A Guide to the Nursing Hierarchy

Certified nursing assistants, or nursing assistants, help patients with activities of daily living such as moving, bathing, eating, and dressing. They also check vital signs and look for changes in their patients’ conditions. CNAs report any patient condition changes to the licensed practical nurse (LPN) or registered nurse (RN) they work under.

Licensed practical nurses monitor patients’ health, provide basic patient care and comfort, and keep patient records. LPNs may insert catheters, care for infants, and change bandages. Responsibilities for LPNs vary between where they live and where they work.

Registered nurses monitor patients’ health, provide patient care, and educate patients. RNs have increased autonomy to coordinate patient care with other healthcare providers, participate in care planning, and advocate for patients. The responsibilities of an RN vary based on whether they work in a hospital, outpatient setting, or nursing home.

Nurse practitioners diagnose, treat and educate patients. NPs and medical doctors share many of the same responsibilities, but NPs are more likely to specialize in primary care. Most NPs work in physician’s offices, hospitals, and outpatient care centers. Their responsibilities vary based on their specialty and the state where they practice.

Clinical nurse specialists provide expertise and consultations with other nurses in their specialty. They focus on researching and implementing best nursing practices in their specialty. They specialize in family practice, pediatrics, adult-gerontology, or neonatal care. They serve in leadership roles as educators, preceptors, researchers, advisors, and policy advocates.

Certified nurse midwives provide patient care and education before, during, and after birth. They oversee births, treat patients with sexually transmitted diseases/infections (STD/STI), educate patients about healthy pregnancies, and care for newborns and their parents after birth.

Nurse educators teach, mentor, and motivate student nurses at all levels of nursing education. They work in colleges, universities, and healthcare settings. They develop nursing courses and monitor their effectiveness. Nurse educators supervise student nurses during their clinical experiences. They also research the best evidence-based practices.

Certified registered nurse anesthetists, or nurse anesthetists, take patients’ medical histories, monitor patients’ vital signs, give local and general anesthesia, and collaborate with physicians. Most CRNAs work in outpatient care as the only anesthesia provider on their shift.

Charge nurses plan patient care for their shift, schedule and oversee nursing staff on their unit, and act as a connection between nursing staff, physicians, and hospital leadership. They determine what care to administer during their shift, and make sure the nursing staff use their resources effectively to deliver that care.

Nursing directors, or nursing administrators, use their clinical knowledge and experience from previous nursing positions to lead nursing staff within a healthcare organization. Nursing directors do not provide direct patient care. Instead, they represent nursing staff in meetings, hire and recruit nurses, and conduct performance reviews and professional development.

Chief nursing officers manage nursing care for the entire hospital or health system, with a focus on safety and promoting optimal patient outcomes. They work alongside other members of hospital leadership to develop patient care strategies. They develop emergency procedures, budgets, and professional development. CNOs do not deliver direct care, but they are required to have an active nursing license in case of staffing emergencies.