So You Want to Be a Chief Nursing Officer?

Laura A. Stokowski, RN, MS


March 26, 2015

In This Article

The Nurse Executive

Figure 1. Peggy Gordin, MS, RN, NEA-BC, Chief Nursing Officer, Vice President of Patient Care Services, St. Louis Children's Hospital

Nurse executives are a very diverse group of nursing leaders. The title "head nurse" is rarely bestowed; these days, nurse executives hold such titles as nurse manager, patient care director, director of nursing, chief nursing officer (CNO), chief executive officer, or vice president. How these nurse executive roles are defined and the levels of responsibility associated with these titles are spelled out in organization-specific policies. Some administrators hold dual titles, as illustrated by nurse executive Peggy Gordin, who is both chief nursing officer and vice president of patient care services at St. Louis Children's Hospital in St. Louis, Missouri (Figure 1).

As the nurse advances from leading at the bedside to leading units, departments, services, and entire healthcare organizations, responsibilities and challenges shift and change. Going from "bedside" to "boardroom" takes years, depending on the organizational structure of the facility or health system. The different levels of leadership that a nurse might achieve and pass through on this journey are shown in the Table, although this is highly organization specific.

Table. Bedside to Boardroom: Levels of Nursing Leadership

Level Title Role
1 Staff nurse/charge nurse The "individual contributor." Manages self, responsible for personal and work time management, adopting professional standards, and integrating into work culture. Begins to take more responsibility—team/committee leadership, charge nurse, coaching new peers, orientation.
2 Assistant director (unit or department) Most challenging step for developing leaders; involves a dramatic shift from managing self to managing others. Must derive work satisfaction and value through others. Motivating and mentoring others to get the job done provides the new leader with a sense of self-worth and accomplishment.
3 Director (unit or department) Begins the transition to pure management with focus on mentoring and identifying new leaders, monitoring leadership development of staff and assistant director, and assigning leadership activities. Begin developing one's own strategic thinking skills.
4 Service director Functional managers; must compete with other service directors for corporate resources. Blend functional strategy with business strategy. Communication becomes challenging because they are two levels removed from frontline nurses and responsible for managing multiple areas that may be outside their own clinical experience.
5 Vice president of nursing Leaders see a direct link between their contributions and business outcomes and enjoy a significant degree of autonomy. Key skills are financial acumen and proficiency at capital allocation and strategic planning.
6 CNO Evaluates strategy for capital allocation and deployment, manages external constituencies, and mentors. Derives satisfaction through the work of others. Demands long-term, visionary, and strategic thinking skills.
7 Systems-level CNO or CNE Full and equal partners in strategic development and decision-making at the highest executive level of the system; participants in system governance.

CNE = chief nursing executive; CNO = chief nursing officer. Data from Hoeger PB, et al[1]; Charan R, et al[2]; and American Organization of Nurse Executives.[3]


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