Hospital Hierarchy

arpeggiated · May 28, 2007

In my hospital, there's the CNA (take vitals, clean up patients, organize rooms, collect supplies for procedures/during codes) who takes orders from the nurses. LVNs and RNs are equally respected around here. The LVN works with an RN who signs off on their charting and also hangs blood and does the IV push meds they need.

We have a charge nurse who does the assignments, assigns admissions, schedules meal breaks, enters orders after the secretary leaves at 2330, collects all of our 'junk' at the end of shift (thermometers, phones, does the narc count, etc) and helps with anything else we need when things go hairy. I LOVE my charge nurse. She is so wonderfully helpful.

We also have a nursing supervisor who assigns beds to admissions, leads codes and the rapid response team (which is when a pt is going bad but hasn't coded and we want to keep it that way), and takes a basic report from all the nurses to help determine staffing. In addition, the nurses do an 'acuity' form on the computer measuring things like assesments, treatments, how much time we've had to spend with the patient which also helps determine staffing.

Since I live in California, we do have a ratio of only 5 patients per nurse, but if things are crazy, they'll call more nurses in. No such luck for CNAs! Generally, the max patients our CNAs have is 14 on night shift, which is still a lot when it comes time to take vitals, do I/Os, pass water, etc. Especially if you get lucky and get stuck with a bunch of incontinent patients.

During day shift, the DON is there, but I hardly see him (and I like it that way ). Nursing administration is mostly at the other hospital in town, so we don't see too much of them either.

Other than nursing staff, we have a unit secretary until 2330. She can be your best friend. Our main secretary has been there for DECADES. She knows where everything is, what you need, what the policy is... She can be a lifesaver. She also helps answer call lights. There is also RT (Respiratory) who come and give breathing treatments, suctioning, and just general help when a patient is not breathing right. They tend to be really busy though, because there are only two of them for the whole hospital, and they attend all codes. Then there is the lab and phelbotomists. I usually get asked to come help them hold a confused patient still for blood draws. And there's housekeeping, who clean rooms and remake the beds after a patient is discharged, bring us supplies (gloves and hand gel), and clean up if a patient has an accident (at least one a week will get in the commode to urinate, and end up peeing all over the floor).

Anesthetize · Jun 8, 2007

What do you mean by power rankings/hierarchy? Are you getting at your responsibilities relative to others, administrative decisions, giving/taking orders, status, or something else maybe? I don't see the hospital environment as a power ranking system. Everyone ultimately has a responsibility to the patient. I'd say the patient is the most powerful, and everyone functions within their scope of practice collaboratively or independently to perform certain tasks. Using the term "hierarchies" when talking about job positions usually implies a pecking order and some measure of status, so you've got to be careful when and how you use it. A "chain of command," "order of operations," or some similar term might be more appropriate. Technically, a "hierarchy" is defined as "the organization of people at different ranks in an administrative body," and "categorization of a group of people according to ability or status," among other similar definitions. Technically speaking, hospitals aren't hierarchies, since there isn't a ranking system or organization based on status. Hierarchy is too loose of a word to use, much like saying that nurses are middle class citizens, doctors are upper class citizens, CNA's are lower class citizens, and the administration is the government in hospital land... et cetera et cetera.