Overview

The vision of the American Organization of Nurse Executives (AONE) is

to shape the future of health care through innovative and expert nursing
leadership. Innovative nursing leadership requires that nurses in leadership
positions are competent.

The AONE Nurse Executive Competencies

AONE believes that managers at all levels must be

competent in:
I. Communication and relationship-building
II. A knowledge of the health care environment
III. Leadership
IV. Professionalism
V. Business skills

Several years ago, the American Organization of

Nurse Executives (AONE) published its paper on the
role and function of nurses in executive practice.
This document outlined the transitions occurring
in health care leadership and the dimensions and
processes that were instrumental in executive
success. The AONE Board of Directors determined
that it was time to update this work with a more
in-depth description of the competencies integral
to the practice of nurse executives.

While all nursing leaders share these competency

domains, the emphasis on particular competencies
will be different depending on the leaders specific
position in the organization.

The turbulent, ever-changing world of health care

continues to present new challenges. With the
mission statement: To shape health care through
innovative and expert nursing leadership, AONE
recognizes that excellent leadership is essential to
ensure excellent patient care.

The competencies are captured in a model developed by

the Healthcare Leadership Alliance in 2004. Members of the
Alliance include AONE, the American College of Healthcare
Executives, American College of Physician Executives, Healthcare
Financial Management Association, Healthcare Information and
Management Systems Society and Medical Group Management
Association. This graphic model is being used in ongoing work
to identify a common core set of competencies for leadership
executives in healthcare.

2011, the American Organization of Nurse Executives

Communication and relationship-building

competencies include:
Effective communication
Relationship management
Influence of behaviors
Ability to work with diversity
Shared decision-making
Community involvement
Medical staff relationships
Academic relationships

The competencies listed on these pages describe

skills common to nurses in executive practice
regardless of their educational level or titles in
different organizations. They are presented as
information for both nurse leaders and those who
employ or work with them. Executives can use these
competencies as a self-assessment tool, useful
in the identification of possible areas for growth.
Aspiring nurse leaders can use them in planning
personal preparation for their careers. Health care
organizations may see them as a guideline for job
descriptions, expectations and evaluations of nurse
leaders. Nurse educators can utilize them as a
curriculum guideline for the educational preparation
of nurses seeking expertise and knowledge in
executive practice.

AONE Nurse Executive Competencies

Knowledge of the health care

environment includes:
Clinical practice knowledge
Patient care delivery models and work
design knowledge
Health care economics knowledge
Health care policy knowledge
Understanding of governance
Understanding of evidence-based practice
Outcome measurement
Knowledge of, and dedication to patient safety
Understanding of utilization/case management
Knowledge of quality improvement
and metrics
Knowledge of risk management

Leadership skills include:

Foundational thinking skills
Personal journey disciplines
The ability to use systems thinking
Succession planning
Change management
Professionalism includes:
Personal and professional accountability
Career planning
Ethics
Evidence-based clinical and
management practice
Advocacy for the clinical enterprise
and for nursing practice
Active membership in
professional organizations
Business skills include:
Understanding of health care financing
Human resource management
and development
Strategic management
Marketing
Information management and technology
The following discussion provides an in-depth
description of the skills needed for competency in
the five AONE leadership domains.

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

1. Communication and Relationship-Building

a. Effective Communication

d. Diversity

Make oral presentations to diverse audiences on

nursing, health care, and organizational issues

Create an environment which recognizes and

values differences in staff, physicians, patients
and communities

Produce cogent and persuasive written materials

to address nursing, health care and organizational
issues appropriate to the audience
Resolve and manage conflict

b. Relationship Management
Build trusting, collaborative relationships with:
Staff
Peers
Other disciplines and ancillary services
Physicians
Vendors
Community leaders
Legislators
Nursing and other educational programs
Deliver bad news in such a way as to
maintain credibility
Follow through on promises and concerns
Provide service recovery to dissatisfied customers

Utilize medical / staff mechanisms to address

physician clinical performance issues

Define diversity in terms of gender, race, religion,

ethnicity, sexual orientation, age, etc.

Facilitate disputes involving physicians and nurses

or other disciplines

Analyze population data to identify cultural clusters

Develop, communicate and monitor

behavior expectations

Identify educational needs of existing and potential

nursing staff

Develop processes to incorporate cultural beliefs

into care

Collaborate with nursing programs to provide

required resources

e. Shared Decision-Making

Collaborate with nursing programs in evaluating

quality of graduating clinicians and develop
mechanisms to enhance this quality

Engage staff and others in decision-making

Promote decisions that are patient-centered

Serve on academic advisory councils

Provide an environment conducive to

opinion-sharing

Provide consultation to community and business

leaders regarding nursing and health care

Reward appropriate behaviors and confront and

manage inappropriate behaviors

Determine current and future supply and demand

for nursing care

Confront inappropriate behaviors and attitudes

toward diverse groups

Accomplish objectives through persuasion,

celebrate successes and accomplishments and
communicate a shared vision

Create and communicate a shared vision

h. Academic Relationships

Define cultural competency and permeate principles

throughout the organization

f. Community Involvement

c. Influencing Behaviors

Collaborate with physicians to determine patient

care equipment and facility needs

Assess current environment and establish indicators

of progress toward cultural competency

Care about people as individuals and demonstrate

empathy and concern while ensuring that
organizational goals and objectives are met

Assert views in non-threatening,

non-judgmental ways

Collaborate with physicians to develop patient care

protocols, policies and procedures

Collaborate with nursing faculty in nursing research

and incorporate nursing research into practice

Represent the organization to non-health care

constituents within the community

Be an effective board member for community

and/or professional organizations

g. Medical / Staff Relationships

Build credibility with physicians as a champion for
patient care, quality and nursing professionalism
Confront and address inappropriate behavior
towards patients and staff
Represent nursing at medical executive committee
and other medical staff committees
Collaborate with medical staff leaders in
determining needed patient care services

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

2. Knowledge of the Health Care Environment

a. Clinical Practice Knowledge

d. Health Care Policy

g. Patient Safety

Maintain knowledge of current nursing practice

and the roles and functions of patient care team
members

Articulate federal and state laws and regulations

that affect the provision of patient care, e.g., tort
reform, malpractice/negligence, reimbursement

Support the development and implementation of an

organization-wide patient safety program

Articulate patient care standards as published by

the Joint Commission, CMS, and professional
nursing literature

Participate in the legislative process concerning

health care through membership in professional
organization and personal contact with public
officials

Understand, articulate and ensure compliance

with the State Nurse Practice Act, State Board of
Nursing regulations, regulatory agency standards
and policies of the organization
Ensure that written organization clinical policies and
procedures are reviewed and updated in accordance
with evidence-based practice
Role model lifelong learning, including
clinical subjects such as disease processes,
pharmaceuticals and clinical technology

b. Delivery Models/Work Design

Maintain current knowledge of patient care delivery
systems and innovations
Articulate various delivery systems and patient care
models and the advantages/disadvantages of each
Serve as change agent when patient care work/
workflow is redesigned
Determine when new delivery models are
appropriate, and then envision and develop them

c. Health Care Economics

Articulate federal and state payment systems and
regulations, as well as private insurance issues
which affect organizations finances
Understand and articulate individual organizations
payer mix, CMI and benchmark database

2011, the American Organization of Nurse Executives

Design safe clinical systems, processes, policies

and procedures
Monitor clinical activities to identify both expected
and unexpected risks
Support a non-punitive reporting environment and a
reward system for reporting unsafe practices

Educate patient care team members on the

legislative and regulatory processes and methods
for influencing both
Interpret impact of state and federal legislation on
nursing and health care organizations

e. Governance
Articulate 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 organizations board
members regarding health care and the value of
nursing care
Represent nursing at the organizations board
meetings

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

Support safety surveys, responding and acting on

safety recommendations

j. Risk Management

Ensure staff is clinically competent and trained on

their role in patient safety

Ensure staff is educated on risk management and

compliance issues

Articulate and take action to support the Joint

Commission National Patient Safety Goals

Develop systems which encourage/require prompt

reporting of potential liability by staff at all levels

h. Utilization/Case Management

Envision and take action to correct identified areas

of potential liability

Articulate organization decision-making for the

criteria model adopted by the organization

Identify areas of risk/liability

Communicate key points of the model to a variety

of audiences (nursing, financial, medical staff)
Involve physicians in on-going utilization
management practices
Design continuum of care options for managing
patient throughput (long term care units, urgent
care centers, admission/discharge units, etc.)

i. Quality Improvement/Metrics

f. Evidence-Based Practice/Outcome
Measurement

Articulate the organizations QI program and goals

Determine patient care quality improvement goals
and objectives

Interpret information from research

Utilize research findings for the establishment of
standards, practices and patient care models in
the organization
Disseminate research findings to patient care
team members
Participate in studies that provide
outcome measurements
Allocate nursing resources based on measurement
of patient acuity/care needed

AONE Nurse Executive Competencies

Define quality metrics by:

Define metrics as related to process improvement

Explain and utilize metrics as a unit of measure
for any process
Articulate the link between metrics and goals
Articulate the link between organization metrics and
national quality initiatives/metrics
Target outcomes that are evidence-based
(comparison data benchmarking)

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

3. Leadership

4. Professionalism

a. Foundational Thinking Skills

d. Succession Planning

Address ideas, beliefs or viewpoints that should be

given serious consideration

Promote nursing management as a desirable

specialty

Recognize ones own method of decision making

and the role of beliefs, values and inferences

Conduct periodic organizational assessments to

identify succession planning issues and establish
action plans

Critically analyze 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 leadership and an
understanding that all leadership begins from within
Provide visionary thinking on issues that impact the
health care organization

b. Personal Journey Disciplines

Value and act on feedback that is provided about
ones own strengths and weaknesses
Demonstrate the value of lifelong learning through
ones own example
Learn from setbacks and failures as well as
successes

a. Personal and Professional

Accountability
Create an environment that facilitates the team to
initiate actions that produce results
Hold self and others accountable for actions
and outcomes

Serve as a professional role model and mentor to

future nursing leaders

Create an environment in which others are setting

expectations and holding each other accountable

Establish mechanisms that provide for early

identification and mentoring of staff with
leadership potential

Answer for the results of ones own behaviors

and actions

e. Advocacy
Role model the perspective that patient care is the
core of the organizations work
Assure that the clinical perspective is included in
organizational decisions
Ensure that nurses are actively involved in decisions
that affect their practice

f. Active Membership in Professional

Organizations
Participate in at least one professional organization

b. Career Planning

Develop a succession plan for ones own position

Develop own career plan and measure progress

according to that plan

e. Change Management

Support and encourage others to participate in a

professional organization

Coach others in developing their own career plans

Utilize change theory to plan for the implementation

of organizational changes

Create an environment in which professional and

personal growth is an expectation

Serve as a change agent, assisting others in

understanding the importance, necessity, impact
and process of change

c. Ethics
Articulate the application of ethical principles
to operations

Support staff during times of difficult transitions

Recognize ones own reaction to change and strive
to remain open to new ideas and approaches

Integrate high ethical standards and core values into

everyday work activities

Adapt leadership style to situational needs

Create an environment that has a reputation for

high ethical standards

Assess ones personal, professional and career

goals and undertake career planning
Seek mentorship from respected colleagues

d. Evidence-Based Clinical and

Management Practice

c. Systems Thinking

Advocate use of documented best practices

Promote systems thinking as a value in the

nursing organization

Teach and mentor others to routinely utilize

evidence-based data and research

Consider the impact of nursing decisions on the

health care organization as a whole
Provide leadership in building loyalty and
commitment throughout the organization
Synthesize and integrate divergent viewpoints for
the good of the organization

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

5. Business Skills
a. Financial Management
Articulate business models for health care
organizations and fundamental concepts of
economics
Describe general accounting principles and define
basic accounting terms
Analyze financial statements
Manage financial resources by developing
business plans

Conclusion
Manage performance through rewards, recognition,
counseling and disciplinary action

e. Information Management and

Technology

Provide mentorship and career counseling to

aspiring clinicians and leaders so they may develop
required skill sets (succession planning)

Demonstrate basic competency in e-mail,

common word processing, spreadsheet and
Internet programs

Identify future skill sets needed to remain

competitive

Recognize the relevance of nursing data for

improving practice

Analyze market data in relation to supply and

demand and manage resources to ensure
appropriate compensation

Recognize limitations of computer applications

Use telecommunication devices

c. Strategic Management

Utilize hospital database management, decision

support, and expert system programs to access
information and analyze data from disparate sources
for use in planning for patient care processes
and systems

Analyze the situation and identify strategic direction

Conduct SWOT and gap analyses

Participate in system change processes and

utility analysis

Champion a diverse workforce

Formulate objectives, goals and specific strategies

related to mission and vision

Participate in the evaluation of information systems

in practice settings

Use corrective discipline to mitigate workplace

behavior problems

Understand what organizations should measure in

order to balance the financial perspective

Evaluate and revise patient care processes

and systems

Interpret and evaluate employee satisfaction/quality

of work surveys

Measure and analyze performance from the learning

and growth, business process, customer and
financial perspectives

Use computerized management systems to record

administrative data (billing data, quality assurance
data, workload data, etc.)

d. Marketing

Use applications for structured data entry

(classification systems, acuity level, etc.)

Establish procedures to assure accurate

charging mechanisms
Educate patient care team members on financial
implications of patient care decisions

b. Human Resource Management

Participate in workforce planning and
employment decisions

Create opportunities for employees to be involved

in decision-making
Reward and recognize exemplary performance
Formulate programs to enhance work-life balance
Interpret legal and regulatory guidelines
Manage collective bargaining environments or
implement programs to avoid the need
Identify and eliminate sexual harassment, workplace
violence, and verbal and physical abuse

Develop and implement recruitment and

retention strategies

Analyze marketing opportunities

This document is not intended

to be an exhaustive list of all areas
of expertise for individual nurses
in executive practice. It does,
however, illustrate how complex
and important their roles
have become.
Nursing leadership/management is as much a
specialty as any other clinical nursing specialty.
As such, it requires proficiency and competent
practice specific to the executive role. The AONE
Nurse Executive Competencies sets the standard
for that practice.
Special thanks to the AONE 2004 Education
Committee for its extensive work on this project:
Patricia Conway-Morana, Rosemary Roth,
Rose Sherman, Kathy Harris, Janice Wharton,
Beth Brooks, Pamela Thompson and Veronika Riley
(staff liaison).

Recognize the utility of nursing involvement in the

planning, design, choice and implementation of
information systems in the practice environment

Develop marketing strategies

Integrate marketing and communications strategies
Use public relations and media outlets to promote
your organization

Demonstrate awareness of societal and

technological trends, issues and new developments
as they apply to nursing
Demonstrate proficient awareness of legal and
ethical issues related to client data, information
and confidentiality

Implement ergonomically sound work environments

to prevent worker injury and fatigue
Develop and implement bioterrorism, biohazard and
disaster readiness plans

Read and interpret benchmarking, financial and

occupancy data

Identify clinical and leadership skills necessary for

performing job-related tasks
Select top talent, matching organizational needs
with appropriate skill sets (assess job candidate
skills sets)

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2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

2011, the American Organization of Nurse Executives

AONE Nurse Executive Competencies

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