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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 influence outcomes in administrative, management, and executive leadership roles.

If you want to advance into a high-level nursing leadership role, there are many potential paths 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?

The 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 Nurse Hierarchy

To understand the role of the nurse executive and how it fits into the rest of the health care organization, consider the full picture of the nurse hierarchy. This may vary from facility to facility, but it typically follows a general outline.

• Licensed Practical Nurses (LPNs): LPNs undergo about a year of training, which equips them to provide basic care and to check vital signs, such as blood pressure.
• Registered Nurses (RNs): RNs usually have two to four years of education, which allows them to collaborate with physicians and to provide more extensive bedside care.
• Advanced Practice Registered Nurses (APRNs): APRNs have 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 MSN degrees at minimum.
• Nurse Supervisors: Nurse supervisors, also called nurse managers, have bachelor’s degrees 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: Directors of nursing occupy administrative positions that involve leadership as well as direct patient care. Directors of nursing usually report directly to nurse executives, and they may work together on specific projects, such as budgeting.

Chief Nursing Officer: A Top Nurse Executive Role

Chief nursing officers (CNOs) are the highest-ranking nursing professionals in a health care organization. 

CNOs are responsible for the overall success of a facility’s nursing practice. They oversee nursing teams, including directors of nursing. CNOs establish nursing standards and practices, ensure that these standards are met, and ensure that all patients receive the same high-quality care.

While CNOs are the head nurses of their facilities, if they’re part of a larger health care system or hospital group, they may report to a chief nurse executive (CNE), who oversees multiple CNOs across the system and ensures consistent care throughout.

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

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, you can compare their responsibilities to other nursing positions.

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 nurse executives, 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, nurse managers report to nurse administrators or directors of nursing.

What Is the Typical Nurse Executive Salary?

The median annual salary for CNOs was approximately $160,230 as of June 2026, according to Payscale data. Those in the top 10th percentile earned an annual salary of around $250,000. Numerous factors can affect 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 23% between 2024 and 2034. This growth rate is much faster than the average for all professions.

The BLS attributes this to an aging population 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, you need to develop the right portfolio of clinical and administrative skills. 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 further nurse education. 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, advancing to the executive role calls for several years of hands-on nursing experience.

Step 4: Earn an Advanced Degree

For nurse executive roles, advanced nursing degrees are the industry standard. Graduate education signifies a higher level of clinical expertise, 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, some earn a Master of Health Administration (MHA) or a Master of Business Administration (MBA). A Doctor of Nursing Practice (DNP) is 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)

The CENP certification is offered by the American Organization for Nursing Leadership (AONL). Eligibility requirements include:

• An active RN license
• A master’s or bachelor’s degree in nursing with the required experience hours
• Passing the CENP exam

Nurse Executive Advanced – Board Certified (NEA-BC)

The NEA-BC certification is offered by the American Nurses Credentialing Center (ANCC). Eligibility requirements include:

• An active U.S. RN license or a legally recognized international equivalent
• A bachelor’s and a graduate degree, at least one in nursing
• Meeting the required experience hours
• Passing certification exam grade

Nurse Executive Board Certified (NE-BC)

The NE-BC certification is offered by ANCC. Eligibility requirements include:

• An active U.S. RN license or a legally recognized international equivalent
• A bachelor’s and a graduate degree, at least one in nursing
• Meeting the required experience hours
• Passing certification exam grade

Step 6: Pursue Continuous Education

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.

• Oral and written communication skills to convey institutional values and coordinate between professionals
• Relationship management to build rapport with professionals and mitigate conflict
• Clinical acumen to demonstrate practical skills and evaluate clinical scenarios
• Health care knowledge to understand the landscape and changing standards
• Leadership to motivate employees, set goals, and offer feedback
• Business acumen to maintain financial standards and keep facilities functional
• Ethics to maintain compliance and uphold patient wellbeing
• Professionalism to represent their organizations

How to Prepare for a Nurse Executive Career

If you want to become a nurse executive, you’ll need to fulfill multiple requirements. Consider a few tips and best practices to prepare for long-term career success.

• Set smaller goals that are attainable and can lead toward an executive position.
• Seek mentors who can impart tips about patient care, collaborating with physicians, providing leadership, and career advancement.
• Pursue lifelong learning and recognize that there is always something new to learn.
• Prioritize balance and create space for sound nutrition, good sleep, physical activity, and mental health breaks.
• Hone communication skills to collaborate across teams, disciplines, or departments whenever possible, actively working on these communication skills.

Pursue an Active Role in Nurse Leadership

Some nurses are passionate about patient care and want to spend their careers in bedside nursing roles. Others are seeking leadership roles, such as a nurse executive.

If you want to move into an executive nursing role, you should consider an advanced degree. The University of Tulsa’s online MSN Leadership and Innovation track offers future nurse leaders coursework in budgeting, staffing, and performance measurement — the skills that employers value.

This program is designed to provide nurses with clinical knowledge that improves patient outcomes and also the leadership skills 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

Nurse Case Manager Career Overview

What Can You Do With an MSN?

Why Critical Thinking Skills in Nursing Are Essential

Sources:

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

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

American Nurses Association, What Is a Chief Nursing Officer / Chief Nursing Executive?

American Organization for Nursing Leadership, AONL Nurse Executive Competencies

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

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