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Building a Career as a Nurse Administrator

Every year, polling firm Gallup runs a nationwide survey asking Americans what profession they find to be the most honest and ethical.

And every year, it’s nurses.

As of 2019, that was 18 straight years in a row that nurses were the most trusted group of people in the country.

It takes someone special to act as the leader and representative of such a group, and that means becoming a nursing administrator always starts with both the right experience and the right education. In a profession that has been hit hard by COVID-19, nurse admins have been caught in the crossfire as nurses have gone on strike to protest over staffing and PPE issues, and are going to be dealing with ongoing challenges that come with a workforce that is estimated to have nearly 30 percent of workers suffering from PTSD in the aftermath.

You’ll come into your new role equipped in a way that few other healthcare administrators are. Nurse administrators are unique in the universe of health administration in that they are expected to be experts in both the clinical side of nursing and the business side of healthcare, and also have the credentials to go along with that expertise. Although the job doesn’t usually involve providing direct patient services of any kind, almost everyone who advances into these positions has a strong background in nursing, and often in advanced-practice nursing, or at least as a master’s-qualified RN.

So you know what you’re getting into by setting off on the path to becoming a nurse manager… but you also know that the good that comes from helping patients and serving your community outweighs the hard parts by a country mile.

What Is Nursing Administration? – The Role is Defined by What Nurse Administrators Do

Nurses lead nurses, so it’s not going to come as any surprise to you that it won’t be easy… if you have 10 staff on the ward, you’ve already got about 15 different opinions about how things should be done. The magic of bringing those strong wills together and creating an effective team involves a certain amount of native talent alongside proven leadership techniques.

No one can give you the talent, but there are a lot of master’s degree programs that can help you out with the leadership and managerial skills you’ll need.

All the hard work of organizing nurses under your watch is just the mechanics of the job. The goals encompass a lot of the most basic functions of the healthcare profession:

Patient welfare – First and foremost, nurses provide care to patients in their charge. Your policies, staffing, procedures, and administrative work all come down to keeping people healthy or helping them recover from illness. Nurses enter the profession to help, and you never forget that, no matter how lofty your managerial title becomes.

Employee supervision – Direct responsibility for overseeing nurses handling the day-to-day tasks in patient care can involve lending a hand, offering tips, providing subtle corrections, or simply keeping the books straight when it comes to scheduling and recording hours worked.

Regulatory and ethical compliance – Most nurses are beacons of ethical responsibility, but from time to time, every nursing manager will have to deal with cases like the Tacoma RN who was caught stealing narcotics from patients in a local emergency department and, along the way, managed to expose almost 3,000 people to Hepatitis C. Constant vigilance makes sure cases like this are very rare.

Coordination of care – It may not be Mars and Venus, but doctors are definitely from one planet while nurses come from another, and nursing managers have to boldly broker working terms when disputes occur. The differences in the medical and nursing approach to care can be complementary, but it can be hard work to get a department to that point… and, you guessed it, you’re going to be the one doing most of that work.

Budgeting – With management comes financial responsibility. Nursing managers have to deal with budgeting and financial tracking at various levels, from a basic estimation of quarterly expenditures for nasal cannulas in the ICU all the way up to annual staff salary and benefit budgets for thousand-bed hospital systems.

Policy – Although some management occurs through direct supervision, the higher you climb through the ranks, the more and more your guidance will be provided directly by institutional and public policy. You’ll learn to set out your objectives clearly and articulately and to make sure everyone is on the same page through procedures for everything from submitting hours to creating EHR (Electronic Health Record) entries.

The Education You Need to Become a Nurse Administrator

In the past, many RNs simply worked their way up the ladder into management positions without ever progressing past their initial nursing education. Those days are long gone, however; you won’t find many jobs in nursing administration today that don’t require a full-fledged master’s degree.

The real question will be what sort of master’s you should pursue. Because of the unique dual role of clinical and administrative work, you have two basic options:

Advanced Clinical Degrees With Leadership Concentration Or Post-Master’s Certificate in Administration

The fastest and most straightforward path to nursing administration runs through a Master of Science in Nursing (MSN) program with a concentration in nursing leadership or healthcare management.

You’ll find these programs available for nurses at every career stage, including through bridge programs that help you fast-forward into advanced practice roles if you choose to become a certified NP or other APRN in the course of earning your advanced degree. Not that a clinically focused master’s is the perfect fit for a career in administration, but it isn’t uncommon for RNs to make the leap into advanced practice with an MSN or DNP, then transition to administration by way of a graduate certificate in nursing administration.

With a clinically focused MSN, the bulk of your education will cover the standard core elements of advanced practice nursing, teaching scientific development, evidence-based practice, and general nursing concepts like population health and cultural competency. But with an MSN in nursing administration specifically, you’ll dive right into an in-depth administrative education complete with courses in:

  • Organizational Theory for Integrated Healthcare Delivery
  • Managing Complex Healthcare systems
  • Business and Finance in Healthcare
  • Human Resources in Healthcare Operations
  • Business Communications

Since these administration courses account for about to two-thirds of your total credit hours, an MSN with a leadership track by itself won’t check the boxes for APRN certification and licensure. It is, however, possible to double up on tracks by taking a clinically focused MSN with a concurrent certificate in nursing administration so you can get all the required courses for both administrative work and for advanced practice certification as an NP or other APRN.

Alternatively, after earning your MSN, you can get much the same training by enrolling in a post-graduate healthcare administration certificate program. These programs essentially compress down the same training you would get in a full-fledged MHA degree, packaged for people who have already earned a master’s in another field. They can be completed in about half the time as a full master’s, although the total credit hours in administrative training is about the same as the MSN leadership track at most schools.

Dual Master’s Degree Combining a Clinical Degree With Advanced Business or Administration Degree

This is a harder path but it’s also one that can open up more doors to top positions outside the nursing field, if that’s your ultimate goal. To take on any clinical leadership role in nursing, you’ll need to go through all the same work involved in earning a clinically focused MSN. But at many schools you also have the option to build your management and leadership skills with dual degree combos that can include almost any type of business or healthcare administration degree. Common MSN dual degree options include earning one of these degrees concurrently:

  • Master of Healthcare Administration
  • Master of Business Administration
  • Master of Public Administration

Dual degree programs involve taking on all the intensive training from both tracks so it’s not for the faint-hearted. But in the end, you get all the in-depth expertise of a master’s in both the clinical side of nursing and the business side of healthcare. This makes for a formidable combination of skills and knowledge.

You are also free to pursue a master’s separately in either of the fields, and continue your training in the other through an even more advanced degree: a doctorate. DNP, or doctor of nursing practice, programs are also available with leadership track studies, and qualify you for even higher levels of management. Alternatively, a DHA, or doctor of healthcare administration, will focus on those advanced leadership and managerial functions.

Professional Certifications Available for Nurse Administrators

Certification is a pretty big deal in healthcare and nursing in general, and nobody knows this better than NPs and other advanced practice nurses. Similarly, you’ll find professional certifications for nurse administrators and executives, though unlike APRN certification there is no requirement to become certified as a condition for state licensure. Those certifications for administrators and executives do, however, tell the story of your education and experience, and will help you advance your nursing administration career.

It’s important to note that these are different from academic certificate programs offered by colleges. A certificate program, like the post-master’s certificate in health administration, is an educational course in its own right. A professional certification, on the other hand, doesn’t offer any training in itself, but assesses your education, experience, and other qualifications to give you a credential that signifies your skills for employers and the public.

In nursing administration, you have a lot of different options for professional certification, both specific to nursing and for healthcare administrators in general:

Each of these require some combination of:

  • Educational credentials, either by degree or continuing education, or both
  • Experience
  • Professional references
  • Passing an examination
  • Engaging in volunteer experiential activities

The right choice for you may depend on the specifics of your goals and the circumstances of your current employment.

Are Online Degrees a Good Choice for Nurse Administrators?

In a word, yes.

Online programs are becoming more and more common in just about every field, but for future nurse administrators, they are an ideal fit. That’s because you are most likely already well into your career by the time you consider earning an advanced degree in healthcare administration.

Nursing is anything but a 9-to-5 job. You could have shifts at any hour of the day or night, and unpredictable overtime coming at you on any given day. That’s a situation where an asynchronous, online class schedule is a real lifesaver. When you can do your classwork from anywhere, at anytime, it makes fitting your degree program into your life that much easier. And with advances in online teaching tools, it’s every bit as good as planting yourself in a traditional classroom seat when it comes to interacting with fellow students and instructors.

Of course, nursing is a hands-on profession, so none of these degrees is truly entirely online. You will inevitably have a hybrid approach, where internships and classes with clinical skills training will definitely be in-person. But the more flexibility the better, so online options definitely make your life easier.

Specialty Accreditation is Key When Selecting a Degree in Nursing Administration

Accreditation is a consideration that many American students spend almost zero time on when picking a college. And in most cases, they don’t need to. Almost every American university has a solid general accreditation from an agency recognized by the Department of Education. Those chains of trust mean that every school has been checked out and validated in terms of academic soundness, administrative competency, and instructional aptitude.

But specialized professions like nursing and healthcare demand a higher standard. That’s why you do need to be concerned about accreditation when you choose your degree in this field. A specialty accreditation will ensure that the school or program has been vetted not just for general academic rigor, but also with a view toward the highly specific skills, concepts, and resources required for a top-notch healthcare education.

Depending on the specific degree you are seeking, different specialty accreditors may apply:

Nurse Administration Jobs and Salary Prospects

It’s no secret that nursing has been facing an impending staffing shortage in the United States for decades. According to the American Nursing Association, there will be more open nursing positions through 2022 than for any other single profession, more than 100,000 per year. The Bureau of Labor Statistics (BLS) forecasts that the job market for RNs from 2019 to 2029 will see a 7 percent expansion, and for APRNs it will expand by a mind-boggling 45 percent during that time.

And all of those estimates were made before the COVID-19 pandemic, a shockwave that ran through nursing that has cost lives in the workforce and caused countless nurses to face long-term disability or medical retirement after having been infected. It’s too soon to tell what the impact on the job pipeline has been, but all signs point toward an even steeper shortage than previously forecast.

That means a lot of headaches for future nursing managers, but a silver lining as well: there will be stiff competition for the expert nurse administrators who remain, causing already hefty compensation packages to rise even higher in the coming decades.

Work Settings and Salary Prospects for Nurse Administrators

Pretty much anywhere that you find nurses, you’ll find nurse administrators. That gives you a lot of options for where to apply your skills as a nursing leader, but it also has implications for your salary and employment prospects.

According to BLS, a typical APRN makes $115,800 per year. That doesn’t account for the higher pay range for managers in the profession, but setting that factor aside, you can see important differences in average salaries in different types of professional settings:

  • Hospitals – $122,420
  • Outpatient care centers – $118,530
  • Physician’s offices – $113,190
  • Other health clinics – $112,590

Although there are no clear lines in the BLS data between supervisory and non-supervisory nursing roles, Modern Healthcare conducted a survey in 2019 that established some executive-level salaries for positions commonly occupied by nurse administrators.

  • Chief nursing officer – $208,800
  • Managed care executive – $312,100
  • Ambulatory care executive – $306,400
  • Quality control – $265,000

Modern Healthcare also found that those salaries had increased, on average, by 6.5 percent year-over-year. Even larger bumps are likely in the future.

Resources for Future Nurse Administrators

Nursing is a very collaborative profession, and that may even be one of the reasons you chose this line of work over medical practice. And so you’ll find that there are a lot of organizations dedicated to offering guidance, networking, resources, and mentorship to nursing leaders. Tapping into these like-minded institutions early on in your career will set you up for success as you get the training and experience you need to become a nurse administrator.

  • American Nurses Association: One of the oldest and most highly respected nursing organizations in the country, the ANA specifically offers an online community of nurse managers for professional networking and sharing the latest tools and techniques.
  • American Organization for Nursing Leadership: AONL doesn’t just offer certification, but also resources for continuing education and study, as well as pioneering initiatives to further strengthen nursing leadership and authority in the healthcare workforce.
  • Association for Healthcare Administrative Professionals: Dedicated to the professionals who support the nation’s top healthcare leaders in nursing and elsewhere, this organization provides leadership opportunities through work on committees and groups in order to strengthen the delivery of healthcare.
  • National Association of Directors of Nursing Administration in Long Term Care: Long-term care is an area where nursing often predominates in leadership roles, with a skillset that is better suited to the holistic treatment of patients in long-term programs. NADONALTC caters specifically to nursing administration professionals in those facilities with networking and continuing education opportunities.
  • American Association of Healthcare Administrative Management: AAHAM represents a broad base of healthcare professionals, providing information, education, and advocacy in the fields of reimbursement, admitting and registration, data management, medical records, patient relations, and so on.
  • American College of Healthcare Executives: This international organization of executive healthcare leaders advances professionalism and expertise in the field of healthcare management. Members receive the latest research and education and receive policy updates at the annual Congress on Healthcare Leadership.