Nurse Leadership Roles: The Differences Among Nurse Executives, Administrators, and Managers

Nurses who want to play an active role in developing healthcare policy and ensuring the quality of nursing practice can do so as a nurse executive, nurse administrator, or nurse manager.

Although each of these roles allows experienced nurses to serve in a leadership capacity, they represent increasing levels of responsibility. The following guide explains the differences among each role in terms of their scope, typical responsibilities, career paths, and earning potential.

Continue reading to learn what to expect in each of these critical positions.

Nurse leaders are committed to providing top-quality care to every patient in the most efficient, effective manner. Nurse executives are the top leaders responsible for leading overall nursing operations, while nurse administrators manage specific departments according to workplace policies and protocols.

Nurse managers work on the unit, managing the day-to-day activities of the staff. All are critical to the overall healthcare delivery system and represent opportunities for nursing career growth.

While nurse executives, administrators, and managers are all leaders in their organizations, their scope of influence varies. Nurse executives are at the top of the hierarchy and typically work at the corporate level with other organizational leaders. Nurse administrators may report to nurse executives but oversee nurse managers. Because nurse managers are directly involved in clinical care, they work on the floor of their unit or department.

However, all three roles work together with the shared goal of delivering the highest-quality health care to every patient.

All nurse leaders need to be competent in specific skills, like soft skills for nurses, to succeed in their roles. In general, any nursing leadership requires competency in clinical care, communication, leadership, and business and operational skills, to varying degrees.

While employers may have additional qualifications, the general competencies for each role are detailed below.

The American Organization of Nurse Leaders (AONL) identifies five core competencies for nurse executives. These competencies align with the role’s focus on patient care that improves patient outcomes while keeping costs in check.

The specific competencies identified by AONL are outlined below.

The American Nurses Association (ANA) has established a draft for specific standards for nurse administrator competencies that apply to any setting. These core skills focus on several areas, all with an eye toward providing the highest quality care and patient experience.

Nurse managers must have the ability to oversee the day-to-day operations of their unit or the office they manage. This requires several core competencies, as identified by AONL.

Nurse leadership roles are filled by experienced nurses with advanced degrees. Nurse managers typically need at least a bachelor of science in nursing (BSN); nurse executives and nurse administrators must have advanced degrees — a master of science in nursing (MSN) or higher. A degree in healthcare administration and nursing experience can also prepare you for a leadership role.

Most facilities also require experience in both nursing and leadership roles, with nurse executives needing the most experience. On average, applicants need at least five years of progressively increasing responsibility.

While a leadership certification is usually not necessary to qualify for a management, administrative, or executive position, it can help demonstrate one’s expertise to employers. The remainder of this article discusses these certifications in depth.

The nursing profession provides four different “leadership” certifications, which vary in education requirements and certifying body. Notably, the American College of Healthcare Executives also offers a certification applicable to nurse practitioners interested in leadership.

Certifications sought by nurse practitioners interested in holding leadership roles include:

The nurse executive certification is awarded by the American Nurses Credentialing Center (ANCC). This certification was previously called nurse administrator, and it is tailored toward the nurse responsible for managing the daily operations of a unit or service line. To be eligible for the nurse executive certification, one must:

The certification requires applicants to pass an exam, which provides a valid and reliable assessment of the entry-level clinical knowledge and skills required of a nurse executive. The initial application and certification fee is $270 for members of the American Nurses Association and $395 for non-members.

The certification exam consists of 175 multiple choice questions, 150 of which are scored. The test evaluates a candidate’s knowledge in four domains of executive practice: structures and processes, professional practice, leadership, and knowledge management. The ANCC provides both a detailed exam content outline as well as sample questions. If one meets the eligibility criteria listed above and passes the exam, he or she will earn the Nurse Executive-Board Certified credential (NE-BC).

The ANCC also offers the credential Nurse Executive, Advanced (NEA-BC). The eligibility criteria for this credential is the same except a candidate must hold either a master’s degree or higher in nursing or a bachelor’s degree in nursing and a master’s degree in another field. The exam for the advanced certification is similar in structure but covers different domains of executive practice: structure and processes, exemplary professional practices, transformational leadership, and new knowledge and practice applications. The ANCC provides both a detailed exam content outline as well as sample questions for this certification as well.

To prepare the the certification exam, the ANCC recommends the following books:

The American Organization of Nurse Executives (AONE) awards the Executive Nursing Practice certification, which is tailored for nurse leaders working at the executive level in their organization. Eligibility criteria for this certification includes:

This certification also requires applicants to pass an exam. This exam has 175 multiple choice questions, 150 of which are scored. It covers five core topics: communication and relationship-building, knowledge of the healthcare environment, leadership, professionalism, and business skills. A detailed outline and sample questions can be found starting on page 22 of the AONE Certified in Executive Nursing Practice Examination Handbook.

The application costs $325 for an AONE member and $450 for a non-member. If one meets the eligibility criteria and passes the exam, her or she will be awarded the CENP credential.

In preparation for this exam, the AONE recommends a review of the following books:

The AONE also awards the Nurse Manager and Leader certification, which is designed for those nurses in the managerial role. The AONE describes this certification as the “industry-recognized certification that demonstrates knowledge of the essential elements of nursing management and leadership…a certificate to showcase your management expertise and share your credentials across the nursing leadership community.”

Eligibility criteria for this certification include having a current, valid, unrestricted registered nurse license and one of the following:

Just like the CENP, this certification requires applicants to pass a multiple-choice exam. The exam includes 115 questions, 100 of which are scored. Topics covered included in the exam are financial management, human resources management, performance improvement, and strategic management and technology. A detailed outline and sample questions can be found in the the AONE Certified Nurse Manager and Leader Examination Handbook. The application costs $300 for AONE members and $450 for non-members.

In preparation for this exam, the AONE recommends the following books:

The American Association of Colleges of Nursing (AACN) awards the Clinical Nurse Leader (CNL) certification, which is tailored toward a clinical leader (i.e. one who is at the point-of-care) focusing specifically on care coordination, outcomes measurement, transitions of care, interprofessional communication, team leadership, risk assessment, implementation of best practices, and quality improvement.

Eligibility criteria for this certification can be found on page nine of the CNL Certification Guide and includes the following:

To earn the certification, a candidate must also pass a 140 question multiple-choice exam. The test covers three key topic areas: nursing leadership, clinical outcomes management, and care environment management. The 2016 Job Analysis Summary published by the AACN contains a detailed outline of content that is covered on the exam. Candidates can also purchase a practice test for $50 from the AACN website.

In preparation for this exam, the AACN recommends the following books:

The American College of Healthcare Executives (ACHE) awards the Fellow of the American College of Healthcare Executives (FACHE) credential, which is tailored toward any healthcare discipline (including nurse practitioners) who serve in executive management roles.

Eligibility criteria for this credential includes:

In addition to meeting the eligibility criteria, to become a certified FACHE, a candidate must pass the Board of Governors Exam. This exam includes 230 multiple-choice questions, 200 of which are scored. It covers 10 core knowledge areas, including business, finance, governance and organizational structure, healthcare, healthcare technology, human resources, laws and regulation, management and leadership, professional ethics, and quality and performance improvement. The exam registration fee is $200. The ACHE offers both a Complete Reference Manual and a practice exam with answer key.

In preparation for the exam, the ACHE recommends the following textbooks:

Nurse leaders at all levels are paid well, especially at the administrator and executive levels. According to Payscale as of May 2022, the average annual salary for a nurse manager is $88,840, with entry level managers earning about $83,000 and experienced managers bringing home over $95,000 per year.

Nurse administrators and executives earn higher salaries. Payscale’s sample size for these two roles is too small to make an accurate assessment of average earnings, but using the U.S. Bureau of Labor Statistics’s data for medical and health services managers, the average annual wage for these roles is estimated at $119,840.

As the nursing workforce ages, and experienced nurses leave the profession, the need for experienced nurse leaders is expected to increase, especially given the ever-growing demand for healthcare services. For some nurses, these positions also represent a career path, as it’s common for employers to require experience as a nurse or nurse manager for higher-level leadership positions.

Although the roles do not typically involve bedside patient care, they do provide the opportunity to influence the future of healthcare and the patient experience.

Page last reviewed: May 3,2022