Day in the Life of a Nurse Executive

Day in the Life of a Nurse Executive

While nurses cover the front lines of patient care, nurse executives work behind the scenes to ensure their organizations’ and employees’ success. These professionals oversee patient care procedures, manage teams, and create and revise policies.

Nurse executives perform crucial work in healthcare, and they continue to rise in demand. The Bureau of Labor Statistics (BLS) projects a rapid 32% growth for healthcare managers, including nurse executives, from 2020-2030.

This page explores a typical day in the life of a nurse executive, including daily responsibilities and nonstandard duties.

What Is a Nurse Executive?

Nurse executives occupy the highest tier of nursing in hospitals, nursing homes, and medical facilities. These professionals manage finances, develop policies, and represent their organizations. They also hire, train, and schedule nursing staff.

Nurse executives differ from clinical nurse leaders (CNLs). Executives oversee business operations rather than patient-level care. Nurse executives typically hold a master’s and are licensed as registered nurses (RNs). They also earn certification, such as certification in executive nursing practice or nurse executive certification (NE-BC®).

Read More About Nurse Executives

What Does a Nurse Executive Do?

Nurse executives lead many roles in their healthcare organizations. These leaders oversee nursing staff, patient care, and budgeting. They also update policies, head safety procedures, and represent their organizations.

Strong-minded people with a knack for multitasking and communication can thrive in these roles. Nurse executives aim to help people through policy and advocacy.

Other organizational leaders, like CNLs and financial managers, report to nurse executives. These professionals meet with staff, board members, administrators, and patients’ families to discuss data and implement changes.

Nurse executives’ many roles and responsibilities can present challenges. Necessary tasks may change daily, and nurse executives must remain adaptable to handle issues that arise. This job can also take an emotional toll on nurse executives, as many organizational responsibilities fall on their shoulders.

Patient safety and well-being top the list of priorities for nurse executives.

Fortunately, nurse executives gain experience working with an array of healthcare facility departments. This makes nurse executives respected, go-to figures in their organizations. These leaders can also advance to other executive positions, like CEO.

The following lists explore typical and nonstandard nurse executive duties.

Roles and Responsibilities of a Nurse Executive

  • Design Patient Care Procedures: Patient safety and well-being top the list of priorities for nurse executives. These leaders monitor organizational culture and patient care procedures to determine effectiveness and areas for improvement. Regular check-ins with staff and patients allow open communication about potential safety issues.
  • Advocate for Staff and Patients: Nurse executives bridge gaps between their staff and patients and external resources through community outreach. For instance, a nurse executive might form an alliance between their organization and a community college to offer continuing education to the team’s nurses or wellness courses to patients.
  • Oversee Human Resources: Nurse executives manage human resources tasks, including addressing harassment allegations and gathering staff satisfaction feedback. While they do not directly complete these tasks, nurse executives ensure that human resources departments operate effectively and follow company policies.
  • Create Organizational Policies: Policies create the foundation of a healthcare organization’s operations. Nurse executives write, implement, and improve policies governing patient care, staff behavior, and financial management. They use clinical research and organizational data to ensure that each procedure meets legal, safety, and efficiency standards.
  • Decipher Organizational Data: As decision-makers in healthcare organizations, nurse executives must analyze patient care and company procedure data. They use this data to improve current processes and policies that affect the organization, staff, patients, and community. Staying up to date with new technology can help nurse executives achieve data-driven results.

Nonstandard Jobs for Nurse Executives

  • Oversee Hiring and Training: When the need for team expansion arises, nurse executives may step into a hiring and training management role. Their responsibilities include equipping other nurse leaders with resources for training and partnering with local facilities to train nurses for open positions within their organizations.
  • Identify and Promote New Leaders: Nurse executives identify nurses to become leaders as new positions become available. Some roles and responsibilities of nurse executives include mentoring future leaders and encouraging staff participation in certification and professional development programs.
  • Represent Their Organization: These leaders connect communities and their organizations. Nurse executives attend community events and communicate with the media as representatives. This responsibility typically appears more with large healthcare organizations rather than smaller medical facilities.
  • Manage Budgets: Nurse executives oversee their organizations’ financial management. These leaders monitor financial statements, find ways to lower costs, and create budgets for short-term and long-term spending. Budget management may occur at different intervals, such as quarterly or semi-annually.
  • Create Staff Incentives: Nurse executives may distribute awards to teams and organizations. These incentives encourage adherence to safety protocol through accurate reporting, follow-ups, and policy compliance. AONL’s Guiding Principles for the Role of the Nurse Executive in Patient Safety suggests awarding annual patient safety incentives.

The Anatomy of a Typical Day as a Nurse Executive

Like other nursing professionals, nursing executives work varied hours each day and week, often extending beyond the average 40-hour workweek. While these executives usually work day shifts, their organizational needs may require weekend or evening work.

Nurse executive jobs often begin with reviewing organizational, patient, and staffing data. These professionals also review safety reports and follow up with relevant individuals, if needed. They then make their rounds with staff and patients, ensuring that each group has the necessary support and resources.

Throughout the day, nurse executives’ tasks vary depending on their organization. Typical duties include:

  • Hosting meetings with nursing staff, board members, and department heads
  • Meeting with patient families to discuss concerns and needs
  • Reviewing patient surveys and following up with staff
  • Offering resources to staff to prevent potential safety issues
  • Connecting with partnered organizations to manage patient care and staffing
  • Reviewing and updating organizational policies to support physicians, nurses, and patients

Nurse executives receive reports from colleagues in their healthcare organization daily. Physicians, nurses, and hospital administrators come to the nurse executive for resources and advice to perform their jobs safely and effectively.

Professional Spotlight: Rhonda Thompson, Chief Nursing Officer and Senior Vice President

What prompted your journey to begin working in nursing leadership/executive roles?

I don’t know if there was one specific moment that jump-started my path toward nursing leadership roles. When I learned that I could have the ability to advocate for patients and families at a much larger scale is when I really became intrigued with leadership and executive roles.

I loved being a bedside nurse, but I was only able to impact a few patients and families at a time. In leadership roles, you can advocate for a broader patient family population.

Why did you choose your specialization, specifically?

When I graduated from nursing school, I was unsure of what type of nursing I wanted to do. I started in geriatrics but eventually found my way to pediatrics, and that is when I fell in love with nursing all over again.

Throughout my time as a bedside nurse, I worked in many different areas — inpatient, outpatient, hematology/oncology, transplant, respiratory, medical/surgical, and intermediate critical care.

I loved taking care of patients and families regardless of the environment. Something sparked in me the first time I took care of kids in a pediatric setting. I just knew I had found a different level of love for the nursing profession caring for children.

For whom do you think this career is a good fit? Why?

Nursing leadership is a good fit for people who have a plethora of different types of nursing experience. There is no chief nursing officer (CNO) I know of that has experience in every single area of nursing. Having varied experience helps set you up to have a better understanding of the different needs of patients and families in different departments.

People who want to go into nursing leadership need to be prepared for an unstructured environment. You never know what will happen, and you need to be prepared for everything. You also need to be agile with your ability to move between a fast pace and slow pace and from crisis to non-crisis situations.

From a competency perspective, you need to have a good emotional IQ and emotional stability. Nursing — especially nursing leadership — can be an incredibly emotional job.

What additional education did you get to qualify for nursing leadership/executive roles? What was it like?

I have a master of science in nursing (MSN), a master of business administration, and a doctor of nursing practice (DNP) in systems leadership from Rush University.

Going back to school and earning those degrees when I did was helpful in that I already had multiple years of experience, not just in nursing but in different organizations and various leadership roles. At the time, I was raising a child with special needs and going to school full time, so it was not easy.

But it was helpful that I had those years of experience in different organizations as a foundation. I could draw from that experience when it came to conversations in class or writing papers.

What certification and licensure tests did you need to pass?

Aside from passing my NCLEX, I earned a nurse executive advanced (NEA-BC) credential, which is highly recommended if you’re going to pursue a higher leadership role in nursing.

How did you prepare for these certifications and tests? What were they like?

My years of experience helped prepare me for the questions on my certification test. I also took a certification review course and read the manual before the exam, which helped. The exam drew a lot from the review course and manual, but there was an expectation that you used your real-world experience in management, as well.

What’s a typical day like for you?

I usually start my day by reviewing the last 24 hours of statistics on volume and our current staffing levels. I also review any safety events over the last 24 hours. When I do that, I’m looking to see if there is any support I need to provide to anyone involved in a safety report.

I do have a lot of meetings, but I’m a stickler about not just having a meeting to have a meeting. I have a lot of productive meetings. I spend a lot of time one on one with my direct reports and ensure they have the support they need to carry out their day-to-day operations.

What’s your favorite part of the current work you do as a CNO, as well as your favorite part of working in a leadership/executive capacity throughout your career? What is the most challenging part?

My favorite part of my role as CNO is rounding on staff, patients and families. That connectivity really matters.

Regardless of your title, if you are in a leadership or executive role, making rounds keeps you grounded. When you see what people are doing and what families are going through, it reminds you why you come to work every day and why you make the decisions you make. Patient families need us. Staff members need us.

One of my goals is to make a real impact on staff members and make sure they know how much they are appreciated. I send a handwritten thank you note to every single staff member who is mentioned by name in a patient experience survey.

They have clearly made an impact on their patients. I send those thank you notes to our staff’s homes because I want them and their families to know how much we appreciate them and all they do at Phoenix Children’s.

For me personally, the most challenging part is not having all the answers and not being able to solve all the problems. If someone comes to me with a problem, I want to be able to help them find a solution right then and there. Sometimes, situations are more intricate and take longer to sort out.

I take it personally when there is a problem that we can’t work through immediately.

What advice do you have for individuals considering becoming a nurse executive?

First and foremost, it’s important to be realistic about that goal and understand that the more years of experience you have, the easier the transition to becoming an executive will be. It makes the transition a little easier when you have multiple years of varied experience under your belt. This not only makes the transition easier, but the collaboration needed in an executive role, as well.

You also need substantial business acumen. In my role, I need to understand the business of healthcare and also any potential legislative matters that may impact expectations or how we deliver care.

What do you wish you’d known before choosing this career path?

I wish I had known how hard nursing would be emotionally. I knew nursing, in general, would be emotional — and it can be, both good and bad. I’m not saying I would have chosen a different path, but I wish someone would’ve told me more about that part.

I am a firm believer that we shouldn’t just wait for big milestones to have a celebration; we need to be sure to celebrate small wins, too. I wish I would’ve realized the importance of this earlier in my career. Every time your staff member passes a certification or is accepted into school — celebrate that.

I wish I had known how hard nursing would be emotionally.

I was on a call recently, and someone mentioned a milestone in our neonatal intensive care unit. I took a step back and thought, “This is big. We need to celebrate this. Let’s not just say ‘good job’ on a call and move on, but let’s take time out to celebrate this milestone.”

Also, regardless of where you are on your career path, ensure that you have one or two confidantes or mentors that you can share with what you’re going through. It’s a lot to carry around — the pressures and the emotional side of nursing.

Portrait of Rhonda Thompson, Chief Nursing Officer and Senior Vice President

Rhonda Thompson, Chief Nursing Officer and Senior Vice President

As CNO and senior vice president at Phoenix Children’s Hospital, Rhonda Thompson, DNP, MBA, RN, NEA-BC, develops and advocates for the organization’s more than 1,400 nurses. She collaborates with physician leadership to drive continuous improvements in clinical services and patient outcomes. Thompson takes an active role in the hospital’s strategic planning and expansion efforts.

Thompson previously served as CNO for The Children’s Hospital of San Antonio and as the William H. Parry, M.D., endowed chair of pediatric nursing. She held pediatric nursing leadership posts at Memorial Hermann in Houston, including director of pediatric special care services, plus leadership roles at Texas Children’s Hospital.

Where Nurse Executives Work

Healthcare organizations and hospitals most commonly hire nurse executives. Some also work for nursing homes, nursing schools, home health agencies, and medical facilities. Additionally, nurse executives may travel among healthcare organizations.

Nurse executives can benefit from working for one organization by narrowing their focus to pinpoint key areas that need assistance. Some professionals might prefer consultant roles with more varied responsibilities as they assist multiple organizations.

According to the BLS, medical and health service managers like nurse executives earn a median salary of $104,280 per year as of May 2020.

Although these professionals work across the United States, the pathway to RN licensure varies by state. However, most states have similar requirements, including graduating from a bachelor’s degree program and passing an exam.

According to the BLS, medical and health service managers like nurse executives earn a median salary of $104,280 per year as of May 2020. Still, location can affect salary potential.

For example, the District of Columbia and New York rank among the highest-paying states for these leaders, with average annual wages of $157,590 and $156,140, respectively. In contrast, Arkansas and Iowa offer the lowest average annual salaries of $89,700 and $91,160, respectively. These figures all reflect May 2020 data.

Work location can also affect salary. Larger companies generally pay more for these positions than smaller organizations, as nurse executives may juggle more departments, staff, and patients each day.

See How Location Affects Salary for Nurse Executives

Should You Become a Nurse Executive?

Nurse executive jobs lead the nursing industry in advocacy, patient care, and organizational policies. These leaders accomplish a lot each day, making the career incredibly rewarding.

Nurse executives also work at the intersection of healthcare and business. This experience can assist them in transitioning to other healthcare careers, like a hospital administrator or chief executive officer.

However, the road to becoming a nurse executive is long and challenging. Nurses looking to limit the time and money they spend on schooling may not find the pathway a good fit.

Nurse executives also face daily challenges. These professionals try to solve any problems with their organizations, staff, or patients, but some issues may be unsolvable. With so many responsibilities on their plates and demanding schedules, their work can lead to burnout.

Finally, consider the emotions behind the job. Like other nursing careers, nurse executives experience highs and lows that can take a toll on their well-being. Emotional intelligence is crucial in this field.

Learn How to Become a Nurse Executive

How to Prepare for a Career as a Nurse Executive

To work as a nurse executive, each candidate must maintain an RN license, earn an MBA or MSN, and obtain relevant certification. They can earn these designations while working to prepare for the nurse executive role.

However, candidates should ensure that they can commit the time, money, and focus to their education without sacrificing their professional and personal responsibilities. Earning a degree online may offer a practical option to work around demanding schedules. Students can also seek the help of study partners.

Finally, consider reviewing test preparation materials for nurse executive certification. For instance, the American Nurses Credentialing Center offers sample tests and a test content outline for its NE-BC credential exam.

Frequently Asked Questions

  • How long does it take to become a nurse executive?

    Nurse executives must obtain bachelor’s and master’s degrees, RN licensure, on-the-job experience, and nurse executive certification. Some also pursue doctoral degrees. Candidates may take 10 years or longer to become nurse executives.

  • Are nurse executive jobs in high demand?

    The BLS projects medical and health service manager jobs like nurse executive to grow by 32% from 2020-2030. As nursing and healthcare systems evolve, the demand for experienced leaders should remain consistent.

  • What skills do nurse executives need?

    Organization, communication, and empathy are critical nurse executive skills. These leaders should also be adaptable, motivating, and business-minded. Strong emotional intelligence can help nurse executives balance the emotional aspect of patient care.

  • Who does a nurse executive report to?

    The nurse executive must report to organizational administrators and leaders, like board members or chief executive officers. Nurse executive reports may include updates on policies, patient care processes, and staffing needs.

Featured Image: sturti / E+ / Getty Images

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