The Hierarchy of Nursing

Graphic of a nursing hierarchy chart.

Hospitals and other traditional healthcare settings use a nursing hierarchy to define order and organizational structure. Nurses are ranked by their level of education and licensure, as well as years of experience. The following section outlines a typical hierarchy of nursing.

Understanding the Hierarchy of Nursing

  • Chief Nursing Officer (CNO): The CNO, sometimes referred to as the chief nursing executive (CNE), is at the top of the pyramid. This position usually works under the CEO of the hospital or agency and has administrative and supervisory roles. The person is responsible for all nursing services delivered across the hospital or healthcare unit. CNOs and CNEs generally have a master’s degree or higher.
  • Director of Nursing: A director of nursing is an administrator who directs patient care and provides general leadership for the department. Administrative duties can include record keeping and budgeting. Related titles at this level include director of patient care services and director of nursing services. Director of nursing positions require at least a master’s degree.
  • Nurse Manager or Nurse Supervisor: As part of the leadership team, nurse managers, nurse supervisors and head nurses assume responsibility of various units. They generally arrange care and support patients, as well as other tasks such as scheduling and hiring staff. A bachelor’s degree is required for management positions, and a master’s degree is recommended.
  • Nurse Practitioner (CRNP): CRNPs are registered nurses (RN) with advanced education and clinical training in a healthcare specialty area. Nurse practitioners can work with people of all ages and their families, and they provide important information useful in making decisions regarding healthcare and lifestyle. Nurse practitioners practice in accordance with the Nurse Practice Act of the state in which they work. Most nurse practitioners are also nationally certified in an area of specialty.
  • Advanced Practice Registered Nurse (APRN): APRNs provide patient care and treatment services in collaboration with a physician. In some states, they can practice independently with full authority and without a collaborative agreement with a physician. They are qualified to diagnose and treat patients. In some environments, they can be the patient’s primary healthcare provider. APRNs need a master’s degree; currently, many APRNs are obtaining advanced degrees such as a PhD or Doctor of Nursing Practice (DNP).
  • Staff Nurse or Bedside Nurse: Staff and bedside nurses provide direct patient care. They are typically registered nurses who monitor, observe and assess patients. They are the first point of contact for questions or concerns that patients may have. RNs traditionally need at least a diploma or associate degree, although many hospitals and other employers now require RNs to have a bachelor’s degree.
  • Licensed Practical Nurse (LPN) and Licensed Vocational Nurse (LVN): LPNs and LVNs provide basic medical care. Duties can include changing bandages, inserting catheters, administering oral medications, taking vital signs and writing notes in the patient’s chart. LPNs and LVNs must complete an approved educational program that requires approximately one year of training.

Career Growth and Other Nursing Positions

There are many titles and roles not covered in the nursing hierarchy. Johnson & Johnson’s website Discover Nursing lists 104 areas of specialty in nursing, demonstrating some of the employment opportunities in the profession.

The potential for career growth in nursing is highlighted by the profession’s growth and size. Employment of RNs is projected to grow 16 percent by 2024, which is much faster than the average for all occupations, according to the Bureau of Labor Statistics.

“Nursing is the nation’s largest health care profession, with more than 3.1 million registered nurses nationwide,” the American Association of Colleges of Nursing says. “Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation’s long-term care.”

Pursuing Opportunities in Nursing

Current nurses can further their education to enhance the quality of patient care and pursue more advanced career opportunities. Alvernia University’s online RN to BSN degree prepares nurses for specialty and management roles. The online DNP is designed for APRNs seeking a practice doctorate in clinical leadership to advance their careers to the highest levels in nursing.

Each program takes place in a convenient online learning environment that accommodates students’ work and personal schedules.