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Who's Who in the Nursing Hierarchy

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Kathy Quan, RN, BSN, PHN

Kathy Quan, RN, BSN, PHN, has over 30 years of experience in home health and hospice care. Teaching patients, caregivers, and other nurses has always been a passion of hers. She also loves to write and has several websites and blogs for nurses, caregivers, and patients. Kathy has also authored four books about nursing, the health care field and caring for aging parents.

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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.