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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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Nurse Manager:
Also known as Nursing Supervisor, Unit Manager, or the Head Nurse, this position oversees one or more similar units, and has 24/7 responsibility for the clinical care of patients and operation of the units. She reports to the Director and has some day-to-day operating budgetary responsibilities. The Nurse Manager interacts with physicians and other non-nurses to coordinate care and advocate for patients. Hiring, firing, and scheduling teams are primary responsibilities of the Nurse Manager. In terms of education, a BSN is required, and a Master’s degree is recommended.

Charge Nurse:
The Charge Nurse or Shift Manager manages the day-to-day clinical patient care on a specific shift and unit. In addition to coordinating staffing with House Supervisors to cover call-ins and make float assignments as needed, the Charge Nurse is responsible for compliance with all policies, procedures, and assignments. The Charge Nurse reports to the Nurse Manager. Charge Nurses are RNs, although in some situations, such as long-term care, Charge Nurses may be LPNs. Several nurses may rotate this responsibility on each shift. Strong leadership and clinical skills are required, and a BSN is highly recommended.

Staff and Bedside Nurse
A Staff Nurse reports to the Charge Nurse, and provides direct hands-on patient care as a team. One Staff Nurse with an RN may be appointed Team Leader managing a group of nurses and aides to provide care to a set assignment. The RN may have one or two LPNs and one or two nursing aides on his team depending on the number and acuity of the patient care.

LPNs and nursing aides provide the bedside nursing care as assigned and supervised by the Team Leader or other RN, like the Charge Nurse of Nurse Manager.