1. Barry, Jean PhD, RN, NEA-BC
  2. Winter, Janet DNP, MPA, RN

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Currently, there are various graduate programs that position a nurse to become a chief nurse executive (CNE). Many nurses have furthered their knowledge by obtaining graduate education outside nursing in management, business, or public administration. Others have completed advanced nursing degrees at the master's or doctoral level. At the doctoral level, some nurses have earned a research-focused PhD degree, whereas others have obtained a practice-focused doctorate of nursing practice (DNP) degree. Each degree offers unique knowledge, skills, and attitudes toward practice. Given the escalating complexity and rapidly changing US healthcare system, the DNP degree with a specialty in health system's leadership (HSL) clearly positions the CNE to lead at the executive level.


Nursing experts have begun to question whether the curricula in nursing administration master's programs are sufficiently robust to prepare the nurses to assume CNE positions in the current and evolving healthcare industry.1-3 Other nurses contend that an MBA is the degree of choice for CNEs.4 In 1 study, chief executive officers expressed high levels of dissatisfaction with curricula in traditional graduate healthcare administration programs with regard to their preparation of administrators who can find and sustain solutions through process and organizational innovation.5 CNEs who possess advanced business knowledge and ability as well as expertise in leading and sustaining transformational evidence-based change are paramount for success in the US healthcare delivery system.


A comparison of the American Association of Colleges of Nursing's Essentials of Master's Education in Nursing6 versus those for DNP education7 reveals an intentional scaffolding of core competencies that further equips the DNP-prepared nurse to lead in and across health systems. For example, the core competency of organizational and systems leadership at the master's level "prepares the graduate to provide quality cost-effective care, to participate in the implementation of care, and to assume a leadership role in the management of human, fiscal, and physical healthcare resources."6(pp11,12)


For the DNP-prepared nurse, achievement of this core competency involves demonstrated expertise in assessing organizations and systems of care, identifying systems' issues, and facilitating organization-wide changes in practice delivery. Political skills, systems thinking, and the business acumen needed for the analysis of practice quality and costs are of critical importance for the ongoing improvement of health outcomes.7


All DNP program graduates must demonstrate the competencies of the 1st 8 essentials. Further DNP preparation falls into 2 general categories of specializations: nurses who plan to function as nurse practitioners and those nurses who specialize at the aggregate, systems or organizational level. Those DNP programs with HSL tracks must ensure that the course work and practica prepare students to assume the challenging and multifaceted role of a CNE.3


The US healthcare financial reimbursement system is rapidly shifting to a model based on service value that takes into consideration acute, preventive, and wellness care. A service value model founded on principles of population health requires that a CNE demonstrate robust knowledge not only in systems thinking and design but also in informatics, healthcare finance, innovation, advocacy, quality improvement, and performance management for sustainability.8 A CNE must also possess sophisticated knowledge and skill in the interpretation of current evidence and its sustained translation into the clinical arena in order to promote the provision of safe, effective, and efficient care. The DNP student in an HSL track must demonstrate competencies in all of the areas noted above.


Nursing care is an essential component to ensuring that healthcare is available to all through a service value-based healthcare system. The DNP-HSL-prepared nurse at the executive level serves as a leader, informing and influencing decisions regarding the delivery of healthcare in a way that places the patient or client at the center, ensures integrity of the nursing profession, and guides effective use of organizational and community resources.


Educational preparation for today's CNE should be viewed as an investment to ensure that the business of healthcare is sustainable through a patient/client centered approach. Albert Einstein stated that "To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science."9 Of all the educational opportunities available today, the DNP degree in HSL provides the optimum foundation for CNEs to lead within the current and evolving healthcare industry.




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3. Barry J. The chief nurse executive as an organizational leader and its moral compass: should a doctorate in nursing practice be a requirement. In: Rundio A, Wilson V eds. The Doctorate in Nursing Practice and the Nurse Executive Role. Philadelphia, PA: Wolters-Kluwer; 2015. [Context Link]


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5. Herzlinger R, Ramaswamy VK, Schulman KA. Bridging health care's innovative education gap. Harv Bus Rev. 2014. Accessed October 6, 2015. [Context Link]


6. American Association of Colleges of Nursing. The Essentials of Master's Education for Advanced Practice Nursing. Washington, DC: AACN; 2011. [Context Link]


7. American Association of Colleges of Nursing. The Essentials of Doctoral Education for Advanced Nursing Practice. Washington, DC: AACN; 2006. [Context Link]


8. Volland J. Remodeling a broken system through hospital-payer partnerships. Nurs Manage. 2014; 45(9): 30-36. [Context Link]


9. Albert Einstein quotes. Brainy Quotes. Accessed October 6, 2015. [Context Link]