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Who's Who in the Nursing Hierarchy

Who's Who in the Nursing Hierarchy

Kathy Quan | NursingLink

Any health care environment, be it a traditional hospital setting, a home health facility or even hospice care, have a hierarchy of health care professionals. Nurses are ranked by their level of education and licensure, as well as years of experience. Advanced and experienced nurses hold leadership positions, while entry-level nurses starting out their career as an LPN or aide, work from the ground up.

The Leadership Team

CNO/CNE:
From the top down, the highest ranking nurse may be known by a variety of names such as the Chief Nursing Officer (CNO), the Chief Nurse Executive (CNE), or even, the Director of Nursing (DON). A nurse in this top level position reports directly to the CEO or primary administrator of the facility or agency. CNOs usually have a Master’s degree in nursing, if not a Ph.D., and it’s primarily an administrative role. The CNO is in charge of all nursing services provided throughout the hospital, facility, or agency.

House Supervisor:
Several nurses may share the House Supervisor role, providing administrative leadership level of nursing services on weekends, holidays, and even off-shifts such as evenings and nights. They primarily handle such responsibilities such as staffing for call-ins. Other responsibilities include inter-facility transfers, emergencies, and on-call systems. Clinical skills and leadership experience is the primary requirement and not always advanced education. This role usually reports to the CNO.

Director of Nursing Services:
The Director of Nursing Services (DONS), also knows as the Director of Patient Care Services (DOPCS) has a largely administrative role, with a smaller clinical component as well. The Director role requires a Master’s degree with a focus in the specific clinical area of work such as Women’s Health, Mental Health, Oncology, etc. The Director is responsible for the clinical services within a department and manages the budget for the department, reporting to the CNO.

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