A nurse executive is a registered nurse (RN) who holds a position of leadership in an organization. Whether they are directors of nursing, nurse managers, nurse educators, or other leadership positions, nurse executives have an important role in directing the mission and vision of a health system. They develop their nursing staff, push toward their organization’s goals, and work to ensure patients receive the best care possible.
Where Do Nurse Executives Work?
Nurse executives can work for a diverse mix of institutions. Sometimes they have nursing staff directly under them, and other times they consult with companies regarding nursing needs. Nurse executives may work for:
Government agencies
Healthcare system corporate offices
Health startups
Hospitals
Insurance companies
Long-term care facilities
Outpatient care centers
Skilled rehab facilities
Universities and colleges
Nurses who take an executive post may have very different responsibilities depending on the type of job they take. Nurse managers, for example, work on a patient unit and stay involved with their staff and patient care. Directors of nursing, on the other hand, typically work in an office suite with other facility executives. If a nurse becomes the dean of a nursing school they will work on a university campus.
What Does a Nurse Executive Do?
Nurse executives set the tone for all staff under them. Their day-to-day can look a little different depending on the type of facility they work for. The following are some common nurse executive responsibilities:
Adjust staffing schedules and ratios
Advance policies and standard-of-care guidelines to ensure high levels of care
Create or update nursing goals for the facility and a plan to reach them
Develop nursing staff through continuing education opportunities
Ensure the efficient flow of patient care
Evaluate nurse managers’ performance
Keep the facility up to date with state and federal regulations
Manage nurse staffing budgets for each department
Meet and collaborate with CEOs, CFOs, unit managers, and nurses
Monitor expenses, and adjust budgets
Promote recruitment plans for new nursing staff
Sometimes nurse executives have to get involved in a conflict between patients, family members, and staff. The nurse executive – usually a director of nursing or nurse manager in this case – helps de-escalate issues and works with everyone to offer solutions and clarify policies as needed.
A nurse executive may also be called in during emergency situations. Pandemic situations like COVID-19 or mass casualty events call for fast authoritative decisions. In conditions like this, nurse executives work with other managers and executives to ensure the best care possible remains available to patients and that their staff stays safe.
How Do I Become a Nurse Executive?
A nurse executive has years of experience as an RN and may have higher-level degrees. First, an aspiring nurse executive must go to nursing school and graduate from an accredited nursing program with a Bachelor of Science in Nursing (BSN).
Graduate nurses must then pass their state licensing exam: the NCLEX-RN. A series of multiple-choice questions, this standardized test shows a nurse’s clinical knowledge and capability to practice in their field.
Any type of bedside experience can help prepare a nurse executive for a leadership role. Nurse managers may need experience in the type of unit they apply to lead. One step toward leadership is to become a charge nurse. A charge nurse spends their shift assigning admissions, monitoring all patients and staff, and troubleshooting any conflicts or emergencies.
After working as a charge nurse, nurses may apply to become assistant nurse managers or nurse managers. The nurse manager oversees their unit: staffing, budget decisions, and policy adherence. When a nurse has held a nurse manager role for two to three years, they may apply for a role as a director of nursing or another leadership role. Every facility has differing experience requirements for its nurse executive positions.
A nurse with a Master of Science in Nursing (MSN) or a Master in Healthcare Administration may be able to more easily land an executive position. Master programs take about two years of full-time hours to complete. Larger facilities or health systems may want their nurse executives to have a Doctor of Nursing Practice (DNP) in Executive Nursing Administration.
Nurse executives can also get certifications in their field. The American Nurses Credentialing Center (ANCC) offers Nurse Executive Certification (NE-BC). To be eligible, nurses must be able to show 2,000 hours of management or administration experience and 30 hours of clinical management experience within the last three years. The ANCC also offers an advanced NE certification, the NEA-BC, for nurse executives with experience in organization-wide or system-wide operations and outcomes.
The American Association of Nurse Executives Services (AADNS) offers Nurse Executive Services (DNS-CT) certification. Their requirements state the nurse executive must have the equivalent of two years of full-time acute bedside experience as an RN, with a minimum of one year of experience either as a nurse executive or other relevant nursing leadership experience.
A nurse executive can become a Certified Director of Nursing Administration for Long-Term Care (CDONA) through The National Association of Directors of Nursing Administration in Long-Term Care. To be eligible, the certification candidate must be a licensed RN, have worked 1,000 hours as a nurse executive or similar position, and have completed 75 hours of continuing education.
How Much Does a Nurse Executive Make Per Year?
Because nurse executives fill high-level roles, they can earn more than bedside nurses. The US Bureau of Labor Statistics (BLS) does not offer specific salaries for nurse executives. However, according to salary.com, nursing director salaries average $162,015 per year as of 2023. This amount can vary depending on the work setting and the cost of living in the area. The low-end average was $123,286, and the high-end was $209,248. Depending on the type of facility, an employer may be able to offer higher or lower compensation.
The US Bureau of Labor Statistics (BLS) does provide the average salary for nurse managers: $127,980 as of 2022. This amount can vary depending on the work setting and the cost of living in the area. The low-end average was $64,100, and the high-end was $209,990. Depending on the type of facility, an employer may be able to offer higher or lower compensation:
Hospitals; State, Local, and Private: $119,450
Government: $117,000
Outpatient Care Centers: $99,540
Offices of Physicians: $98,230
Nursing and Residential Care Facilities: $83,550
Other salary reporting organizations put nurse executive salaries much lower, with averages around $87,643 and $95,730. Salaries also vary depending on which state a nurse executive practices. The west coast generally pays nurses the best, but they also have a higher cost of living. San Francisco boasts the highest pay for nurse executives.
California, Washington, Rhode Island, and New York pay nurse executives the highest wage, but the cost of living in these areas can also be high. The lowest-paying state is South Dakota.
Certified nurse executives can be paid more than a nurse executive who is not certified, depending on the facility. In general, the more experience and proof of expertise, the more a nurse executive will be able to earn.
What Are the Benefits of Being a Nurse Executive?
Nurse executives hold power. They can use that power to improve their facility, implement policies that attract top-tier nursing staff, and ensure better patient care. A day in the life of a nurse executive may look quite different from other nursing roles. Nurse executives usually work regular business hours and don’t have to work on weekends or holidays. They can also make a higher salary than other nursing professionals.
Many employers offer significant perks for their nurse executives, including:
Employee assistance programs
Employee discounts
Life and Accidental Death and Dismemberment (AD&D) insurance
Loan forgiveness
Medical benefits
Relocation assistance
Travel reimbursement
Tuition reimbursement
Are Nurse Executives in High Demand?
US health facilities need more nurse executives, and the Bureau of Labor Statistics predicts this demand will grow. The BLS states medical and health services manager needs will increase by 32% between 2020 and 2030. Many nurse executives are nearing retirement age, and that will leave a lot of open positions in the coming years.
Additional Resources About Becoming a Nurse Executive
To learn more about becoming a nurse executive, these additional resources may help:
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