Who’s Who on the Nurse’s Corporate Ladder?

Who’s Who on the Nurse’s Corporate Ladder?
Photo by Eben Kassaye / Unsplash

There is a certain professional hierarchy in any health care environment, whether that setting happens to be a hospital, a doctor’s office, a hospice care facility or something else.

Nurses are ranked among this hierarchy based on their level of education, their licensure and their years of experience.

Seasoned nurses usually work their way up to leadership positions while those who are just entering the field typically start their career as a nurse’s aide or LPN.

Let’s take a closer look at the various roles within the nurse’s hierarchy below.

Leadership Team

Chief Nursing Officer (CNO) / Chief Nurse Executive (CNE) / Director of Nursing (DON)


Starting from the top down, the highest rung on the nurse’s corporate ladder may be referred to by a number of different titles, whether it’s CNO, CNE or DON.

Whatever the technical title happens to be, this individual oversees all of the nursing services and generally reports to the primary administrator or CEO of the health care facility or agency.

To reach this level, one must have either a Ph.D. or Master’s in nursing.

This role is primarily an administrative role and rarely, if ever, involves direct interaction with patients.

House Supervisor


This position may be shared among several nurses. House supervisors are charged with providing nursing services at an administrative leadership level and generally work on off-shifts, such as nights, weekends and holidays.

This team is responsible for handling staffing and scheduling, on-call systems, inter-facility transfers and emergencies, among other responsibilities.

House supervisors typically report to the CNO/CNE/DON.

The primary requirements for this role tend to focus more on clinical skills and leadership experience and less on advanced education level.

Director of Nursing Services (DONS) / Director of Patient Care Services (DOPCS)


The role of a DONS/DOPCS is largely administrative in nature, though there is a small clinical component involved as well.

The director is tasked with overseeing the clinical services within a specific department and managing the budget for that department.

This role typically requires a Master’s degree, usually with a focus on a specific area of work, such as oncology, mental health, women’s health, etc.

The director generally reports directly to the CNO.

Nurse Supervisor / Nurse Manager / Unit Manager / Head Nurse


This role carries the responsibility of overseeing one or more units within a health care facility and includes 24/7 clinical care of patients in said units.

It may also include some budgetary responsibilities.

This management position interacts with physicians and other staff to coordinate care and advocate for patients.

He or she reports to the DONS.

Other responsibilities of the nurse supervisor/manager include the hiring, scheduling and firing of teams.

A BSN is required for this role, though most employers also prefer someone with a Master’s degree.

Charge Nurse / Shift Manager


This individual is tasked with managing the day-to-day clinical patient care of a specific unit and shift.

In addition to staffing coordination to cover call-ins, the shift manager/charge nurse is also responsible for ensuring compliance with all policies and procedures.

Charge nurses are RNs, though in some instances, they may be LPNs.

This responsibility may also be rotated amongst several nurses on each shift.

This role commands strong leadership skills as well as clinical prowess.

In terms of education, a BSN is usually preferred.

Staff Nurse / Bedside Nurse


Staff or bedside nurses report to the shift manager/charge nurse, providing hands-on patient care as part of a team.

One staff nurse may be promoted to the title of team leader and subsequently responsible for overseeing other nurses and aides.

This would usually involve an RN overseeing several LPNs and/or nursing aides.

The number of reports may vary, depending on the volume and acuity of patients being cared for at the time.

LPNs and aides then deliver the care as assigned and supervised by the team leader.

Non-Management Leadership Roles


In addition to the management positions listed above, there are also a number of other non-management leadership roles available to practicing nurses.

These may include such titles as clinical nurse specialist, risk management, staff educators, nurse researchers, infection control specialists, quality improvement specialists and nurse practitioners.

Despite the fact that these positions aren’t technically considered management roles, they still typically require a BSN and sometimes a Master’s degree, especially those with a clinical specialty focus.

Career Path Opportunities


Without question, the field of nursing offers tremendous opportunity for professional growth.

Some nurses may decide to spend their entire career providing bedside care to patients while others may choose to further their education and expand their horizons by pursuing a specialty or working their way up to a management position.

As the health care needs of our growing and aging population continue to increase and evolve, so will the demand for experienced, ambitious nursing professionals.
Salaries and career path opportunities will ultimately depend upon the level of education, experience and licensure.

In some cases, clinical experience can prove even more valuable than education level.

For instance, BSN nurses frequently earn more than RNs doing the same job.

Likewise, a staff nurse just starting out may outrank an experienced RN with a diploma or ADN/ASN.

Generally speaking, nurses with a BSN are expected to possess more leadership skills as well as a deep-seeded knowledge base upon which to draw.

In terms of quality of care, research has proven that patient outcomes are better when the nurse providing care has a higher level of education.

This is driven by consumer demand for a higher quality of care, along with quality improvements being mandated by those that subsidize health care costs, such as private health insurers and Medicare.

It is strongly suggested that anyone pursuing a career in nursing seriously consider obtaining a BSN at the bare minimum.

This can be achieved either through a BSN program, or by obtaining a LPN license and then working upward to RN / BSN.

Finally, of course, there is the importance of ongoing certification.

Most employers require all nursing professionals to maintain active certification in BLS, ACLS and, in some cases, PALS.

To learn more about our convenient, affordable online medical certification courses, please click here.

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