Nurses are often considered to be the heart of healthcare, offering patients who are sick or injured treatment, moral support, and vital information. They also serve as intermediaries between patients and their care providers. Most people see and interact more often with nurses than with any other medical professional. What patients do not see, however, are the nurse executives who ensure that care continues behind the scenes. Very few (if any) patients interact directly with nurse executives, yet these administrators are every bit as vital to patient care as the nurses they manage.
Nurse executives—closely related to nurse administrators, directors of nursing, or chief nurse executives—work to improve patient experiences and outcomes at the very highest level. They not only recruit, train, and monitor staff, but they also design and implement strategic goals, care initiatives, and best nursing practices. Additionally, they manage budgeting, policy, and human resources. At the end of the day, nurse executives are the professionals held most accountable for the quality and outcomes of a patient’s day-to-day treatment, both medically and at the bedside. Such responsibility sets nurse executives apart from all other nurse leaders and managers.
Nursing executives work at the highest echelons of the leadership ladder, but they rely upon other types of nurse leaders and managers to see initiatives through. Education, duties, and earnings can change dramatically from one position to the next, yet it is often difficult to discern roles by title alone. This table can help.
|Nurse Leader||Clinical Nurse Manager||Clinical Nurse Leader||Nurse Executive|
|Role||Directs nurses and nursing assistants for a single nursing unit or nursing shift. Reports directly to a clinical nurse leader or clinical nurse manager.||Mentors nursing staff. Coordinates care by creating schedules, giving work assignments, setting unit priorities, assessing patient outcomes, and evaluating staff.||Monitors unit-wide patient treatment plans and outcomes, modifying, improving, or replacing practices as needed. Keeps pace with the latest technologies and practices and trains staff how to use them.||Chief executive of an organization’s nursing staff and practices. Manages finances and directs strategic planning, human resources, standards, and best practices. Sometimes referred to as a CNE (Chief Nurse Executive) or CNO (Chief Nursing Officer).|
|Management Level||First-line manager||Middle manager||Middle manager||Senior manager|
|Direct Patient Care?||Yes||Yes||Minimal||Little to none.|
|Education||Diploma, ADN, or BSN||BSN or MSN||MSN||MSN, MSN/MBA, or DNP|
|Certifications||Certified Nurse Manager and Leader (CNML)||Certified Nurse Manager and Leader (CNML)||Clinical Nurse Leader (CNL)||Nurse Executive (NE-BC) and Nurse Executive, Advanced (NEA-BC)|
Please note that this guide uses “nurse executives” and “nurse administrators” interchangeably.
Nursing administration is an advanced leadership position requiring the right training and experience. The majority of nurse executives become licensed registered nurses (RNs) and earn graduate degrees or certificates in nursing administration or executive leadership. While some states license RNs with associate degrees in nursing (ADNs), graduate schools and professional certifications typically require bachelor’s degrees to qualify, particularly for online programs. Therefore, starting out with a BSN can save aspiring nurse executives valuable time and money. Registered nurses and other experienced students interested in BSNs might be eligible for efficient RN-to-BSN and ADN-to-BSN bridge programs. These accelerated programs can shave months and thousands of dollars off one’s education.
New and experienced nurses can complete programs online or on-campus. The former is especially helpful for working students. Online BSN, RN-to-BSN, and ADN-to-BSN degrees usually offer more flexible scheduling than campus-based programs, but students should still expect some on-site clinical requirements, often in their home communities.
A national shortage of nursing instructors drives nursing school admissions competition. It is not uncommon for BSN programs to require volunteer hours, an interview, or an entrance exam. Most schools also expect students to take certain undergraduate math, science, and other general education courses before they apply. Other common admissions criteria include:
Bachelor’s of science in nursing programs impart the foundational and working knowledge necessary for safe and effective nursing practice. Coursework includes a mix of general education, core, elective, and, depending on the program, specialty-determined classes.
The following are among some of the most common core courses:
Accreditation is an important marker of program quality. It is a voluntary process in which third-party organizations evaluate a college or department to confirm its programs follow established financial, teaching, and administrative standards and practices. Prospective students are encouraged to attend only programs accredited by the Accreditation Commission for Education in Nursing (ACEN) or the American Association of Colleges of Nursing’s Commission on Collegiate Nursing Education (CCNE), plus whatever regional body oversees accreditation in the institution’s home state. The Council for Higher Education Accreditation (CHEA) maintains a current list of regional accrediting organizations online.
All states require practicing RNs to have licenses and so do graduate admissions boards, some employers, and certification organizations. Only candidates who pass the National Council Licensure Exam for RNs (NCLEX-RN) and any other state-specific exams are eligible for licensure. Each state board of nursing sets its own exam qualification and other licensing criteria. This process usually requires an accredited nursing degree and a minimum number of clinical hours. Prospective students can visit the NCSBN for a complete list of state nursing boards to determine eligibility.
Nursing executives need thorough and working knowledge of clinical standards and procedures to do their jobs effectively—knowledge honed in the field. Graduate school admissions boards and employers typically require a minimum number of clinical hours or years of experience, as do most state licensing boards and professional certification organizations. Not surprisingly, earnings and advancement potential also tend to grow with experience.
The nature of nurse executives’ experience will vary by job and specialty, but the more, the better. Aspiring nurse executives are encouraged to research any and all experience-related state and graduate school requirements. Practicing RNs and other professionals may want to discuss advancement expectations with their employers, as well.
According to the BLS, most employers require healthcare managers such as nursing executives to have master’s degrees. Even facilities that accept candidates with BSNs and less time-consuming postgraduate certificates generally prioritize candidates with graduate degrees over those without. Examples of some of the most common credentials for nursing executives include:
Please note that only students who intend to work in research of the academia typically need doctoral degrees (e.g., a doctor of nursing practice [DNP] in nursing administration or a related specialty).
MSN Admissions Requirements
Like BSN programs, MSN admissions requirements vary by school. Some of the most common criteria for MSN in Nursing Administration programs include:
Students who apply to an MBA or MSN/MBA program may have to submit a minimum score on the Graduate Management Admission Test (GMAT), though the requirement sometimes waived for nurse leaders and similarly-experienced applicants. Admissions standards for post-master’s certificates in nursing administration are similar to those listed above.
Master’s degrees in nursing administration provide a balance of core, elective, and specialty courses. They are far more specialized than BSNs, requiring fewer general education and basic nursing coursework. Example coursework from real MSN in nursing administration and MSN in nursing leadership programs include:
Most MSN programs publish a complete schedule of courses with descriptions online. Students pursuing online MSN in nursing administration degrees should note and plan for any onsite clinical requirements or mandatory campus visits. Online programs often let students complete practicums and internships at approved healthcare facilities near their homes.
Many employers prefer certified candidates. Professional nursing administration certifications signify advanced knowledge of (and experience in) nursing leadership. Not to be confused with certificates from nursing schools, nursing administration certifications were designed by professional nursing organizations specifically for working and experienced nurse executives. Examples include:
Most professional nursing administration certifications require candidates to pass an exam, though exam criteria vary. Readers can visit the Illinois Healthcare Action Coalition for a list of nursing administration and leadership certifications and related requirements.
Any professional who stays on the cutting edge of new nursing research, practices, and technologies benefits from ongoing education. Most nurse executives are also RNs and must meet continuing education requirements to renew their licenses. The same can be said for some professional certifications. Nursing organizations offer continuing education courses (CECs)—including many online CECs—suitable for any of these scenarios, often at a lower cost than state-approved college courses.
Professional and Government Organizations