What is the chain of command?

  1. This seems like a really dumb question, but it was never really explained to me when I was hired a couple of months ago, and I am struggling with people I work with not performing the roles I was led to believe they had.

    I know the nurses are supposed to delegate to the CNAs, but do they delegate to the ward clerk/unit secretary, too? I mean, is it appropriate to ask/expect a ward clerk to call a doctor's office to relay a message?

    Besides making patient assignments and helping out nurses who get overwhelmed, what is the role of the charge nurse, and what role do they play in performance evaluations? Are they considered "bosses"?
  2. 7 Comments

  3. by   RN1982
    I don't think its appropriate to ask a clerk to relay a message to a physciain's office. When I worked as charge nurse, I made assignments for the next shift, did staffing for the next shift, helped out my co-workers as well as taking my own assignment. We weren't ever considered the "boss". We didn't participate in performance evals. That was for management.
    Last edit by RN1982 on Apr 24, '09
  4. by   vashtee
    Thanks for your response. I wonder if your experience with being charge was typical of most hospitals?

    Also, I don't really see much of my manager. How would she know if I am doing a good job? That was where I thought the charge nurse might fit in.
  5. by   RN1982
    I think it varies. That was my last job that I talked about. I was in charge, had an assignment, did staffing, was in touch with the admissions office for new admits and transfers. Now I work in an extremely large ICU and the charge nurse does staffing and bed placement for admits. They don't take assignments but they will help out if needed.
  6. by   zuzi
    nice subject... from long time ago i wish to start a subject like that...

    well lets' see.. the cahin of command came from miltatry... "chain of command is the line of authority and responsibility along which orders are passed within a nursing unit and between different nursing units. orders are transmitted down the chain of command, from a higher-ranked nurse, such as a nurse manager, to lower-ranked personnel who either carry out the order personally or transmit it down the chain as appropriate, until it is received by those expected to carry it out". so in our case top level management to down side.
    in general, in military, personnel give orders only to those directly below them in the chain of command and receive orders only from those directly above them. a service member who has difficulty carrying out a duty or order and appeals for relief directly to an officer above his immediate commander in the chain of command is likely to be disciplined for not observing the chain of command.
    the concept of chain of command also implies that higher rank alone does not entitle a higher-ranking service member to give commands to anyone of lower rank. for example, a nurse from unit "icu" (for exemple) does not directly command lower-ranking members of unit "med surg", and is generally expected to approach an charge nurse of unit "med surg" if she requires action by members of that unit.
    the chain of command means that individual members take orders from only one superior and only give orders to a defined group of people immediately below them.

    unfortunatelly this rule will be never find it in us nursing area. in civilian management this term is described by hierachic structure of authority.

    structure of authority and chain of comand, after my nursing experience here in us, could have a lot of perverted, deviant and abnormal, traits, soo starting from here...is not any doubt that sometime thinks in health care are not working on a good path.

    as soon as you don't know how the chain of comand works in a ideal way and how it works in real way, probably will be a little confuse for you. my advice.. ask your good sense what is true and fair to be and act and go by it!
  7. by   diane227
    First of all, let me explain what it means. It is a term used to describe the different levels of management in the hospital and the increasing responsibilities of each. For example, my manager will have more responsibility than I do as charge nurse. I have a certain responsibility to keep her informed of issues that occur on my shift. She in turn has a boss, the director of nursing. Each level has a broader area of responsibility. The higher up, the more you get away from the bedside and more focused on the overall responsibility of running the facility.

    Now as far as being a nurse on the floor. You have the license. When you delegate a task to a CNA you have some responsibility there. You have to be sure, under the rules of delegation (refer to the nurse practice act for your state) that the person you are delegating to knows how to perform that task or procedure properly and that they have been trained. Failure to do so places your license at risk. Let me give you an example. On a pediatric floor a nurse asked a CNA to go in and DC a foley on a child. She asked the CNA if she had ever performed this task before and she said that she had. The nurse sent her in the room to pull the foley. She cut the foley off completely and the remaining foley retracted into the bladder resulting in surgery for the child in order to get the foley out of the bladder. Guess who got in trouble? The nurse, she got fired for delegating this task to a CNA.
  8. by   Daytonite
    The information you are looking for is in everyone's job description. You can also go to your manager, the nursing office, the nursing education department or the person who conducts the hospital's orientation program and ask the questions you are asking here.

    I can see circumstances where CNAs can delegate things to the ward clerk/unit secretary. I can also see where it would be appropriate to ask a ward clerk to call a doctor's office to relay a message. She's going to reach another clerk and not the doctor. However, if the doctor gets on the line then the ward clerk needs to politely put the doctor on hold and have the RN take the call and speak with the doctor. Performance evals are done on a yearly basis. When I was a manager I got my information for them a number of ways. I informally spoke with the staff, made rounds of the patients, reviewed the charting and had access to human resource reports and records.
  9. by   vashtee
    Thanks, guys!

    Haha! Diane - I know the definition of "chain of command". I guess I named this thread inappropriately!

    Anyway, I've figured it out. Thanks again.