Change management and technological savvy are emerging as essential skills for the next generation of chief nursing officers, nurse leaders told Becker’s.

As hospitals and health systems continue to grapple with workforce shortages and rising care demands, CNOs are increasingly expected to navigate a proliferation of new technologies, lead efforts to improve operational efficiency and foster stronger interdisciplinary collaboration. Leaders say these capabilities are becoming even more critical as patient acuity rises and care delivery grows more complex.

Here, four CNOs share how the role is evolving and what skills will define its future:

Question: How do you see the chief nurse role evolving in the next two to five years, especially given the increasing complexity of workforce management, quality oversight, and operational strategy?

David Marshall, DNP, RN. Senior Vice President and Chief Nursing Executive at Cedars-Sinai (Los Angeles): In response to changes and trends in healthcare and in society, the role of nurse leaders will evolve. One of the first areas that comes to mind where nurse leadership might progress is fostering interprofessional collaboration to enhance patient care. Another important area for progress is the development of cultures that inspire, empower and expect the development and implementation of innovation. As technology becomes more integrated, nurse leaders will play a crucial role in managing change, fostering a culture of innovation and communicating to address potential resistance. Yet another area is the pivotal role of nurse leaders in influencing policy making. Nurse leaders will need to have a stronger influence over healthcare policies, advocating for changes that benefit those we serve and the nursing profession. As a result of workforce shortages, nurse leaders will need to rethink the role of the nurse and how care is delivered. Overall, nurse leaders will continue to be agents of change in healthcare, adapting to new technologies, advocating for patients and staff, and contributing to the evolution of healthcare practices and policies as their roles evolve.

Autum Shingler-Nace, DNP, RN. CNO of Cooper University Health Care (Camden, N.J.): The role of the chief nursing officer is inherently dynamic — that’s one of the reasons I’m so passionate about it. As a CNO, you have the opportunity to collaborate with a wide range of stakeholders and advocate meaningfully for nursing at the highest levels. While that core function will remain, the scope of the role has expanded significantly in recent years.

Looking ahead, I believe the CNO will continue to evolve into a more strategic leader. Operational excellence will always be important, but strategic thinking — particularly around care coordination and community partnerships — will be essential to leveraging resources and improving outcomes. One of the most significant shifts on the horizon is digital transformation. Artificial intelligence is already a frequent topic of discussion, but its true impact on patients, nurses and communities is still unfolding. Navigating this change thoughtfully will be a defining challenge for future CNOs.

Vicky Tilton, DNP, MSN, RN. Vice President of Patient Care Services and CNO at Valley Children’s (Madera, Calif.): I’m fairly new to the CNO role, but it really feels like it’s becoming more of a strategic, systems-level leadership position. Increasingly, it involves more enterprise-level leadership, where it used to be frontline focused. We’re not stepping away from that, but now we’re really looking at all the disciplines across the organization – workforce, innovation and our patient outcomes. We’re helping to shape long-term financial and strategic plans for the organization. A lot of collaboration happens now that we have interdisciplinary connections. It still involves that bedside focus, but it’s shifting to broader, strategic work.

Janet Tomcavage, MSN, RN. Executive Vice President and Chief Nurse Executive at Geisinger (Danville, Pa.): Typically, the CNO role has been focused primarily on the inpatient segment of healthcare, and I see the critical need to take a more proactive approach to leadership in the ambulatory space. Care is moving quickly into the outpatient arena and the need to optimize the nursing role – particularly how we leverage the skill set of RNs, LPNs and the broader care team – will be crucial to achieving high-value care in the ambulatory setting. Continuing to drive skill mix and care team modifications on the inpatient setting must continue. Optimizing the care team and who provides the care is important for quality, retention and professional development. Additionally, more fully leading their healthcare organizations in the AI/technology space will be important – driving efficiencies for our teams, improving quality, engaging patients and families in their care, all enhanced by technology.

Q: Is there anything about leading nursing operations now that feels fundamentally different from just a few years ago?

DM: Leading nursing operations today is a markedly different experience from just a few years ago, marked by new challenges and opportunities that we’ve had to navigate. The COVID-19 pandemic, for instance, has brought workforce challenges to the forefront, with increased burnout and staffing shortages. We are also witnessing a shift in societal interactions, which has directly influenced the environments where nurses practice. These evolving dynamics require us to double down on empathy, effective communication, safety and resilience — all of which are crucial for creating a supportive workplace and ensuring top-notch patient care.

Personally, I’ve seen how these changes demand more adaptive leadership styles. With the release of AI models like ChatGPT by OpenAI in November 2022, we’re now at the cusp of an exciting era of innovation in nursing leadership. AI has the potential to transform how we manage communication and streamline administrative tasks. As nurse leaders, we’re exploring new horizons to optimize operations and provide better support to our teams.

For instance, at Cedars-Sinai we have launched an AI-enabled ambient listening tool to ease the burden of documentation for nurses and nursing assistants. The immediate results were better experiences for our patient and our nurses and nursing assistants. These tools aren’t replacing the human touch; instead, they’re offering us ways to be more resilient and adaptive. It’s fascinating to consider how this technological evolution can pave the way for a healthcare future that’s both responsive and forward-thinking.

In essence, leading nursing operations now invites us to embrace change and innovation while staying grounded in the core values that define our profession.

ASN: A few years ago — especially during the height of the COVID-19 pandemic — nursing leadership was almost entirely focused on operations. Many of us were embedded in incident command structures, working tirelessly to ensure staff safety and maintain high-quality patient care under extraordinary circumstances.

Post-pandemic, operations remain a priority, but the context has shifted. Today, leading nursing operations means balancing the day-to-day demands of patient care, relationship-building and data management with the need to standardize workflows across increasingly complex, matrixed health systems. As organizations grow and merge, integration becomes critical. For me, the most significant change is the need to lead with a systems mindset — sensitive to integration while still managing the essential components of nursing operations. It’s challenging work, but it’s also vital to the success of modern healthcare organizations.

JT: The acuity of the patient, the changing landscape for hospitals as they seek to drive efficiencies and value, the impact of the aging demographics and rural healthcare (lack of community resources), the advent of technology opportunities and labor market challenges not just for RNs but the whole care team. All of these components are driving operational changes today.

Q: Looking ahead, what new skills or leadership qualities do you think will define the most successful CNOs in the next phase of healthcare?

DM: As we look toward the future of healthcare, the role of CNO is poised for significant transformation. This evolution will require a blend of new skills and leadership qualities to navigate the increasingly complex landscape of healthcare.

First and foremost, adaptability and agility will be paramount. Successful CNOs will need to rapidly adapt to changes in healthcare regulations, technology advancements and shifts in patient demographics. This agility will extend to making informed decisions swiftly, particularly in crisis situations where time is of the essence.

Moreover, technological savvy will define the modern CNO. Proficiency in healthcare technology and data analytics will be essential to improve patient outcomes and operational efficiencies. An understanding of artificial intelligence and automation tools will also be crucial, as these technologies offer new opportunities to enhance healthcare delivery and streamline processes.

Strong communication skills will continue to be a cornerstone of effective leadership in nursing. CNOs must communicate clearly and effectively with staff, patients, and stakeholders to build trust and collaboration. This includes cultural competence, enabling them to communicate inclusively with diverse patient populations and a multicultural workforce.

Emotional intelligence will be equally important. Successful leaders will need to maintain a compassionate approach, essential for leading teams and managing patient care under stress. Fostering resilience within oneself and the nursing team, while effectively managing stress and burnout, will be critical components of emotional intelligence in leadership.

Strategic vision will set apart top CNOs. Visionary thinking will empower them to foresee industry trends and implement strategies that position their organizations for future success. Encouraging innovation and creative problem-solving among teams will drive improvements in healthcare delivery.

Collaborative leadership will also be a defining trait. CNOs will need to foster strong partnerships across professions, ensuring cohesive and comprehensive care. Engaging with community stakeholders to address broader healthcare needs and social determinants of health will further enhance their collaborative efforts.

Finally, ethical decision-making will underpin all aspects of effective leadership. A commitment to integrity and patient-centered care will uphold the values of the nursing profession. Transparency in policies and practices will promote trust and accountability.

As CNOs anticipate these evolving demands, those who invest in developing these skills and qualities will be well-prepared to lead effectively in the next phase of healthcare, driving progress and innovation while maintaining a focus on compassionate care.

ASN: Trust-building is, in my view, a core competency for any successful CNO. The ability to build and sustain trust—with teams, peers, dyad partners and communities — will be a key differentiator. The world has changed dramatically since the pandemic, and healthcare leaders must be attuned to the evolving needs of patients, staff and the broader community.

Successful CNOs will need to remain informed, engaged and adaptable. As technology and AI continue to reshape healthcare, leaders must be comfortable with change and capable of pivoting quickly. Trust is what enables that agility. When trust is strong, teams can move faster, adapt more easily and stay aligned through uncertainty.

VT: A good leader should always have emotional intelligence. They have to be adaptable and a systems thinker. Those are nonnegotiable skills. CNOs of the future and healthcare leaders in general will have to be on top of data interpretation. They also need to be okay with change and change management. Disruption is good. Change is hard for some folks, so you have to really be adept to change yourself so that you can help your teams grow.

You have to be innovative and willing to bring on technology advancements. Underpinning all of those things is never losing sight of the patient. We can never lose sight of the patient and family, especially in pediatrics. I’m very passionate about that because it should always be the center; that’s our hospital’s mission. As long as you do that, you’ll continue to drive on quality and safety. If you hold high expectations and that’s what your team’s delivering on, you’ll build a strong culture and teams thrive on that — that’s what drives recruitment and retention.

JT: Broader operations experience and input — stepping up to own larger components of hospital and ambulatory operations, including assuming responsibility for teams not typically under the umbrella of nursing. Expanding accountability for transitions of care across the care continuum will also be critical, as well as fully engaging in technology and the performance indicators that will be needed to demonstrate impact.

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