Occupations and Terms of Reference › Chief nursing officer (CNO)
Universal terms of reference · POS-006 · version 1.0 · status: draft · next review 2027-10-27
Chief nursing officer (CNO)
To lead nursing and midwifery practice across the organisation, so that every patient receives safe, compassionate and competent nursing care, and nurses are well led, developed and supported.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You lead nursing across the organisation. You set nursing standards, make sure there are enough competent nurses on every shift, lead nurse education and development, and make sure nursing care is safe, compassionate and based on evidence.
Reports to: Chief executive officer.
Leads or supervises: Directors of nursing, nurse educators, infection prevention and control lead, ward managers, midwifery lead and staff development.
What you do on a typical day
- Review staffing levels, skill mix and vacancies for every service each day.
- Review nursing incidents, pressure injuries, falls and complaints, with ward managers.
- Lead nursing governance and standard setting; approve nursing policies and protocols.
- Support ward managers with difficult staffing or care problems.
- Plan competence and training for nurses, with the education team.
- Round on wards and clinics to see care in practice.
Working conditions and demands
- Accountable for nursing staffing levels across all services.
- Often on call for staffing and care escalations.
- Balance between workforce management and direct professional leadership.
What good looks like
- Every shift has a safe, competent skill mix.
- Nursing incidents fall and learning is visible on the ward.
- Nurses are licensed, competent, supported and developed.
- Patients and families describe nursing care as safe and kind.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- Every decision that affects patient safety is made on evidence and recorded.
- Patient safety and quality come before financial targets; no trade-off that puts patients at risk is accepted.
- Every staff member can raise a concern without fear of reprisal, and every concern is answered.
- Legal, licensing and accreditation duties are known, owned and reviewed.
- Finances, people and information are managed openly and within the law.
- Mandatory training and policies apply to the executive as much as to frontline staff.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-006 |
| ISCO-08 | 1342 (skill level 4) |
| ESCO | to map |
| Department | Governance |
| Facility types | Hospital, Ambulatory, Aesthetic |
3. Reporting line and working relationships
Reports to: POS-003. Supervises: POS-013, POS-094, POS-030, POS-079, POS-083, POS-168.
| Works with | Nature of the relationship |
|---|---|
| Chief medical officer | Joint leadership of clinical care and safety. |
| Chief quality and safety officer | Nursing quality, audit and incident learning. |
| Chief operating officer | Staffing, rotas and patient flow. |
| Chief human resources officer | Recruitment, competence and workforce planning. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Nursing standards | Sets and assures nursing standards and protocols across all services. | Standards approved; practice audit results reviewed | Quarterly | C-01 | T-05 | POL-INC | 2 |
| Staffing and skill mix | Makes sure every shift has enough competent nurses and an appropriate skill mix. | Staffing reports reviewed; gaps escalated the same day | Daily | C-02 | T-08 | POL-EQUAL | 2 |
| Nursing safety | Leads learning from nursing incidents, falls, pressure injuries and medication errors. | Incident actions closed; trend reports reviewed | Monthly | C-03 | T-05 · T-07 | POL-INC · POL-SAFEG | 2 |
| Competence and development | Makes sure nurses are licensed, competent and supported to develop. | Licence register current; competence assessments completed | Quarterly | C-04 · C-05 | T-08 | POL-EQUAL | 2 |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Nursing standards and protocols within organisational policy | Staffing shortfalls that cannot be covered safely (COO and CEO) |
| Staffing deployment across services within budget | Nursing practice concerns with legal or public consequences |
| Competence requirements for nursing roles | Changes to nursing services with budget impact |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Registered nurse or midwife licence, current | Yes | per regulator |
| Q-02 | Degree in nursing or a related field | Yes | Lifetime |
| Q-03 | Nursing leadership or master's qualification | No | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Senior nursing experience, including management of nursing teams across more than one service | 10 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | C-01 · C-03 |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | – |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | C-03 |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | C-02 · C-04 · C-05 |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-01 | Immunity to vaccine-preventable diseases relevant to the setting, documented at entry | At entry or as set | essential | Documented hepatitis B status at entry |
| H-02 | Tuberculosis screening at entry, then as the national rule requires | At entry or as set | essential | Symptom screening at entry and after exposure |
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Nursing standards and clinical leadership | Follows nursing standards | Leads nursing standards in a service | Sets and assures nursing standards across the organisation | Practice audit | Every 12 months | T-05 |
| C-02 | Workforce planning and skill mix | Records shift staffing | Plans staffing for a service | Designs workforce and skill mix across the organisation | Workforce review | Every 12 months | T-08 |
| C-03 | Nursing quality and incident learning | Reports nursing incidents | Leads nursing incident reviews | Designs nursing safety improvement across the organisation | Incident review audit | Every 12 months | T-05 · T-07 |
| C-04 | Nurse education and competence assurance | Keeps own competence current | Assesses competence of nurses | Designs the competence and education system | Competence audit | Every 24 months | T-08 |
| C-05 | Leading nurses and multidisciplinary teams | Works in a team | Leads a team of nurses | Leads organisational change in nursing | 360 feedback | Every 24 months | T-08 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Shifts meeting the agreed skill mix | 100% | rota and staffing system | Monthly |
| PI-02 | Nurses with a current licence and competence assessment | 100% | HR and licence register | Quarterly |
| PI-03 | Nursing incidents reviewed with actions completed | 100% | incident register | Monthly |
| PI-04 | Staff turnover in nursing | set by facility | HR data | Quarterly |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Chief nursing officer (CNO) | 10 years (recommended) | Q-01, Q-02 | C-01 expert, C-04 expert | T-07 · T-08 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |