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Effective health care organizations rely on effective leadership. Although nurses, physicians, and other front-line medical workers are the face of a hospital or health care facility, it takes the skills, knowledge, and competent leadership of administrators like chief nursing officers (CNOs) to orchestrate a workforce capable of delivering high-quality patient care.

As health care executives, CNOs ensure that their facilities maintain a standard of excellence. However, they face considerable challenges. With a constantly evolving health care landscape, strict policies and regulations, the ongoing nursing shortage, and the difficulties of overseeing a large team of clinicians in a fast-paced environment, CNOs have demanding jobs that are integral to the success of their organizations.

If you’re wondering how to become a chief nursing officer, know that CNOs must have a specific set of hard and soft skills in nursing to be effective in their role. The required skills and knowledge base of a CNO can be developed by pursuing an advanced education, such as a Master of Science in Nursing (MSN) degree.

What Does a Chief Nursing Officer Do?

The CNO has one of the most senior positions in any health care system. In addition to overseeing a team of clinicians and administrative workers, CNOs’ responsibilities include:

• Improving the quality of patient care

• Performing audits to eliminate redundancies and cut costs

• Developing strategies that improve the nursing staff’s performance

• Ensuring compliance with local, state, and federal laws, policies, and regulations

• Overseeing the interviewing and onboarding process for new nurses

• Providing ongoing administrative and clinical training

• Ensuring the health care facility’s medical equipment and nursing technology remain up to date

• Overseeing budgets

• Facilitating collaboration among different departments

• Serving as the face of the health care facility for public relations efforts

• Collaborating with physicians and other members of the leadership team

• Providing nurse mentoring to new nurses beginning their careers

• Ensuring that the actions of the organization reflect its mission statement, goals, and values

How to Become a Chief Nursing Officer: 5 Steps

Most CNOs start as nurses who have acquired the skills, knowledge base, and experience that qualify them for a leadership position. If you want to become CNO, consider the following steps:

Step 1: Earn a BSN Degree

Aspiring CNOs usually begin by earning a Bachelor of Science in Nursing (BSN). This undergraduate degree helps you develop the foundational knowledge and skills to become a registered nurse (RN). BSN students also learn about the many challenges that nurses face, which helps them develop strategies to improve conditions as managers.

Step 2: Pass the NCLEX-RN and Become an RN

After earning a BSN, you can sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN), which is required to be licensed as an RN. After passing the exam and becoming licensed, you need considerable experience as an RN, ideally in a range of roles and departments.

Step 3: Earn a Master’s Degree

If you’re interested in pursuing leadership positions, consider earning an MSN to develop essential leadership skills. MSN programs focus on clinical and managerial expertise. Not all health care facilities require that CNOs have advanced degrees; however, it can help you stand out to employers as leaders.

Step 4: Gain Management Experience

In addition to experience as RNs, aspiring CNOs should work their way up the health care hierarchy to gain experience in administrative or management roles. You may want to consider pursuing a nurse manager role or becoming a department director before being promoted to CNO positions.

Step 5: Earn Certification

While additional certification isn’t always required, you may opt to earn a credential focused on executive leadership in health care. The American Nurses Credentialing Center (ANCC) offers two different certifications:

• Nurse Executive Board Certified (NE-BC): Demonstrates competency in coordinating a single nursing unit or team

• Nurse Executive Advanced-Board Certified (NEA-BC): Demonstrates the ability to manage multiple groups of nurses or non-nursing staff and operations, including finance, strategy, and resource management

The American Organization for Nursing Leadership (AONL) also offers certification for nurse managers:

• Certified Nurse Manager and Leader (CNML): Demonstrates knowledge of the essential elements of nursing leadership

In addition, you should develop the right set of skills. Successful CNOs possess the following competencies:

• Interpersonal communication

• Advanced clinical experience and expertise

• Administration

• Leadership

• Problem-solving abilities

• Resilience under pressure

• Strategic thinking

• Organizational skills

CNO Salary and Job Outlook

As of April 2026, chief nursing officers earned a median annual salary of approximately $160,000, according to Payscale. Top earners made up to $250,000 per year, making this among the highest-paid positions in health care.

The U.S. Bureau of Labor Statistics (BLS) groups CNOs under the umbrella category of medical and health services managers. According to their most recent data, employment in those roles is expected to grow by 23% between 2024 and 2034. This is much faster than the 3% growth the BLS projects for all occupations in the same period.

Begin Your Journey to Becoming a Leader in Health Care

Becoming a chief nursing officer requires developing the right skills and competencies, gaining clinical and administrative experience, and learning how to lead a team effectively. Those who rise to the position have the opportunity to make a positive impact on their organizations through their leadership. Additionally, CNOs have long-term stability with highly competitive salaries.

If you want to advance into a leadership role like CNO, explore The University of Tulsa’s online MSN program.

MSN students engage with a curriculum of core nursing courses, which include:

• Advanced Theoretical Frameworks of Nursing

• Research and Evidence-Based Practice

• Health Care Policy

• Health Promotion

• Pathophysiology

• Pharmacology

The program offers a Leadership and Innovation track specifically geared toward developing the essential skills and competencies for effective nurse leaders. We also offer a Family Nurse Practitioner, Doctor of Nursing Practice (FNP, DNP) program that can prepare you to become an APRN or clinical leader.

Learn more about how TU can support your professional aspirations of becoming a CNO.

Recommended Readings

Change Theory in Nursing: How It’s Evolving the Profession

A Nurse Educator’s Role in the Future of Nursing

The Most Important Leadership Skills for Nurses

Sources:

American Nurses Association, What Is a Chief Nursing Officer / Chief Nurse Executive?
American Nurses Credentialing Center, Nurse Executive Certification (NE-BC)

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

American Nurses Credentialing Center, Nursing Shortage Fact Sheet

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

Indeed, “How to Become a Nursing Officer in 5 Steps”

National Council of State Boards of Nursing, NCLEX

Payscale, Average Chief Nursing Officer (CNO) Salary

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