Licensed practical nurse or licensed vocational nurse
Known as LPNs and LVNs, these nurses only undergo about a year of education to earn their credentials. They stick to basic medical care with common duties, including blood pressure checks, inserting catheters, taking vitals and helping with basic care, such as dressing and bathing.
Some states limit what LPNs can do. For example, they might not be able to insert IVs or administer medicine to patients in some states.
Registered nurse
Registered nurses (RNs) complete about two years of schooling to earn their credentials, and some RNs earn a bachelor’s degree. They might be called staff or bedside nurses, and they handle the bulk of direct patient care, including treatments and medication administration.
RNs spend the most time with patients, so they often communicate with physicians to help create the plan of care. They can specialize in certain areas or departments, such as the ER, critical care, oncology and labor and delivery.
Advanced practice registered nurse or nurse practitioner
The advanced practice registered nurse is the highest level nurse position outside of supervisory and administrative roles. Most APRNs work with a physician to provide patient care, diagnose conditions and create a treatment plan, but some states allow APRNs to have complete authority to practice without a physician overseeing the treatment and care.
The minimum education for an APRN is a master’s degree, but many earn a doctoral degree. The master’s option typically takes two or three years to complete, while the doctoral path takes another three to four years. Types of APRNs include nurse practitioners, clinical nurse specialists, certified nurse midwives and nurse anesthetists.
Nurse supervisor
Supervisory positions might be called a nurse manager or nurse supervisor. Ranking higher in the nursing hierarchy, they typically have a minimum of a bachelor’s degree, although master’s degrees are often preferred and sometimes required.
A nurse supervisor or manager typically oversees the nurses in a certain department, and they don’t usually provide direct patient care. Supervisors and managers are often involved with hiring and training new nurses.
Director of nursing
The director of nursing is a higher administrative position tasked with providing leadership and directing patient care. This position requires a master’s degree. A director of nursing rarely works with patients, and instead, focuses on decisions and policies that influence patient care. They often work with the chief nursing officer on issues, such as budgeting and policies.
Chief nursing officer
Some health care organizations have a chief nursing officer, who’s in charge of all nursing services for the facility. In a hospital, that means the CNO is responsible for the nurses in all departments of the hospital. It’s an administrative position that usually requires at least a master’s degree.
FAQs about the nursing hierarchy
Do nurses have to progress through every stage?
Nurses don’t have to progress through every stage. Many nurses earn an RN degree before they start working in the medical field, skipping over working as an LPN. Some nurses stop at the LPN or RN level, while others want to pursue advanced degrees or supervisory positions. Before someone can earn an APRN degree, they need to have an RN license and work experience in nursing, so this would require an individual to work up through the ranks. Supervising nurse positions typically move up through the hierarchy to earn those positions.
Who supervises nurses?
Nurses with more experience or seniority often supervise the nursing staff below them. For example, charge nurses are experienced nurses who manage a particular shift in a specific department in the health care facility. The nursing manager or supervisor and the chief nursing officer oversee all nurses, but they don’t typically provide direct supervision for nurses on a day-to-day basis since they deal with administrative tasks.
Are there related positions that aren’t nurses?
Certified nursing assistants (CNAs) can earn a certificate in a few months, putting them below LPNs in the nursing hierarchy. They work with patients to handle basic care tasks, such as bathing, feeding and turning patients. They also assist the nursing staff in other ways, such as preparing rooms for new patients.
