Experienced nurses looking to assume greater responsibilities in their jobs pursue chief nursing officer (CNO) positions. A CNO takes on the day-to-day challenges of running nursing units throughout a medical facility. These challenges include legal compliance, personnel planning, and care quality audits. CNOs also work with division heads and other administrators to coordinate services and develop budgets.
A combination of leadership skills, experience, and education allows a CNO to succeed. This position is rewarding because you are responsible for determining the vision and direction for nursing and ensure excellent service across multiple departments. If you pursue this career path, it’s might be helpful to know how much a CNO makes. A CNO salary in Texas can depend on where you work in the state, the size of the organization, the scope of your position and your employer’s overall pay scale.
Comparison to regional, national averages
Texas CNO salaries differ significantly from salaries in other states. The state’s average salary for a CNO was $101,639 in 2019, according to Indeed. This average fell below the national average of $120,582 for comparable positions. The average salaries for surrounding states put Texas CNO salaries in context:
These CNO salaries are significant bumps from the average registered nurse salary of $34.29 nationwide, which translates into an annual salary of approximately $71,000.
Regional salary variations within Texas
A CNO working in one part of Texas is unlikely to make the same salary as other CNOs. The variation in CNO salaries reflects the market, type of facility, scope of the position as well as fiscal resources of the organization. PayScale offers a helpful glimpse into CNO salaries in major cities throughout the state.
PayScale cites an average CNO salary of $141,585 in Houston with salaries ranging from $109,000 to $210,000. A CNO in San Antonio averages $124,954 per year with salaries varying from $105,000 to $179,000. In Dallas, a CNO can expect to make an average salary of $115,046 with a salary range from $105,000 to $176,000.
The aforementioned average salary in Texas balances these higher salaries with lower salaries in small communities. Soliant’s May 2017 map of Texas registered nurse salaries shows nurses in less-populated western and southern communities making half of their big-city counterparts.
A CNO’s salary is not the only reward they receive for years of hard work and education. The American Organization for Nursing Leadership (AONL) published survey results in 2016 from 2,541 chief nursing officers, managers, and executives across the United States. This survey detailed salaries among nurse executives as well as job satisfaction for CNOs and nurse managers.
AONE found that 81% of respondents were somewhat or very satisfied with their roles as nursing executives. The survey determined that 59% of respondents were satisfied with their salaries and 72% were satisfied with their benefits.
AONE asked CNO respondents why they remained in their jobs, finding:
- 85% found joy in their work
- 90% enjoyed relationships with co-workers
- 96% enjoyed relationships with direct reports
- 84% liked the amount of authority offered by their position
Despite the challenges of this profession, AONE’s survey highlighted the primary reasons why CNOs tend to be satisfied in their jobs.
Charlene Ingwell-Spolan is a registered nurse and academic who has written extensively on the challenges facing CNOs. In a presentation titled “Authentic Work Experiences of Chief Nursing Officers,” Ingwell-Spolan highlighted several issues facing CNOs and their employers including:
- Turnover rates of 3-5 years in CNO positions
- Limited pool of experienced registered nurses for promotion
- Poor communication to nurses by department managers
- Budgetary limits set by chief executives
Ingwell-Spolan goes beyond these structural issues in a 2018 article in the journal Healthcare. A CNO bridges the worlds of the registered nurse and hospital executive. This tenuous balance means that CNOs have to balance bottom-line concerns from executives, grassroots issues from nurses, and optimal patient outcomes. Ingwell-Spolan found that CNOs juggled patient care, hospital policies, compliance requirements, negotiations over hours with personnel, and resource allocation on a day-to-day basis.
The challenges facing every CNO can be stressful, but Ingwell-Spolan offers some glimpses of the pot of gold at the end of the rainbow. CNOs interviewed by Ingwell-Spolan found mentoring registered nurses rewarding because they could see these relationships translate into positive patient outcomes. The CNOs in question also suggested that their hospitals and facilities provided the resources necessary for nurses to serve as many patients as possible. Ingwell-Spolan highlighted the positive traits of CNOs including consistency, courage, persistence, and intelligence. Registered nurses with these traits should consider the CNO path as they progress through their careers.
Education and experience
You will need the right combination of education and experience to become a CNO in Texas. Nutex Health’s description of a CNO position in Texarkana illustrates what it takes to reach this position. This description includes the following requirements:
- Completed MSN or DNP degrees in nursing
- Five years of experience in managing nurses
- Eight years of experience as a registered nurse
- Current RN license
- Current certification from ALCS and ENPC or PALS
Baylor University's Louise Herrington School of Nursing Online helps experienced nurses take the next step as CNOs. This DNP program allows nurses to complete coursework on their time through online courses. Baylor University does not require DNP applicants to complete the GRE or GMAT exams. After completing core coursework, you can finish the doctoral residency and final project in your community without heading to Baylor’s Waco campus.