Chief nursing officer poses at her hospital with colleagues in the background

Leadership in Health Care: How to Become a Chief Nursing Officer

According to the U.S. Bureau of Labor Statistics, health care is expected to produce 4 million new jobs from 2016 to 2026 — accounting for almost one-third of all new jobs.

“The global health care industry doesn’t show any signs of slowing down in 2019,” states the “2019 U.S. and Global Healthcare Industry Outlook” from Deloitte. “Aging and growing populations, greater prevalence of chronic diseases, and exponential advances in innovative, but costly, digital technologies continue to increase health care demand and expenditures.”

Nurses account for a substantial part of this growth. The U.S. Bureau of Labor Statistics (BLS) reported that the number of jobs for registered nurses is expected to grow 15% from 2016 to 2026 — a much higher growth rate than the average for all jobs of 7%.

As the health care industry thrives, qualified nurse leaders must guide the next generation of nurses into the future. That’s where the role of chief nursing officer (CNO) comes in. One of the top specialty career choices for nurses, the CNO holds a critical, executive role in health care.

Here is a guide on how to become a chief nursing officer — including information on responsibilities, academic requirements, and salary outlook.

What Is a Chief Nursing Officer? 

The first step in learning how to become a CNO is understanding the role and the needed skills for success.

The Chief Nursing Officer is the top-ranking nursing management professional in a healthcare organization. With overall responsibilities for managing the nursing staff and relative operations, the CNO creates patient care strategies, budgets for equipment and resources, maintains standards and safety policies, and represents the team at conferences and meetings. The CNO coordinates daily operations while setting a vision for the goals of the nursing operation. This person serves as the link between other executives and the nursing staff, finding opportunities to improve productivity, quality of care, and the general work environment.

“You are that voice that is speaking on behalf of the nurses, on behalf of the patients, and bringing the physicians to the table,” CNO Erin LaCross told HealthLeaders. “You're bringing everybody to the table who needs to be there and seeing the big picture. You're asking the tough questions and ensuring accountability.”

Along with clinical knowledge and skills, CNOs must have strong leadership, communication, and organizational skills. They serve as mentors to their nursing staff and critical thinkers in navigating constant change in their industry and practice. CNOs also have practical skills to manage finances, conduct analytics, and implement technologies that support their facilities.

Steps to Become a Chief Nursing Officer

For anyone interested in how to become a CNO, the job requires advanced education and extensive work experience. Here are the steps to getting there.

Academic Preparation

Prospective CNOs must earn a Bachelor of Science in Nursing degree from a four-year college. This degree provides a foundation in the principles of nursing, anatomy, and patient care delivery.

Aspiring CNOs typically earn a Master of Science in Nursing degree, such as the one offered online through Norwich University. This degree program deepens knowledge and skills, providing training in advanced clinical concepts, nursing informatics, leadership, and health care management practices.

On-the-Job Experience

In addition to educational preparation, future CNOs must have experience in a hospital setting or other health care organization. Working as a manager in nursing can prepare professionals for attaining this executive-level position.

For example, Rhonda Foster, former CNO of Children’s Hospital of Michigan, held a leadership position in an ambulatory care unit for five years. Based on her experience, she was selected as director of nursing, quality, research, and education.  Eventually, she was promoted to assistant vice president, beginning her ascent to CNO.


CNOs can gain critical skills and credibility by receiving certifications such as:

  • Certified in Executive Nursing Practice (CENP) and Certified Nurse Manager and Leader (CNML) from the American Organization for Nursing Leadership. These certifications are awarded through exams that assess knowledge of the core principles of communication, health care, and strategic management.
  • Nurse Executive Certification (NE-BC) from the American Nurses Credentialing Center. This certification is awarded through a competency-based exam that assesses clinical knowledge and skills needed to manage a nursing unit.

This is an extra step that current or prospective medical professionals who are interested in how to become a CNO may want to consider.

Salaries of a Chief Nursing Officer

According to PayScale, CNOs earn between $90,000 and $198,000 a year, with an average salary of $126,630. To attain a salary in the upper end of this range, prospective and current CNOs typically possess advanced education in the nursing management field. Degrees may include a Master of Science in Nursing degree, a Master of Business Administration degree, or a Master of Health Administration degree. High-earning CNOs also may have years of additional experience in nurse leadership or management positions acquired from managing employees, budgeting, and coordinating resources.

Future Growth of Chief Nursing Officer Jobs

Global health care spending is expected to reach $10 trillion by 2022, up from $7.7 trillion in 2017, according to Deloitte. As the health care industry and the job outlook for nurses grow, CNOs are needed in different organizations to lead nurses through the evolving landscape.

“Nurses are really the experts in coordinating care and have always been that integral linchpin in the care-coordination team, whether it was five years ago, 10 years ago, or 20 years ago,” CNO Ann Marie Leichman told Modern Healthcare. “I think what's really changed, though, is the recognition by all disciplines that we need to work collaboratively in this changing health care world to produce better outcomes, and that's been a major shift in how people now see their roles on the health care team.”

Technology, in particular, will affect the health care industry and the job of the CNO. Implementing tools like wearable tech and virtual reality equipment, nurses will virtually evaluate a patient’s health and deliver care. Technology also improves processes like compliance, employee management, and data collection and analysis — creating a more connected future for CNOs, nurses, and patients.

Start a Chief Nursing Officer Career

Since 1819, Norwich University has maintained a leadership position in innovative education. Through its online programs, Norwich delivers relevant and applicable curricula so students can make a positive impact in their work place and community.

Norwich University’s online Master of Science in Nursing program helps students hone knowledge and skills to assume leadership positions in nursing informatics, health care systems leadership, or nursing education. Students are trained to become nurse leaders who shape health policy, manage teams of clinicians, and provide high-quality care. The program is based on guidelines by the American Association of Colleges of Nursing and is accredited by the Commission on Collegiate Nursing Education.


Recommended Readings

What to Expect from the MSN Curriculum at Norwich University

6 Common Nurse Leadership Jobs for Master of Science in Nursing Graduates

5 Leadership Styles for Clinical Nurse Leaders



Employment Projections, U.S. Bureau of Labor Statistics

2019 U.S. and Global Healthcare Industry Outlook, Deloitte

Registered Nurses, U.S. Bureau of Labor Statistics

5 Strategies New CNOs Should Know, HealthLeaders

Leadership Insights, American Nurse Today

Chief Nursing Officers Need New Skill Sets,” Healthcare Finance

Top Executives, U.S. Bureau of Labor Statistics

Master of Science in Nursing, Norwich University

Certified in Executive Nursing Practice Certification, American Organization for Nursing Leadership

Certified Nurse Manager and Leader Certification, American Organization for Nursing Leadership

Nurse Executive Certification (NE-BC), American Nurses Credentialing Center

Average Chief Nursing Officer (CNO) Salary, Payscale

Chief Nursing Officer Roundtable: Managing Technology and the Continuum of Care, Modern Healthcare