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Transitioning from CNO to CEO — What It Takes to Rise and Succeed

By , Chief Executive Officer, ContinueCARE Hospital at Medical Center March 14, 2023 Executive Staffing, Hospital Management

CNOs who have advanced to become hospital CEOs are still somewhat rare, but the move makes a lot of sense. In fact, hospitals that place a nurse at the top of the organization are finding that CNOs with the right preparation make excellent CEOs. In this article, Laci Harris, CEO of ContinueCARE Hospital at Medical Center in Odessa, Texas, shares insights from her own experience moving from the role of Chief Nursing Officer to becoming CEO.

At the beginning of your career, did you hope to one day become a CEO?

When I started out as a certified nurse aide, I never imagined I would become a hospital CEO. Back then, I was a single mom with two kids and was focused on getting by — although part of me felt I had something to contribute and I began to think more and more about getting ahead. Eventually, I became a registered nurse. 

Was there an experience or a mentor who inspired you to advance your career?

Absolutely! After I became an RN, I decided to pursue a Master of Science degree in nursing in hopes of advancing my career. At that time, a supportive leader stepped in and persuaded me to add to my plan; I found a program that offered both the MSN and MBA so I could have the best of both worlds.

Looking back, that was a major milestone along my journey to becoming a CEO. My clinical and administrative experience, combined with my business acumen, gave me the credentials — and courage — to toss my hat in the ring when the CEO position opened up at ContinueCARE Hospital at Medical Center in Odessa, Texas. I’ve been the CEO here since January 2020. But first, I did what most aspirational nurses do — I rose through the ranks and became a CNO. 

How did your experience as a nurse and CNO prepare you to become a CEO?

I’ve come to appreciate how well my previous nursing experience serves me in my current role. In fact, when it comes to running a hospital, nurse CEOs bring unique qualifications to the table, including a practical and passionate understanding of what it takes to deliver quality, service-oriented care. CNOs have excellent interpersonal and teamwork skills. If promoted from within, they have already earned the respect of frontline workers, and they understand, through first-hand experience, the challenges they face. They also have first-hand experience that helps create the type of environment that will attract and engage clinicians.

As a nurse, and later as a nurse leader, I gained the capacity to quickly sort out details, make decisions and manage risks. I mastered the art of communicating complicated information and relaying difficult news.

What skills did you need to develop to become a CEO? 

Serving as CEO does involve a different skill set than being a CNO. There were gaps in my knowledge that I needed to fill in order to become CEO material. As a CNO, I hadn’t concerned myself with such financial matters as net patient revenue and what drives that number. So, although I had managed large budgets as a CNO, I needed to gain a deeper and broader understanding of healthcare finance. I also needed to develop my knowledge of data analytics, federal and state health policy, and workplace dynamics and policies.  

My MBA degree with an emphasis on healthcare administration and business management went a long way toward filling those knowledge gaps. Personally, I’m glad I chose the MBA route as opposed to earning an MSN, although an MSN doesn’t limit you from rounding out your business education through certifications, fellowships and on the job experience — for example, by joining the finance committee.

As a CEO, it’s important to “speak the language” of your organization’s various constituents, including some degree of fluency in tech-speak and legalese. It’s just as important to listen, though, and trust team members to do their jobs without micromanaging them. 

The healthcare environment is complex and ever-changing. It’s vital, therefore, that CEOs keep freshening their skill sets and furthering their education in order to stay on top of things. I’m currently working toward my board certification in healthcare management as a Fellow of the American College of Healthcare Executives (FACHE). This rigorous curriculum covers every core aspect of healthcare administration, from human resources to financial management. 

What do you miss most about your time as a nurse and CNO?

I recently took part in a panel discussion made up of hospital CEOs who had previously served as CNOs. Each one of us said that we missed our caregiving roles; however, we still get to interact with clinicians, patients and family, albeit in a different capacity. Moreover, we realize that CEOs can greatly influence patient care delivery. Despite that realization, one of my biggest challenges as a nurse CEO is balancing clinical performance and organizational considerations. No longer can I assess situations through the eyes of a nurse. With that said, I became a nurse because I wanted to help people. This same motivation drives the work I do and the decisions I make as CEO. 

What advice do you have for other nurses interested in pursuing the position of CEO?

I am all about encouraging other CNOs to apply for CEO positions if they feel called to lead at that level. By the same token, I encourage hospital boards to give more consideration to CNOs as prospective CEO candidates. This type of support and mentorship is so helpful. While my previous places of employment didn’t offer a formal mentoring program, I sought advice and learning opportunities from people I admired who would nudge me out of my comfort zone. I cultivated relationships beyond the clinical staff to gain a broader view of the organization. Volunteering for special projects and multidisciplinary committees is one way to broaden your perspective and build your network.

If you do transition from CNO to CEO, remember to light the way for others to follow in your footsteps. Our organization provides professional development opportunities for nurses, and we provide flexible scheduling for nurse aides and registered nurses who want to enroll in school to further their education. Propelling our rising stars not only helps them succeed as individuals, but it also supports my retention and succession-planning strategies. 

With today’s focus on value-based care and patient experience, I believe the time is ripe to put more nurses at the helm of hospitals and health systems. 

By , Chief Executive Officer, ContinueCARE Hospital at Medical Center March 14, 2023 Executive Staffing, Hospital Management
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