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COMMUNICATION

KNOWLEDGE

LEADERSHIP

PROFESSIONALISM

BUSINESS SKILLS

Nurse Executive
Competencies

2 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

Suggested APA Citation: AONE, AONL. (2015). AONL Nurse Executive Competencies. Chicago, IL: AONE, AONL.

Accessed at: www.aonl.org

Accessible at: www.aonl.org/competencies

Contact: [email protected] or (312) 422-2800

© 2015 American Organization of Nurse Executives (AONE), American Organization for Nursing Leadership (AONL). All materials contained in
this publication are available to anyone for download on www.aonl.org, for personal, non-commercial use only. No part of this publication may
be reproduced and distributed in any form without permission of AONL, except in the case of brief quotations followed by the above suggested
citation. To request permission to reproduce this material, please email [email protected].

3 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

Nurse Leaders in executive practice set

the vision for nursing practice in the

delivery of safe, timely, efficient, equitable

and patient-centered care. Working within

a collaborative and interprofessional

environment, the nurse in executive

practice is influential in improving the

patient experience of care (including quality

and satisfaction), improving the health of

populations and reducing the per capita cost

of health care.

The AONL Nurse Executive Competencies

detail the skills knowledge and abilities that

guide the practice of nurse leaders in executive

practice regardless of their educational

level, title or setting. The competencies are

captured in a model developed in 2004 by the

Healthcare Leadership Alliance1 that identify

the common core set of competency domains

for health care leadership: communication

and relationship management; knowledge

of the health care environment; leadership;

professionalism; business skills and principles.

OVERVIEW

1 Members include the American Organization for Nursing Leadership, The American College of Healthcare Executives, American Association for
Physician Leadership, Healthcare Financial Management Association, Healthcare Information and Management Systems Society, and Medical
Group Management Association.

Reliability and validity for the AONL Nurse Executive Competencies is established by periodic job analysis/role delineation studies. These
competencies are based on A National Practice Analysis Study of the Nurse Executive (2014).

4 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

A. EFFECTIVE COMMUNICATION

� Make oral presentations to diverse
audiences on:

» Nursing

» Health care topics

» Organizational issues

� Produce written materials for diverse
audiences on:

» Nursing

» Health care topics

» Organizational issues

� Facilitate group discussions

� Demonstrate skill in interpersonal
communication

B. RELATIONSHIP MANAGEMENT

� Build collaborative relationships

� Exhibit effective conflict resolution skills

� Create a trusting environment by:

» Following through on promises and
concerns

» Establishing mechanisms to follow-up on
commitments

» Balancing the concerns of individuals with
organizational goals and objectives

» Engaging staff and others in decision-
making

» Communicating in a way as to maintain
credibility and relationships

C. INFLUENCING BEHAVIORS

� Assert views in non-threatening, non-
judgmental ways

� Create a shared vision

� Facilitate consensus building

� Inspire desired behaviors and manage
undesired behaviors

� Achieve outcomes through engagement of
stakeholders

� Promote decisions that are patient-centered

� Apply situational leadership skills

D. DIVERSITY

� Establish an environment that values
diversity (e.g. age, gender, race, religion,
ethnicity, sexual orientation, culture)

� Establish cultural competency in the
workforce

� Incorporate cultural beliefs into care delivery

� Provide an environment conducive to
opinion sharing, exploration of ideas and
achievement of outcomes

E. COMMUNITY INVOLVEMENT

� Represent the organization to non-health
care constituents within the community

� Serve as a resource to community and
business leaders regarding nursing and
health care

� Represent the community perspective in
the decision-making process within the
organization/system

� Represent nursing to the media

� Serve on community-based boards, advisory
groups, and task forces

F. MEDICAL/STAFF RELATIONSHIPS

� Build credibility with physicians as a
champion for patient care, quality and the
professional practice of nursing

� Confront and address inappropriate or
disruptive behavior towards patients
and staff

� Represent nursing at medical executive
committee and other department/medical
staff committees

COMMUNICATION AND
RELATIONSHIP BUILDING1

5 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

� Collaborate with medical staff leaders and
other disciplines in determining needed
patient care service lines

� Collaborate with physicians and other
disciplines to develop patient care protocols,
policies and procedures

� Collaborate to determine patient care
equipment and facility needs

� Use medical staff mechanisms to address
physician clinical performance issues

� Address and model appropriate conflict
resolution

� Create opportunities for physicians and
nurses to engage in professional dialogue

G. ACADEMIC RELATIONSHIPS

� Determine current and future supply and
demand for nurses to meet the care delivery
needs

� Identify educational needs of existing and
potential nursing staff

� Collaborate with nursing programs to
provide required resources

� Collaborate with nursing programs in
evaluating quality of graduating clinicians
and develop mechanisms to enhance this
quality

� Serve on academic advisory councils

� Collaborate in nursing research and translate
evidence into practice

� Collaborate to investigate care delivery
models across the continuum

� Create academic partnerships to ensure a
qualified workforce for the future

COMMUNICATION AND RELATIONSHIP BUILDING1

6 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

A. CLINICAL PRACTICE KNOWLEDGE

� Demonstrate knowledge of current nursing
practice and the roles and functions of
patient care team members

� Communicate patient care standards as
established by accreditation, regulatory and
quality agencies

� Ensure compliance with the State Nurse
Practice Act, State Board of Nursing
regulations, state and federal regulatory
agency standards, federal labor standards
and policies of the organization

� Adhere to professional association
standards of nursing practice

� Ensure that written organizational clinical
policies and procedures are reviewed and
updated in accordance with evidence-based
practice

� Integrate bioethical and legal dimensions
into clinical and management
decision-making

� Ensure protection of human subject rights
and safety in clinical research

B. DELIVERY MODELS / WORK DESIGN

� Demonstrate current knowledge of patient
care delivery systems across the continuum

� Describe various delivery systems and age-
appropriate patient care models and the
advantages/disadvantages of each

� Assess the effectiveness of delivery models

� Develop new delivery models

� Participate in the design of facilities

C. HEALTH CARE ECONOMICS AND POLICY

� Understand regulation and payment issues
that affect an organization’s finances

� Describe individual organization’s payer mix,
CMI and benchmark database

� Align care delivery models and staff
performance with key safety and economic
drivers (e.g., value-based purchasing,
bundled payment)

� Take action when opportunities exist to
adjust operations to respond effectively
to environmental changes in economic
elements

� Use knowledge of federal and state laws
and regulations that affect the provision of
patient care (e.g., tort reform, malpractice/
negligence, reimbursement)

� Participate in legislative process on health
care issues through such mechanisms as
membership in professional organization
and personal contact with officials

� Educate patient care team members on the
legislative process, the regulatory process
and methods for influencing both

� Interpret impact of legislation at the state
and federal level on nursing and health care
organizations

D. GOVERNANCE

� Use knowledge of the role of the governing
body of the organization in the following
areas:

» Fiduciary responsibilities

» Credentialing

» Performance management

� Represent patient care issues to the
governing body

� Participate in strategic planning and quality
initiatives with the governing body

� Interact with and educate the organization’s
board members regarding health care and
the value of nursing care

� Represent nursing at the organization’s
board meetings

� Represent other disciplines at the
organization’s board meetings

KNOWLEDGE OF THE HEALTH
CARE ENVIRONMENT2

7 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

E. EVIDENCE-BASED PRACTICE/OUTCOME
MEASUREMENT AND RESEARCH

� Use data and other sources of evidence to
inform decision making

� Use evidence for establishment of
standards, practices and patient care models
in the organization

� Design feedback mechanisms by which to
adapt practice based upon outcomes from
current processes

� Design and interpret outcome measures

� Disseminate research findings to patient
care team members

� Allocate nursing resources based on
measurement of patient acuity/care needed

� Monitor and address nurse sensitive
outcomes and satisfaction indicators

F. PATIENT SAFETY

� Support the development of an
organization-wide patient safety program

� Use knowledge of patient safety science
(e.g., human factors, complex adaptive
systems, LEAN and Six Sigma)

� Monitor clinical activities to identify both
expected and unexpected risks

� Support a Just Culture (non-punitive)
reporting environment, supporting a reward
system for identifying unsafe practices

� Support safety surveys, responding and
acting on safety recommendations

� Lead/facilitate performance improvement
teams to improve systems/processes that
enhance patient safety

G. PERFORMANCE IMPROVEMENT/METRICS

� Articulate the organization’s performance
improvement program and goals

� Use evidence-based metrics to align patient
outcomes with the organization’s goals and
objectives

� Apply high reliability concepts for the
organization

� Establish quality metrics by

» Identifying the problem/process

» Measuring success at improving specific
areas of patient care

» Analyzing the root causes or variation
from quality standards

» Improving the process with the evidence

» Controlling solutions and sustaining
success

H. RISK MANAGEMENT

� Identify areas of risk/liability

� Facilitate staff education on risk
management and compliance issues

� Develop systems that result in prompt
reporting of potential liability by staff at all
levels

� Identify early warning predictability
indications for errors

� Correct areas of potential liability

� Ensure compliance by staff with all required
standards

KNOWLEDGE OF THE HEALTH CARE ENVIRONMENT2

8 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

A. FOUNDATIONAL THINKING SKILLS

� Address ideas, beliefs or viewpoints that
should be given serious consideration

� Recognize one’s own method of decision
making and the role of beliefs, values and
inferences

� Apply critical analysis to organizational
issues after a review of the evidence

� Maintain curiosity and an eagerness to
explore new knowledge and ideas

� Promote nursing leadership as both a
science and an art

� Demonstrate reflective practice and an
understanding that all leadership begins
from within

� Provide visionary thinking on issues that
impact the health care organization

B. PERSONAL JOURNEY DISCIPLINES

� Learn from setbacks and failures as well
as successes

C. SYSTEMS THINKING

� Use knowledge of classic and contemporary
systems thinking in problem solving and
decision making

� Provide visionary thinking on issues that
impact the healthcare organization

� Recognize the contribution of mental
models on behavior

� Promote systems thinking as an expectation
of leaders and staff

� Consider the impact of nursing decisions on
the healthcare organization as a whole

� Use resources from other paradigms

D. SUCCESSION PLANNING

� Develop a leadership succession plan

� Promote nursing leadership as a desirable
specialty

� Mentor current and future nurse leaders

� Establish mechanisms that provide for early
identification and mentoring of staff with
leadership potential

� Develop a workforce analysis plan and
implement strategies to ensure an adequate
and qualified workforce

E. CHANGE MANAGEMENT

� Adapt leadership style to situation needs

� Use change theory to implement change

� Serve as a change leader

LEADERSHIP3

9 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

A. PERSONAL AND PROFESSIONAL
ACCOUNTABILITY

� Hold self and others accountable for mutual
professional expectations and outcomes

� Contribute to the advancement of the
profession

� Participate in and contribute to professional
organizations

� Demonstrate and promote leader and staff
participation in professional organizations

� Promote leader and staff participation
in lifelong learning and educational
achievement

� Achieve and maintain professional
certification for self

� Promote professional certification for staff

� Role model standards of professional
practice (clinical, educational and leadership)
for colleagues and constituents

B. CAREER PLANNING

� Coach others in developing their own career
plans

� Seek input and mentorship from others in
career planning and development

� Develop a personal and professional career
plan and measure progress

� Solicit feedback about personal strengths
and weaknesses

� Act on feedback about personal strengths
and weaknesses

C. ETHICS

� Uphold ethical principles and corporate
compliance standards

� Hold self and staff accountable to comply
with ethical standards of practice

� Discuss, resolve and learn from ethical
dilemmas

D. ADVOCACY

� Promote clinical perspective in
organizational decisions

� Involve nurses and other staff in decisions
that affect their practice

� Represent the perspective of patients and
families

� Advocate for optimal health care in the
community

PROFESSIONALISM4

10 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

A. FINANCIAL MANAGEMENT

� Develop and manage an annual operating
budget and long-term capital expenditure
plan

� Use business models for health care
organizations and apply fundamental
concepts of economics

� Interpret financial statements

� Manage financial resources

� Ensure the use of accurate charging
mechanisms

� Educate patient care team members
on financial implications of patient care
decisions

� Participate in the negotiation and monitoring
of contract compliance (e.g., physicians,
service providers)

B. HUMAN RESOURCE MANAGEMENT

� Ensure development of educational
programs to foster workforce competencies
and development goals

� Participate in workforce planning and
employment decisions

� Use corrective discipline to mitigate
workplace behavior problems

� Evaluate the results of employee
satisfaction/quality of work environment
surveys

� Support reward and recognition programs to
enhance performance

� Formulate programs to enhance work-life
balance

� Interpret and ensure compliance with legal
and regulatory guidelines

� Provide education regarding components of
collective bargaining

� Promote healthful work environments

� Address sexual harassment, workplace

violence, verbal and physical abuse

� Implement ergonomically sound work
environments to prevent worker injury and
fatigue

� Develop and implement emergency
preparedness plans

� Analyze market data in relation to supply
and demand

� Contribute to the development of
compensation programs

� Develop and evaluate recruitment,
onboarding, and retention strategies

� Develop and implement an outcome-based
performance management program

� Develop and implement programs to re-
educate the workforce for new roles

C. STRATEGIC MANAGEMENT

� Create the operational objectives, goals and
specific strategies required to achieve the
strategic outcome

� Conduct SWOT and Gap analyses

� Defend the business case for nursing

� Utilize the balanced scorecard analysis to
manage change

� Evaluate achievement of operational
objectives and goals

� Identify marketing opportunities

� Develop marketing strategies in
collaboration with marketing experts

� Promote the image of nursing and the
organization through effective media
relations

BUSINESS SKILLS5

11 AONL NURSE EXECUTIVE COMPETENCIES ©2015 AONE, AONL

D. INFORMATION MANAGEMENT
AND TECHNOLOGY

� Use technology to support improvement of
clinical and financial performance

� Collaborate to prioritize for the
establishment of information technology
resources

� Participate in evaluation of enabling
technology in practice settings

� Use data management systems for decision
making

� Identify technological trends, issues and
new developments as they apply to
patient care

� Demonstrate skills in assessing data
integrity and quality

� Provide leadership for the adoption and
implementation of information systems

BUSINESS SKILLS5

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