Complex Nursing cadre and hierarchy of nursing 2022

health care professionals smiling at the camera

Hospitals and other traditional healthcare settings use a nursing cadre and hierarchy of nursing to define order and organizational structure. Nurses are ranked by their level of education and licensure, as well as years of experience. The following section outlines a typical hierarchy of nursing.

Nursing is a bit unique in that you do have different tracks of hierarchy. You can get into hospital administration and work your way up there, or get into academia, or in roles providing direct care to patients. (There are more, but let’s stick to these for now!) It does get confusing, so hang in there.

To simplify, I’ve split this into four levels of nursing cadre and hierarchy of nursing based on education requirements:

  • L1: the LPN and RN
  • L2: Nurse Manager, Nurse Educators, Nurse Practitioners
  • L3: Directors of Nursing
  • L4: Doctorate-Prepared Nurses, Chief Nursing Officers

Truly, I am over-simplifying a very complex field – so please take this structure of the hierarchy with a grain of salt. I mean no offense in “ranking” but it is helpful to understand what’s required of people who are at different nursing cadre and hierarchy of nursing.

group of people on a conference room or nursing cadre and hierarchy of nursing board room
nursing cadre and hierarchy of nursing board room

Nursing cadre and hierarchy of nursing arrangement

  • Nursing officer 2/ Nursing tutor 2
  • Nursing Officer 1/ Nursing Tutor 1
  • Senior Nursing officer/ senior nursing tutor
  • Principal Nursing officer/ Principal Nursing Tutor
  • Asst. Chief Nursing officer/ Asst. Chief Nursing Tutor
  • Chief Nursing officer/ Chief Nursing tutor Gl.14
  • Assistant Director of Nursing Service
  • Deputy Director of Nursing Service or Director state
  • Director of Nursing Service (Federal)

Chief Nursing Officer (CNO)

At the very top of the nursing cadre and hierarchy of nursing within a healthcare system is the Chief Nursing Officer (CNO). This position requires overseeing and communicating with nursing departments about business matters, best nursing practices, and nursing issues. This position ensures that a hospital’s nursing operations are efficient.  

Education and training required to be a CNO are extensive, as it is one of the highest administrative role within the nursing profession. To become a CNO, a nurse needs several years of nursing and leadership experience, as well as business expertise by working as a mid-level nurse manager. Becoming a charge nurse and unit director is a helpful way to get this experience.  

Education to become a CNO includes a Masters of Science in Nursing (MSN) or higher, with a focus on business administration.  

Doctor Of Nursing Practice (DNP)

A Doctorate Of Nursing Practice (DNP) is the highest level of nursing education and expertise within the nursing cadre and hierarchy of nursing. DNP’s work in nursing administration or direct patient care as an Advanced Practice Registered Nurse (APRN). As thought leaders, DNP’s also implement health policy and influence healthcare outcomes.  

In the healthcare setting, DNP’s work in:

  • Organizational leadership
  • Nurse management
  • State and national health policy
  • Health informatics

Education to obtain a DNP requires three to six years of study, depending on what level of nursing education you currently have. Most DNP programs require that you have a master’s degree in nursing, although some will start at the BSN level and require more years of study.

Advanced Practice Registered Nurse (APRN)

An APRN is a master’s degree prepared RN with a post-master’s certificate, or a DNP in one of the following four roles:

  • Nurse Practitioner
  • Clinical Nurse Specialist
  • Certified Registered Nurse Anesthetist
  • Certified Nurse-Midwife

APRN’s are licensed through the state board of nursing in which they practice. In many states, APRNs can prescribe medication and practice independently, while in other states, they do so under the oversight of a Medical Doctor (MD).

Many nurses who are APRNs also have a DNP, but you can have one without the other. An APRN with a DNP is considered a practicing doctorate, it is one of the nursing cadre and hierarchy of nursing.

READ ALSO What You Should Know Before Taking the OET

Master’s of Science in Nursing (MSN)

Obtaining an MSN helps nurses increase their earning potential and advance their careers away from the bedside. Nurses with an MSN work in advanced nursing roles with increased responsibility. To obtain an MSN, nurses must first obtain an RN and Bachelor of Nursing (BSN) degree. 

black chairs and white table, understanding the nursing cadre and hierarchy of nursing
understanding the nursing cadre and hierarchy of nursing

Here are a few career choices for those with an MSN degree:

  • Director of Nursing
  • Nursing Educator
  • Professional Practice Director
  • Nurse Manager
  • Patient Educator
  • Healthcare Administrator
  • Patient Safety Director
  • Quality Improvement (QI) Executive 

Nursing Director

A Director of Nursing, also known as a unit manager, works directly with patients and staff within the healthcare setting and handles various administration and management duties within respective nursing units.  

Nursing Directors are registered nurses with a minimum education of an MSN, with a focus on business administration. They have many years of experience working in nursing and other administrative nursing cadre and hierarchy of nursing board room roles.  

Bachelors Of Science in Nursing (BSN)

A BSN is a 4-year nursing degree for students who want to be a registered nurse (RN), or for RNs who currently only have an associates degree in nursing (ADN). Many nurses who start their careers with an ADN eventually advance their careers by achieving a BSN. 

Bachelor’s trained nurses work in nursing specialties throughout the hospital setting. For example, cardiac, neuro, pediatrics, labor & delivery, emergency room, and ICU, to name a few.

Nurses are encouraged to become certified within their chosen specialty after they have gained at least one or more years of direct nursing experience. For example, a nurse on an ICU neuro/trauma can study and sit for the Certified Neuroscience Registered Nurses Certification (CNRN). Achieving certification within your chosen specialty shows that you are an expert nurse in a particular nursing field. In addition, many institutions will pay nurses more when they are certified within their specialty.

Both ADN and BSN graduates must pass the NCLEX-RN examination to become licensed to work as an RN.

Associates Degree in Nursing (ADN)

An ADN is a 2-year degree and is the minimum amount of education required to obtain a license to work as an RN, other than an RN diploma in the Nursing cadre and hierarchy of nursing.  

Most RN’s begin their careers working at the bedside performing direct patient care. This experience is usually preferred for nurses who wish to advance their careers and eventually earn a BSN, MSN, APRN, or DNP in Nursing cadre and hierarchy of nursing. However, there are also many career paths that an RN can take outside of the hospital setting, including case management, or aesthetic nursing.

RN Diploma

An RN diploma is another route to becoming a registered nurse which is part of the nursing cadre and hierarchy of nursing. Like the ADN, these programs typically take around two years to complete and they both prepare students to take the NCLEX-RN. The main difference is that the ADN is a college degree while the diploma is not. Diploma programs are typically offered at hospitals, but may also be available at technical or vocational schools. 

READ ALSO Male nurses earn $5,000 more per year than female nurses, according to a study.

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