The CNO of a critical access hospital leads the nurses in the ER, the inpatient and swing beds, and outpatient care. The CNO also runs case management, infection prevention and therapy, sets staffing and policy, and may work a shift when the schedule has a hole.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring a chief nursing officer to lead nursing across our emergency department, inpatient and swing beds, and outpatient services. In a hospital our size, you also oversee case management, infection prevention, respiratory therapy and physical therapy, and you may step in on the floor. You'll set staffing, policies and competencies, keep patient care ready for survey, and recruit nurses in a rural market.
2. Essential Duties and Responsibilities
Set nurse staffing plans for the ED, inpatient unit and swing beds, and approve agency or traveler contracts.
Recruit nurses and aides with the HR director, including school partnerships and pathways from CNA to LPN to RN.
Write and update nursing policies to match the Conditions of Participation, state nurse practice rules and current evidence.
Run competency checks and annual skills days for ED care, med-surg, swing beds, restraints and code response.
Set nursing quality goals for falls, pressure injuries, medication safety and restraint use, and report results to the medical staff and board.
Keep nursing ready for state survey or accreditation, and carry out plans of correction.
Work with the medical staff on order sets, transfer guidelines and nursing concerns raised in peer review.
3. Key Tasks / Daily Activities
Review census, staffing, transfers and overnight events with the nurse manager and house supervisor.
Review the staffing outlook for the next [24–48] hours, and approve agency, traveler or incentive shifts outside the budget.
Round on the ED and inpatient unit, and talk with patients, families and staff.
Review safety reports for falls, medication errors and pressure injuries, and assign follow-up.
Meet with the CEO, HR, case management and pharmacy on open issues.
Patient experience scores for nurse communication: [your target].
5. Required Qualifications and Skills
Active [State] RN license, or a multistate RN license under the Nurse Licensure Compact if your state is a member, and current BLS.
Bachelor of Science in Nursing (BSN).
[5+] years of nursing leadership, including emergency or inpatient nursing.
Working knowledge of the critical access hospital Conditions of Participation, EMTALA and your state's nurse practice act.
Experience building staffing plans and nursing budgets.
6. Preferred Experience
MSN or a master's degree in healthcare administration.
ANCC Nurse Executive (NE-BC) or AONL Certified in Executive Nursing Practice (CENP) certification.
Experience leading nurses in a critical access or rural hospital.
Experience with swing bed programs and infection prevention.
7. Physical Requirements
Sit, stand and walk through the day, moving between units and offices.
Stand for long periods and help with patient care during codes or staffing gaps.
With or without reasonable accommodation.
8. Work Environment and Schedule
Hospital-based, weekday schedule: [hours].
Administrator-on-call or nursing on-call rotation: [rotation].
Exposure to infectious disease and bloodborne pathogens on the units, with PPE provided.
Evening meetings with the board's quality committee: [schedule].
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new chief nursing officer gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
Need help filling this role? HireBus posts the ad, Iris interviews every applicant by phone before you do, and you decide who to hire. Start hiring now
What makes nursing leadership in a critical access hospital different
A CNO anywhere owns nursing quality and staffing. Here one small nursing staff covers emergencies, acute patients and skilled care, under Medicare's critical access rules.
An RN directs every patient's nursing care
Under Medicare's critical access rules, an RN gives or assigns the nursing care of every patient, swing bed patients too. An RN, or a physician assistant where state law allows, oversees and checks that care. Each inpatient needs a current nursing care plan. An RN, clinical nurse specialist or LPN must be on duty whenever there is an inpatient. Source: eCFR: 42 CFR Part 485 Subpart F, conditions of participation for critical access hospitals.
Swing bed patients bring nursing home rules
A swing bed patient gets skilled nursing care in a hospital bed. For those patients the hospital must meet set parts of the nursing home rules, including resident rights, freedom from abuse and neglect, discharge rights, a full care plan, therapy and nutrition. It doesn't have to use the state's nursing home assessment form. Source: eCFR: 42 CFR Part 485 Subpart F, conditions of participation for critical access hospitals.
Emergency readiness includes births
Since July 1, 2025, every critical access hospital needs emergency protocols that fit its services and follow national guidelines. They must cover birth emergencies and care right after delivery, even where the hospital doesn't deliver babies. The board names which staff train on them each year, and personnel files must show it. The CNO usually runs that training. Source: eCFR: 42 CFR Part 485 Subpart F, conditions of participation for critical access hospitals.
Scope of practice comes from your state
Every state has a nurse practice act and a board of nursing that writes rules under it. What your RNs and LPNs may do, from IV care to taking verbal orders, comes from those rules first and your own policies second. Write policies from your state's act, not from a binder brought over from another state. Source: NCSBN: Nurse Practice Act toolkit.
Infection prevention leans on nursing
Medicare's critical access rules have nursing and medical staff leaders recommend who the board appoints as infection preventionist, so the CNO helps pick the person. The program has to track national guidance and match the hospital's mix of services. Here the preventionist reports to the CNO, who guards real hours for that work instead of leftover time. Source: eCFR: 42 CFR Part 485 Subpart F, conditions of participation for critical access hospitals.
How much hospital chief nursing officers make
The closest BLS group for hospital chief nursing officers is medical and health services managers. Medical and health services managers who work for general medical and surgical hospitals earned a median of $134,050 a year ($64.45 an hour) in May 2025, according to the Bureau of Labor Statistics. That’s above the $123,860 median for medical and health services managers in all industries. About 158,730 of the 597,080 medical and health services managers in that survey work for general hospitals.
Salaried. Settle before the offer how on-call time and any patient care shifts are handled, because in a small hospital both come up often and cause friction when left vague.
General hospitals
$134,050$134,050 median Middle half $107,390–$172,180 10th–90th $92,480–$223,600
All industries
$123,860$123,860 median Middle half $94,700–$166,100 10th–90th $73,390–$224,340
$50k$75k$100k$125k$150k$175k$200k$225k$250k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
General hospitals
$92,480
$107,390
$134,050
$172,180
$223,600
All industries
$73,390
$94,700
$123,860
$166,100
$224,340
These figures cover general medical and surgical hospitals of every size. Rural hospitals often pay less than city hospitals. Post a real range for your market in the ad.
Skills to hire for, and what you can teach
Hire for these
An active RN license, single-state or multistate, and recent ER or med-surg work
Has written a nurse staffing plan and a nursing budget, and kept to both
Has led nursing through a state survey or accreditation visit and carried out the plan of correction
Coaches a small leadership group: the nurse manager, house supervisors and case manager
Steady judgment during a code, a long wait for a transfer bed or a sudden rush with few staff
Teach these on the job
Swing bed rules, for a candidate from a hospital without them
Running departments outside nursing, such as respiratory and physical therapy
Your EHR's nursing charting, staffing and incident report tools
Your transfer guidelines and the contacts at your referral hospitals
The quality measures your board and medical staff review each month
The CNO lives in staffing reports, the policy library, incident reports and the EHR's nursing dashboards more than in charting. In the posting, list every department the CNO will run besides nursing, since that changes who applies.
Two years of your own staffing and safety reports make a fair baseline for these blanks. Take the targets to the quality committee for a yearly check.
Nurse turnover
RN and LPN departures over the last year, measured against your average nurse headcount, with first-year leavers and night shift on their own lines.
Agency and traveler hours
Hours worked by agency and travel nurses each pay period as a share of all nursing hours, by unit, beside the openings they cover.
Patient falls with injury
Falls that caused any injury, as a rate against patient days, using one definition month after month, and reviewed one by one in the safety meeting.
Hospital-acquired pressure injuries
New pressure injuries found after admission, per patient days, with swing bed patients tracked apart, since their stays run longer.
Patient experience scores for nurse communication
The nurse communication questions on your patient survey, as a rolling average because small monthly counts swing. Add notes from discharge calls when few surveys come back.
Career path
Registered NurseBedside RN in the emergency room or inpatient unit, often covering both.
Nurse ManagerRuns the inpatient unit's staffing, schedules and quality work day to day.
Chief Nursing OfficerLeads nursing and the clinical support departments for the whole hospital.
The template requires a BSN and prefers a master's. The two main executive credentials set their own bars. ANCC's Nurse Executive (NE-BC) asks for an active RN license, a nursing bachelor's or higher, recent leadership hours and 30 hours of leadership education. AONL's CENP asks for a valid, unrestricted RN license and executive nursing hours, with either a master's or higher (one degree in nursing) or a BSN and twice the hours.
How much does a hospital chief nursing officer make?
Medical and health services managers who work for general medical and surgical hospitals earned a median of $134,050 a year ($64.45 an hour) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $107,390 and $172,180 a year. Pay also depends on your local market, experience and bonus terms.
Can our CNO work on a multistate nursing license?
Yes, if your state belongs to the Nurse Licensure Compact and the CNO's home state does too. The compact's site lists 43 member jurisdictions and flags some with notes on how far they have put it in place, so check your state there. A nurse who moves from one compact state to another must apply for a license in the new home state within 60 days.
Is a director of nursing the same as a CNO?
In a small hospital it can be the same job with a different title. Other hospitals use director of nursing for a role that runs the inpatient unit under a CNO. Go by the duties, not the title, and tell applicants whether this person sits on the leadership team and answers to the CEO.
Should the CNO pick up patient shifts?
The template expects it during codes and staffing gaps. Put limits in writing: how many shifts a month before the hospital books agency help, and who covers the CNO's work meanwhile. A CNO who works every weekend can't fix the schedule that keeps creating the gaps.
What does the CNO do when surveyors arrive?
Expect surveyors to read nursing policies, care plans, staffing records, skills checks and any restraint charting, and to talk with staff. The CNO walks them through the units, pulls records fast, and leads the nursing part of any plan to fix what they find.
