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Many factors should be considered by persons thinking about a move from midlevel to top-level nursing administration. A number of different programs exist, all of which involve mentoring with the chief nurse executive for a time. The seven-month VA program is described, which trains for the positions of Associate Chief for Education, Supervisor, Nursing Home Care Unit and Assistant Chief Nurse. Key steps include 1) developing a clear understanding of the proposed role, 2) getting personal affairs in order and 3) considering the fiscal implications.