The Nurse Hierarchy: Understanding the Roles and Responsibilities of Nurses

Posted on December 6, 2023 By Mathew Berg

The nursing hierarchy in the US healthcare system is a clear structure where the roles and responsibilities of every person involved are well-defined. These roles and responsibilities assigned to different nurse ranks depend upon the experience and education level of the individual. The nurse hierarchy is kept in place to give the best care to the patients from qualified and competent nurses.

The Nurse Hierarchy In the US Medical System

Foreign candidates need to know and understand the nursing hierarchy in the US medical system. This will help them get the nursing license and also assist them in applying for the position they are qualified for.

Let's find out more about the nursing ranks in a hospital or clinical setting for better understanding:

The Leadership Positions

Nurses in the leadership positions ensure the delivery of high-quality patient care.

People in these positions involve overseeing the work of other subordinate nurses and providing guidance and support. They also make sure that nursing practices are aligned with organizational goals and standards of care.

Let's see the different types of nurses in USA in the leadership positions:

Chief Nursing Officer (CNO):

  • Chief nursing officers are the top nursing executives in the healthcare system.
  • They are responsible for the overall leadership and management of nursing practice across the entire healthcare organization.

Nurse Manager or Nurse Director:

  • They oversee specific nursing units or departments within a healthcare facility, like the cardiology or pediatric department.
  • They are responsible for managing the nursing staff, coordinating patient care, and ensuring that the specific unit operates efficiently.

Charge Nurse:

  • A charge nurse oversees the nursing staff during a specific shift in many clinical settings.
  • They coordinate patient care, manage staffing assignments, and serve as a point of contact for communication between staff and other departments.

These roles may vary in their responsibilities and requirements depending on the type and size of the healthcare organization. New leadership roles may also emerge as the healthcare landscape evolves to address emerging challenges and opportunities.

Advanced Practice Nurse Ranks In The US Medical System

Advanced Practice Nurses (APNs) receive specialized education and training to take on extended roles within the healthcare setting.

There are several advanced practice nursing positions, each with its focus and scope of practice.

Here are some of the key advanced practice nursing roles in the US healthcare system:

Nurse Practitioner (NP):

  • NPs are the most common type of APRN. They provide primary, acute, and specialty care across the lifespan by assessing, diagnosing, and treating illnesses and injuries.
  • NPs can prescribe medications, order and interpret tests, and manage chronic conditions. They can practice in various specialties, such as family practice, pediatrics, adult gerontology, and mental health.

Clinical Nurse Specialist (CNS):

  • CNSs are expert clinicians who provide specialized care in a particular area of nursing, such as oncology, critical care, or pediatrics. 
  • They focus on providing direct patient care, consulting with other healthcare providers, conducting research, and educating other nurses. 

Certified Nurse-Midwife (CNM):

  • CNMs provide primary, reproductive, and gynecological health care to women, including prenatal care, childbirth, and postpartum care.
  • They also provide contraception counseling, STI screening, and menopause management. 

Nurse Educator:

  • Nurse educators work in academic or clinical settings to train nursing students and current nursing staff. 
  • They play a vital role in developing and implementing educational programs to ensure nurses have the necessary knowledge and skills.

Certified Registered Nurse Anesthetist (CRNA):

  • CRNAs provide anesthesia care to patients undergoing surgery or other invasive procedures.
  • They assess patients’ needs, administer anesthesia medications, monitor patients’ vital signs during procedures, and manage potential complications.

APRNs are in high demand, and the job outlook for these positions is excellent. APRNs are well-positioned to shape the future of nursing practice and improve patient outcomes with their advanced education, clinical expertise, and leadership skills.

Entry-Level Nursing Positions The US Healthcare Setting

Entry-level nursing positions typically require a high school diploma or equivalent and provide on-the-job training to develop foundational nursing skills and knowledge.

Here are the three main types of entry-level nursing positions in the US healthcare system:

Certified Nursing Assistant (CNA):

  • They provide direct patient care, such as bathing, dressing, feeding, and assisting with ambulation. CNAs also help with patient hygiene, perform vital signs measurements, and monitor patients’ overall condition.
  • They work under the supervision of licensed nurses and play an important role in assisting with daily care tasks.

Licensed Practical Nurse (LPN):

  • LPNs are licensed nurses who provide a broader scope of care than CNAs.
  • They can administer medications, take vital signs, perform basic nursing procedures, and provide wound care.
  • They also work under the supervision of licensed nurses but have more responsibilities and autonomy in patient care.

Staff Nurse or Registered Nurse (RN):

  • This is the most common entry-level nursing position.
  • Staff nurses work in various healthcare settings, such as hospitals, clinics, and long-term care facilities.
  • They provide direct patient care, administer medications, collaborate with healthcare teams, and monitor patients’ conditions.

How Can Nursing CES Help Foreign Students Climb the Nurse Ranks In The US?

Nursing credential evaluation services (CES) are crucial in helping foreign-educated nurses (FENs) climb up the nurse ranks in the US.

By providing an official and recognized evaluation of their credentials, nursing CES can open doors to career advancement opportunities for FENs.

Here's how nursing credential evaluation services can help foreign-educated nurses climb up the nurse ranks in the US:

Validating Nursing Education and Licensure:

  • Credential evaluation services thoroughly review and verify the educational transcripts, diplomas, and nursing licenses obtained by FENs in their home countries.
  • This process ensures that their nursing education meets the minimum curriculum requirements and licensure standards set by the Commission on Graduates of Foreign Nursing Schools (CGFNS).

Equivalency Determination:

  • Credential evaluation services go beyond mere verification and provide a detailed assessment of the equivalency of FENs’ credentials to the US standards.
  • They evaluate the coursework, clinical training, and licensure requirements of the FENs’ nursing education and compare them to the corresponding provisions in the US.

Enhancing Employability:

  • With an official credential evaluation report, FENs can demonstrate to potential employers and regulatory bodies that their nursing education and licensure meet the standards of the US healthcare system.
  • This improves their employability and increases their chances of securing nursing positions in the US.

Enabling Licensure Eligibility:

  • By validating and equating FENs’ credentials, credential evaluation services can make them eligible for licensure in the US.
  • This allows them to practice nursing legally and pursue career advancement opportunities in the US healthcare system.

Final Words

Nurses are vital in the healthcare system, providing care to patients across various settings.

The nursing hierarchy reflects nurses' diverse responsibilities and contributions at different levels of education and experience. From CNAs and LPNs to APRNs, nurses work together to deliver high-quality patient care.

As healthcare evolves, the nursing hierarchy will adapt to meet changing needs. However, the core nursing principles – compassion, competence, and collaboration – will remain constant, ensuring nurses play a central role in providing patient-centered care.

Start Now



Educational Records Evaluation Service helps Non-US educated individuals to receive their US equivalences with our credential evaluation reports.

Contact us

Tue - Fri: 10:00 to 16:00 ( PST )

4773 Mangels Blvd, Fairfield, CA 94534, USA.

© 2024 Educational Records Evaluation Service. All rights reserved.

|Privacy Policy |Cookie Policy | |Terms and Conditions