Becoming a Nurse Executive

Written by: University of Tulsa   •  Apr 12, 2024

Becoming a Nurse Executive: How MSN Graduates Can Climb the Ladder                                              

Nurses play an integral role in patient care. From triage to surgical prep, and the operating room to community clinics, nurses promote healthy outcomes at every level. In addition to providing direct patient care, nurses affect outcomes through positions of administration, management, and executive leadership.

Those who have nursing experience and wish to advance into leadership-oriented roles have numerous nurse executive positions to choose from. Executive-level roles can afford the opportunity to lead and develop nursing teams, shape clinical policies, and ensure efficient standards of care. When setting your sights on an executive position, obtaining the right education, such as a Master of Science in Nursing (MSN) degree, is crucial.

What Is a Nurse Executive?

Starting with a sound definition of what a nurse executive is and what role they play within a hospital or health system is important. 

Also known as a chief nursing officer (CNO) or a chief nursing executive (CNE), this role is typically the highest-ranking nurse within an organization. The basic function of the nurse executive is to oversee the policies and procedures that lead to efficient delivery of care and to the best possible patient outcomes.

As high-level leaders, nurse executives collaborate with department heads, other C-suite executives, and stakeholders within a hospital or health system.

What Is a Nurse Executive Job Description?

This role involves a wide range of managerial and administrative tasks. While a specific job description can vary from one organization to the next, a typical list of duties and responsibilities includes the following:

• Managing the entire nursing staff and providing personnel support
• Recruiting, interviewing, hiring, and developing nurses
• Conducting regular performance reviews for members of the nursing team
• Ensuring that the nurse schedule is seamless and provides full coverage for patient care needs
• Developing and leading training sessions for staff nurses
• Managing budgets for all nursing teams
• Evaluating patient care and administrative policies and suggesting improvements

Understanding the Nursing Hierarchy              

To understand the role of the nurse executive and how it fits into the rest of the health care organization, considering the full picture of the nurse hierarchy is helpful. This may look a little different from facility to facility, but here is a general outline.

• Licensed Practical Nurses: An LPN undergoes about a year of training, which equips them to provide basic care and to check vital signs, such as blood pressure.
• Registered Nurses: An RN usually has two to four years of education, which allows them to collaborate with physicians and to provide more extensive bedside care.
• Advanced Practice Registered Nurses: An APRN has a more advanced level of training and certification, allowing for a higher level of specialized or primary care. APRNs, including nurse practitioners, are required to have at minimum an MSN.
• Nurse Supervisors: A nurse supervisor, also called a nurse manager, has a bachelor’s degree or higher, along with a few years of patient care experience. Their position involves providing direct oversight to nurses within a particular department.
• Director of Nursing: A director of nursing occupies an administrative position that involves leadership as well as direct patient care. Directors of nursing usually report directly to the nurse executive, and they may work together on specific projects, such as budgeting.
• Chief Nursing Officer: A CNO is a nurse executive who is at the top of the nursing hierarchy, reporting directly to the CEO or to the board of directors.

How Do Nurse Executives Compare With Other Nurse Leaders?

This hierarchy demonstrates the range of different positions in the field, each contributing to optimal patient outcomes and high standards of clinical efficiency. To better understand the scope of the nurse executive position, it can be helpful to compare the role with other nurse leadership trajectories.

Nurse Administrators

Some hospitals or health systems employ nurse administrators to oversee nursing staff, with duties that include basic human resources (HR) functions, such as hiring and training. Nurse administrators also ensure that relevant policies and procedures are upheld. They may work with other nurse leaders, including the nurse executive, to draft and maintain budgets.

Nurse Managers

Nurse managers fulfill both administrative and clinical duties, providing direct leadership to their nursing teams or floors but also caring for patients. Typically, a nurse manager reports to a nurse administrator or directly to the executive.

Nurse Executive vs. Director of Nursing

How does the executive role compare with the director of nursing role? Several points of distinction are worth highlighting:

• Scope of Authority: In an organizational chart, a nurse executive outranks a director of nursing. The executive has responsibilities over all nurses within an organization, while a director may focus on a particular department or team. The director of nursing reports to the executive.
• Salary: Because of their heightened responsibilities, executives usually have a higher salary than any other nurses within the organization.
• Focus: Both nurse executives and directors of nursing work to promote the best patient outcomes and the highest standards of care. They go about this in different ways, however. Executives tend to focus more on big-picture strategy and decision-making, while directors of nursing are more focused on personnel management and development.

While these distinctions are significant, the roles overlap in many areas, including the need for an RN license and an advanced degree in the field of nursing. 

What Is the Typical Nurse Executive Salary?

The median annual nurse executive salary is approximately $143,110 as of February 2024, according to Payscale data. Executives in the top 10th percentile earned an annual salary of around $220,000. Numerous factors can affect the nurse executive salary range, including years of experience, level of education, and the size of the hospital or health system.

Nurse Executive Career Outlook

According to the U.S. Bureau of Labor Statistics (BLS), positions for medical and health service managers, including nurse executives, are projected to grow by 28% between 2022 and 2023. This growth rate is much faster than the average for all professions.

The BLS attributes this to aging baby boomers, who require extensive specialized care to address chronic health issues as they age. Nurses working in executive positions can help meet this need.

How to Become a Nurse Executive

To succeed as a nurse executive, cultivating the right portfolio of clinical and administrative skills is imperative. This involves a combination of academic and hands-on training, along with certification. Here is a general outline of the nurse executive career trajectory.

Step 1: Earn a Bachelor’s Degree

An undergraduate degree is the foundation for all other nurse training. A four-year program covers relevant coursework, such as anatomy, biology, and physiology, and paves the way for licensure as an RN. Earning a Bachelor of Science in Nursing (BSN) is the essential first step in becoming a nurse executive.

Step 2: Become a Registered Nurse

A career in nurse leadership always begins with RN licensure. This involves registering with the state nursing board and completing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). In many states, RNs are also required to become certified in CPR, basic life support, or advanced cardiac life support.

Step 3: Gain Clinical Experience

Working as a nurse leader requires knowledge of how the entire nursing infrastructure functions. This means gaining direct familiarity with patient care in multiple departments. Typically, ascending to the executive role calls for several years of hands-on nursing experience. 

Step 4: Earn an Advanced Degree     

For nurse executive roles, a more advanced nursing degree is mandatory. Advanced degrees signify a higher standard of clinical acumen, as well as important leadership skills, familiarity with policies and procedures, and a focus on nurse ethics. These degrees can not only ensure higher standards of competence but also lead to higher nurse executive salary ranges.

While the typical route is to pursue an MSN, it may also be valuable to earn a Master of Health Administration (MHA) or a Master of Business Administration (MBA). Meanwhile, a Doctor of Nursing Practice (DNP) denotes the terminal level of academic training for nurses. A DNP is usually not required for executive positions, but it can open the door to higher salaries or more prestigious positions.

Step 5: Get Certified

Certification demonstrates a rigorous commitment to patient care and safety. Not all executive roles require certification, but becoming certified can help procure more prestigious positions with higher salaries. Worthwhile certifications to pursue include the following:

• Certified in Executive Nursing Practice (CENP), which is available through the American Organization for Nursing Leadership
• Nurse Executive Advanced – Board Certified (NEA-BC), which is available through the American Nurses Credentialing Center
• Nurse Executive Board Certified (NE-BC), which is available through the American Nurses Credentialing Center

Step 6: Pursue Continuous Education

Beyond the question of how to become a nurse executive is the question of how to remain a nurse executive. To maintain licensure, most states require nursing professionals to complete a specified number of continuing education courses each year. These courses are essential for remaining up to date with the latest nursing technology, procedures, and best practices.

What Are the Essential Competencies for a Nurse Executive?

Through this combination of formal education and career experience, aspiring executives can master the skills necessary to lead effectively and efficiently, promoting patient health and institutional success. Several competencies are foundational to success as a nurse executive.

Communication Skills

Those in positions of nurse leadership must have strong communication skills, both oral and written. Oral skills are necessary to convey the institution’s values, vision, and policies to nursing personnel and to coordinate with other executives. Written skills are crucial when writing reports for the board of directors and other stakeholders. 

Relationship Management

Nurse executives should be able to build strong relationships with health care professionals across disciplines. This can help bridge caps and facilitate holistic care, as well as mitigate conflict, disagreements, or miscommunication between teams or professionals. It can also aid in understanding the administrative or procedural factors that affect care, such as supply chain disruptions, different care delivery models, material costs, and more. 

Clinical Acumen

Typically, executives spend very little, if any, time providing direct bedside care to patients. Even so, having the right clinical bona fides is important. Being able to demonstrate practical nursing skills, to “speak the language” of clinicians, is an important way to earn the trust and respect of other nurses. Also, in some cases, executives may need to intervene in especially challenging patient care scenarios.

Health Care Knowledge

Alongside clinical competence, nurse executives should have an in-depth understanding of the health care landscape. This includes awareness of changing regulatory and compliance standards, as well as health care policy and legislation developments. Executives should also understand best practices for care delivery models and ensure that the execution of these models is done safely and effectively. 

Leadership

Most importantly, a nurse executive is a leader. The role requires the ability to set goals, motivate employees, build morale, and offer constructive feedback or discipline when appropriate. These leadership skills can be cultivated through experience, as well as through an advanced nursing degree program.

Business Acumen

While nurse leaders have to be proficient in clinical work, business and finance knowledge is also a must. Basic business acumen is necessary for creating and maintaining budgets and for ensuring that policies and procedures ultimately uphold the financial interests of the organization. Ultimately, good business sense ensures that the hospital or health system can continue to serve patients in increasingly optimal ways.

Ethics

A basic understanding of nursing ethics is essential for success in the executive role. A clear sense of ethics not only protects patients but also shields the entire nursing team from allegations of inappropriate or dishonest behavior. Furthermore, it can be essential for keeping the institution in full regulatory compliance. 

Professionalism

Through years of training and experience, executives can hone their professionalism. This is essential, as these leaders are often called upon to represent their organizations at conferences and events and even before government bodies.

How to Prepare for a Nurse Executive Career

When considering how to become a nurse executive, all of the training and skills required may seem daunting. Consider a few tips and best practices to prepare for long-term career success.

• Set smaller goals. Nobody becomes an executive overnight. It usually takes several steps, making it helpful to set attainable short-term goals that lead toward the executive position. For example, for a new RN, a goal may be to become a shift leader or a manager within two or three years and then to move forward from there.
• Seek mentors. Much can be learned in a classroom; however, formal education in and of itself is not enough. Also important is learning the ropes from skilled and experienced nurses who can impart tips about patient care, collaborating with physicians, providing leadership, and career advancement. Be active in courting potential mentors.
• Pursue lifelong learning. The most effective leaders continue to refine their skill sets and stay abreast of new nursing techniques. Effective nurse leaders recognize there is always something new to learn.
• Prioritize balance. Becoming a nurse executive requires hard work, and often many long shifts. As such, the risk of burnout is real and can derail an otherwise promising career trajectory. Nurses must create space in their lives for sound nutrition, good sleep, physical activity, and mental health breaks.
• Hone communication skills. One area where nurses benefit from ongoing practice and improvement is communication. They need to be intentional about writing and speaking with clarity and brevity. They should make it a point to collaborate across teams, disciplines, or departments whenever possible, actively working on these communication skills.

By following these guidelines, aspiring executives can not only keep their skills sharp but also work toward more prestigious roles and more competitive nurse executive salary ranges.

Pursue an Active Role in Nurse Leadership

Some nurses simply love patient care and are happy spending their careers in bedside nursing roles. For others, entertaining the prospect of a nurse leadership position is exciting, even a high-ranking role like a nurse executive.

To obtain an executive-level role, education is fundamental. Beyond an undergraduate degree, seeking an advanced education is imperative. This can start with an MSN, such as The University of Tulsa’s online MSN.

This program is designed to provide nurses with clinical knowledge that improves patient outcomes and also the leadership skills they’ll need to climb the hierarchy. The program is flexible, making it possible to achieve career advancement on any timetable. Find out more about TU’s program today, and take an important step toward an executive-level position.

Recommended Readings

International Travel Nursing: How to Work Abroad as a Nurse

What Can You Do With an MSN?

Population Health Nursing: What It Is and How to Make It Your Career

Sources:

American Organization for Nursing Leadership, AONL Nurse Executive Competencies

Indeed, “Chief Nursing Officer vs. Director of Nursing: An Overview”

Indeed, Understanding the Nursing Hierarchy

Indeed, “What Is the Role of a Nurse Executive? A Career Guide”

Payscale, Average Chief Nursing Officer (CNO) Salary

U.S. Bureau of Labor Statistics, Medical and Health Services Managers