So You Want to Be a Chief Nursing Officer?

Who Has the "Right Stuff" to Become a Nurse Executive?

What does it take to become a nurse executive? According to the nurse executive competencies delineated by the AONE, nurse executives at every level of healthcare administration must exhibit professionalism; have a broad knowledge of healthcare environments; and be skilled in leadership, business, and communication and relationship building.^[3]

Gordin also emphasizes the need for "people skills." The successful nurse executive, according to Gordin, "has the ability to ask questions or deliver a challenging message in a way that people can hear it." Gordin looks for someone who is positive, embraces change, thinks creatively, and follows through on ideas.

Systems CNOs are decision-makers, visionaries, and change agents for multiple facilities in a healthcare network. For systems CNO positions, Polhemus looks for nurse executives who know how to bring people together and build teams, who understand collaboration, and who have proven track records in advancing healthcare quality. A systems CNO must have strong communication skills (especially with physicians), emotional intelligence, and financial know-how.

Nurses often wonder whether they have the right clinical background to move up the nurse executive ladder beyond the familiarity of the unit or department. Polhemus has observed that successful systems CNOs can come from any specialty. "Clinical credibility is important, but I have seen CNOs with backgrounds in medical-surgical nursing, emergency department nursing, and even the operating room because experience in managing surgeons is a valuable asset. Having knowledge about ambulatory care services is another plus. The ability to have seen how every part of the organization works is valuable."

Polhemus admits, however, that it can be difficult to find nurse executives with the right skills to make the jump to the systems level and be successful on the business side of healthcare management, although "the really tough decisions perhaps become easier in proportion to the distance from the bedside," she acknowledges. "You need to have experienced good leadership roles with a lot of people under you, where you get to cut your teeth on a lot of different cultures, personalities, and thorny problems. If you have worked in a less intense setting, these experiences might be lacking," adds Polhemus.

Gordin has observed that a disproportionate number of nurse executives come from critical care backgrounds but doesn't know why this is the case, speculating that "it might be because intensive care unit (ICU) nurses are more challenging to lead. It might be that if you can successfully navigate a large, multigenerational ICU staff, you have the skills needed to manage an even larger workforce."

Another question often asked by nurses interested in an executive career is: What educational preparation or advanced degree is required or most desirable? Polhemus and Gordin agree that a master's degree in healthcare administration or a master's degree in business administration (MBA) are most helpful at the present time. This is changing, however. "If you are young and think leadership is in your future, you should think about the doctor of nursing practice (DNP) in healthcare administration or healthcare systems leadership. Doctoral level education is already a requirement for CNO positions in some organizations and will be mandatory in the future," maintains Gordin.

The AONE offers many educational resources for emerging and current nurse executives, from the manager level up to the systems CNO. These include seminars and webinars on such topics as shared governance; a leader mentorship program; competencies for nurse executives; and certifications for nurse managers, nurse executives, care innovation and transformation, and healthcare finance. AONE also has an Emerging Leader Institute, a Nurse Manager Institute, nurse manager orientation, and a nurse manager fellowship program.

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Cite this: So You Want to Be a Chief Nursing Officer? - Medscape - Mar 26, 2015.