years to meet the typical educational and experience requirements. Earning an MSN often takes 5-6 years to complete. However, graduation timelines vary by student, and if they study part or full time. Many nurses also work for years as RNs and gain management prior to taking on an executive administrative role such as a CNO.
Do you need an MBA or MHA to be a CNO?
No. CNOs need a background in executive administration and business, but a master’s in business administration (MBA) or master’s in health administration (MHA) is not a prerequisite. But, an MBA or MHA degree can make you a more competitive candidate for a CNO position at larger hospital systems.
Some nurses earn an MBA or MHA in preparation for executive leadership positions. An MBA or MHA degree teaches you about accounting, human resource management, financial management, and marketing, which may provide a competitive advantage over other candidates.
Can a DNP be a CNO?
Yes. Candidates who hold a doctorate of nursing practice can pursue CNO positions as long as they meet the experience requirements. CNOs typically need several years of experience managing other nurses.
What degrees do you need to be a CNO?
You need at least a bachelor’s degree, if not an MSN degree, to become a CNO. An MSN program helps future CNOs build nursing executive leadership and management knowledge and skills.