Nurse Administrator (Leader)

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The complex and multi-faceted nature of modern healthcare requires nursing leadership professionals who can create effective intra-departmental and facility-wide systems of healthcare delivery, while leading a productive and efficient workforce. This allows for optimal patient care in any medical setting, from private hospitals and clinics to large medical centers and veteran’s administration hospitals. Nursing administration is a broad term that encompasses nursing professionals who are knowledgeable of leadership practices as they relate to the nursing profession. As such, nursing administration, or leadership, may refer to a number of management supervisory and executive titles, including:

  • Nurse Manager
  • Nurse Administrator
  • Nursing Supervisor
  • Director of Nursing
  • Vice President of Nursing
  • Cheif Nursing Officer (CNO)

The Journal of the Medical Library Association (JMAL) defines nurse administrators, or leaders, as those who design, manage, and facilitate patient care delivery within any number of healthcare settings.

Nurse leadership is typically thought of as encompassing a hierarchy comprised of three general levels:

  • First-Line Nurse Managers – Also known as nurse managers, first-line nurse managers are those professionals who are responsible for overseeing first-level nursing services.
  • Middle Nurse Managers – Inclusive of clinical nurse managers, coordinators and case managers, middle nurse managers are often responsible for overseeing several units within a facility.
  • Nurse Executives – Inclusive of Chief Nursing Officers (CNOs), nursing directors, and executive vice presidents of nursing, these professionals are responsible for designing patient care delivery systems and directing patient care services throughout a facility.

The Role of Nursing Leadership Professionals

Nursing leadership professionals must be able to develop a successful vision for the nursing organization and nurture collaborative relationships among interdepartmental staff and management in an effort to implement that vision. Nurse leaders must apply analytical and problem solving skills on a daily basis, and provide direct guidance and mentorship to their unit nurses, often acting as a liaison between staff, various levels of management, and the hospital’s executive team.

Nurse administrators are often responsible for large-scale policy planning, staff management, financial resource management, and business management, in addition to their core responsibilities of coordinating and supervising the delivery of health care.

Because nursing care has expanded to include outpatient clinics, surgical centers, urgent care centers, and home health care, the role of nurse leaders has also expanded. As such, nurse administrators are now often responsible for contract negotiation and the management of interdisciplinary support services. Additionally daily duties would often include:

  • Planning work schedules and delegating responsibilities and tasks to nursing staff
  • Arranging and overseeing training of nursing staff
  • Observing nursing staff to ensure proper delivery of care
  • Establishing a budget and ensuring budgetary compliance
  • Recommending policy and structural changes
  • Overseeing the implementation of policy and structural changes

Educational Requirements for Nursing Leadership Professionals

The most widely accepted route to a career in nursing leadership is with an advanced degree, usually a Master of Science in Nursing with a concentration in management or administration that places a functional emphasis on leadership, or a Master of Health Administration. Specific degrees include:

  • MS Nursing – Management and Organizational Leadership
  • Master of Science in Nursing Administration
  • Master of Science in Nursing/Master of Health Administration
  • MS in Nursing: Leadership in Health Care Systems

Bridge programs, and blended MSN-MBA degrees are also common among nurse leaders:

  • MBA & MS in Nursing: Leadership in Health Care Systems
  • Master of Science in Nursing/Master of Business Administration/Health Care Management
  • MBA & MS in Nursing: Nursing Leadership in Health Care Systems (Bridge)

Although the curriculum may differ among advanced degree programs, it is common to find classes that focus on:

  • Administrative practices in healthcare
  • Nursing research
  • Business finance
  • Human resource management
  • Theoretical foundations of nursing
  • Strategic leadership and management
  • Healthcare finance and economics

Executive-level nurse leaders such as vice presidents of nursing and chief nursing officers often hold doctorates, such as the Doctor of Nursing Practice-Executive Leadership degree.

Residencies and internships are also vital aspects of graduate and post-graduate nursing leadership degree programs.

To qualify for national certification, most national certifying bodies require an active RN license and an advanced degree from an institution accredited by either the Commission on Collegiate Nursing Education (CCNE) or the National League for Nursing Accrediting Commission (NLNAC).

National Certification Programs for Nursing Leadership Professionals

Beyond an advanced degree in nursing administration, it is widely recognized that most institutions require nursing administrators to possess certification from a national certifying body. Certification ensures that nurse leaders have meet strong professional development requirements and are up to date with the latest developments in healthcare delivery and administration.

Certification through the American Nurses Credentialing Center (ANCC), the American Organization of Nurse Executives (AONE), or the American College of Healthcare Executives provides nursing leadership professionals with a number of options for professional designation:

The American Nurses Credentialing Center (ANCC), which is a subsidiary of the American Nurses Association, is the world’s largest nursing credentialing organization. The ANCC offers certifications for nursing leadership professionals that include the Nurse Executive (NE-BC) accreditation and the Nurse Executive, Advanced (NEA-BC) accreditation. The organization states that board-certified nurses are in the greatest demand and command the highest salaries.

The American Organization of Nurse Executives (AONE) is an accrediting organization that is geared toward nurse leaders in the executive nursing practice. Nurses who are eligible for certification through the AONE, in addition to holding an active RN license, must also possess a master’s degree and at least 2 years of experience in an executive nursing role, or a bachelor’s of science in nursing (BSN) and at least 4 years in an executive nursing role. The specialty certifications offered through the AONE for nursing leadership professionals include the Certified in Executive Nursing Practice (CENP) and the Certified Nurse Manager and Leader (CNML).

The American College of Healthcare Executives is an international professional society that includes more than 40,000 healthcare executives from hospitals, healthcare systems, and other healthcare organizations. The ACHE offers the FACHE credential, which signifies board certification in healthcare management. In addition, the ACHE has an established network of more than 80 chapters that serve as local sources for networking, education, and career development.

Salary Expectations for Nursing Leadership Professionals

Advances in technology and the ever-changing organizational structure of the healthcare system have had a profound influence on nursing practices, standards, and regulations in recent years. As such, qualified nursing leadership professionals – and similar nursing executive professionals – who understand and embrace these changes will continue to be in high demand.

The Bureau of Labor Statistics (BLS), Occupational Outlook Handbook 2010, reported that the median pay for medical and health service managers (also called healthcare executives and healthcare administrators) was $84,270 per year in 2010. The median salary among the top 10 percent of these professionals was $144,880. The Bureau of Labor Statistics also noted that employment for medical and health services manager is expected to grow by 22 percent from 2010 to 2020 – faster than the average for all other occupations.

The Occupational Employment and Wages, 2011, report published by the Bureau of Labor Statistics showed that the mean annual wage for medical and health services managers was $96,030, while the top 10 percent in this field earned an average annual salary of $147,890.

According to the BLS, the top-paying states for medical and health services managers were:

  • Massachusetts – Mean annual wage $112,690
  • Rhode Island – Mean annual wage $112,260
  • New York – Mean annual wage $111,270
  • New Jersey – Mean annual wage $110,100
  • Washington – Mean annual wage $108,620

According to the BLS, the average salaries for the five industries that employed the greatest number of medical and health services managers were:

  • General Medical and Surgical Hospitals – Mean annual wage $102,040
  • Offices of Physicians – Mean annual wage $93,770
  • Nursing Care Facilities – Mean annual wage $80,750
  • Home Health Care Services – Mean annual wage $85,860
  • Outpatient Care Centers – Mean annual wage $92,860

Resources for Medical and Health Services Managers

The Journal for Nursing Leadership (JONA) is an authoritative source for information as it relates to patient care leadership. Readers of JONA are typically nurse executives, directors of nursing, and nursing managers in any number of settings, including hospital, community health and ambulatory care environments.

The American Nurses Association is the only full-service professional organization that represents more than 3.1 million registered nurses in the United States through its state nurses associations and affiliates.

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