LPN, RN, APRN, DONS, CNO. The nursing world is an alphabet soup of acronyms and titles. Figuring out what thetitles mean, much less how they all relate to one another in the hierarchy, can be difficult. To helpdemystify nursing titles and ranks, we’ve rounded up 25 of the most common nursing roles and defined whateach of them means below.
Nursing Aid and Nursing Assistant
While they may wear nursing scrubsand have the word “nursing” in their titles, nursing aids aren’t actually nurses. Nursing aids and nursingassistants assist patients with daily activities such as eating, bathing and dressing. They may also engagein some medical activities, such as measuring vital signs and administering medication, depending on thestate they work in and their education. Nursing aids may also receive training and get a license to become acertified nursing aid (CNA).
Licensed Practical Nurse (LPN) and Licensed Vocational Nurse (LVN)
It’s all in the name...except when it’s not. Licensed Practical Nurses and Licensed Vocational Nurses areactually the same position. California andTexas use the title Licensed Vocational Nurse, while the rest of the United States use LicensedPractical Nurse. These nurses communicate the care plan to patients and their families and handle basicmedical tasks such as taking blood pressure readings, changing bandages and inserting catheters.
Registered Nurse (RN)
Registered Nurses have an associate’s or bachelor’s degree in nursing and perform a variety of clinical andadministrative tasks in many different settings. They assist physicians, record medical history, monitorpatient symptoms, administer medicine, perform diagnostic tasks and much more. They may oversee othermedical professions such as CNAs and LPNs. RNs can take on lots of different specialized roles, and we’llget to many of them later on in the list.
Staff Nurse or Bedside Nurse
Staff Nurses provide direct, hands-on patient care, often working at their bedsides in a hospital (hence thename). Staff Nurses may work in many different units and execute many different tasks, and some facilitiesgive nurses the option of whether they’d like to practice as a generalist or a specialist. Some Staff Nursesmay also decide to pursue further training and become certified in one particular specialty, taking on a newtitle (more on these below).both sides.
Charge Nurse or Shift Manager
A Charge Nurse manages a shift of Staff Nurses, in addition to performing the patient care duties of a StaffNurse. Charge Nurses oversee administrative and managerial tasks such as coordinating the staffing schedule,covering call-ins, managing teams of Staff Nurses and making sure all policies are complied with. MostCharge Nurses are RNs, though in a few select cases they may be LPNs instead. They report to the NurseManager or Supervisor.
Nurse Manager or Nurse Supervisor
While Charge Nurses manage one shift of nurses, Nurse Supervisors manage an entire unit (and sometimes morethan one), assuming 24/7 responsibility for their operation and patient care. They have the power to hireand fire employees and oversee scheduling and operating budget duties. They also coordinate with physiciansand other non-nurses on patient care. A master’s degree is recommended though not always required. NurseManagers report to the Director of Nursing.
Director of Nursing
A largely administrative role, the Director of Nursing provides overall leadership for an entire department.This role may also be called a Director of Nursing Services (DONS) or a Director of Patient Care Services(DOPCS). Directors have at least a master’s degree and specialize in their department’s work (i.e.,oncology, mental health, etc.). They manage the budget, oversee clinical services for the department andreport to the Chief Nursing Officer.
Chief Nursing Officer (CNO) or Chief Nursing Executive (CNE)
The highest nursing position you can get, these roles belong to the C-suite of executives and usually reportdirectly to the top leader in the organization, the Chief Executive Officer (CEO). The CNO is responsiblefor making strategic administrative decisions and for guiding the direction of the organization. CNOs havemany years of experience, a proven track record and usually a master’s degree or higher.
Advanced Practice Registered Nurses (APRNs)
The next level up from an RN, Advanced Practice Registered Nurses have earned their Master of Nursing Science(MSN). They can do everything an RN can, plus take on greater responsibilities such as referring patients tospecialists and ordering or evaluating test results. Like RNs, APRNs may manage a team of people and/or workin specialized settings. There are four main types of APRNs—nurse anesthetists, nurse midwives, certifiednurse practitioners and clinical nurse specialists—and some MSN degree programs even offer concentrations ineach of these paths.
Nurse Anesthetist
Certified registered nurse anesthetists (CRNAs) work to ensure the safe and effective administration ofanesthesia during a variety of medical procedures. They may work in hospitals, dental practices and otherenvironments that require the use of anesthesia. Depending on the position, they may also have dutiesoutside of the surgery itself, such as overseeing patient recovery or assisting with pain management.
Nurse Practitioner
According to the AmericanAssociation for Nurse Practitioners, Certified Nurse Practitioners (CNPs) are “clinicians that blendclinical expertise in diagnosing and treating health conditions with an added emphasis on disease preventionand health management.” CNPs may diagnose and treat conditions, prescribe medications, order and interpretdiagnostic tests and much more. They may work with many diverse populations and also focus on one particularspecialty (acute care, gerontology, etc.) or subspecialty (cardiovascular, orthopedics, etc.).
Clinical Nurse Specialist
Clinical Nurse Specialists (CNS) are certified in a specialty of their choice. Specialties may take manyforms, including population (pediatrics, geriatrics, women’s health), setting (critical care, emergencyroom), disease or medical subspecialty (diabetes, oncology), type of care (psychiatric, rehabilitation) andtype of health problem (pain, wounds, stress). Not all MSN programs offer all certifications, so anaspirational CNS student should choose a program carefully.
Nurse Midwife
Certified nurse midwives (CNMs) combine their RN with specialized training in pregnancy, labor and postpartumconcerns. They may help provide reproductive healthcare services, counsel expectant mothers pre-birth,deliver babies, perform exams both before and after childbirth, assist with breastfeeding training andeducate new parents on caring for infants. While CNMs do provide clinical and medical care, they may call inan OB-GYN if there are complications that require intervention.
Family Nurse Practitioner
Family Nurse Practitioners (FNPs) are trained to work with both adults and children within the context of afamily practice. They work with patients to maintain good health and prevent problems over the long-term.Depending on the state, FNPs may work under the supervision of a physician or they may be allowed topractice independently. Many FNPs choose to work with underserved populations. In fact, part of the reasonsome states allow them to practice independently is because of the shortage of physicians, especially inunderserved areas.
Travel Nurse
Travel nurses take on temporary assignments in different locations, either domestically or internationally.They perform many of the tasks that typical RNs do, and they’re usually employed by an agency who helpsfacilities manage their staffing. Travel nursing isn’t for everyone, but if you don’t have many commitmentsand want to see more of the country (or the world), travel nursing can be a great way to combine work andmoving around.
Nurse Care Manager
Nurse Case Managers research, plan and schedule long-term patient care plans, usually with the ultimate goalof prevention (or at least keeping patients out of the hospital). All nurses are patient advocates, butNurse Case Managers play this role to the fullest, acting as a liaison between the patient and their family,the hospital and facility and sometimes the insurance company as well. Nurse Case Managers may choose tospecialize in certain populations or diseases.
Intensive Care Unit Registered Nurse
Intensive Care Unit Registered Nurses work in the intensive care units (ICUs) of hospitals, caring forpatients with serious injuries or illnesses. ICU nurses may treat patients of all ages and conditions, orchoose to work in specialty hospitals or units (i.e., the pediatric ICU). Because of the complexity andseverity of the cases, most facilities require additional training before nurses can work in the ICU.
Neonatal Intensive Care Registered Nurse
Even more specific than an Intensive Care Unit Registered Nurse is the Neonatal Intensive Care RegisteredNurse. These nurses work with infants who are premature or critically ill and thus kept in the neonatalintensive care unit (NICU). They monitor the babies and their life-saving technology and comfort them whenthey can.
Emergency Room Registered Nurse
Nurses who excel at staying calm and mastering chaos often thrive in the emergency room (ER), where you neverknow what case might walk through the door. ER nurses help patients experiencing serious illnesses andinjuries, many of them acute. Since no two shifts are ever the same, ER nurses must be adept at stabilizingpatients and treating a variety of conditions.
Operating Room Nurse
Sometimes called perioperative nurses, Operating Room (OR) nurses care for patients before, during and aftersurgery. They also serve as a bridge between the surgical team and patients and their families. OR nurseswork with patients and their families to make sure they have everything they need to ensure a fast recovery.
Post-Anesthesia Care Unit Registered Nurse
Post-Anesthesia Care Unit (PACU) Nurses focus specifically on helping patients recover from anesthesiapost-procedure. Also referred to as peri-anesthesia nurses, they are trained to handle patients who wake upconfused or in pain or otherwise react adversely to the anesthesia. PACU nurses comfort patients as theywake up and offer tips for recovery.
Medical-Surgical Registered Nurse
The largest nursingspecialty in the United States, Med-Surg Nurses treat adult patients with a wide range of injuriesand illnesses. While this was originally considered an entry-level position for nurses looking for training,over time, medical-surgical has become its own specialization since it requires nurses to be well-educatedon so many diseases and injuries.
Oncology Registered Nurse
Oncology nurses care for patients who have cancer or who are at risk for developing it. They monitor thepatient’s condition and administer treatments such as chemotherapy. Nurses support the patient and theirloved ones through the difficult diagnosis and treatment process. Oncology is a challenging but rewardingspecialty, given the long-term nature of cancer and its treatment.
Dialysis Registered Nurse
Also called nephrology nurses, dialysis RNs administer dialysis treatment to patients with kidney disease orother conditions. They can work out of a variety of facilities, including hospitals, dialysis clinics,patients’ homes and transplant units. In addition to performing the dialysis treatments themselves,nephrology nurses also implement other treatment plans.
Home Care Registered Nurse
As the name indicates, Home Care Nurses work out of patients’ residences instead of hospitals. They oftenwork with elderly adults or young children or people with developmental or mobility issues. These nurses pack up their nursing bags tovisit patients in their homes as well as other residences such as senior living centers. Those looking towork with patients outside of a traditional hospital setting may be drawn to home care RN positions.
To recap, the nursing hierarchy from bottom to top is: nursing aids, LPNs, Staff Nurses, Charge Nurses,Nursing Managers, Directors of Nursing and finally the Chief Nursing Officer. Nurses may go by manydifferent titles depending on their specialty (or lack thereof). Refer back to this list whenever you need aquick refresher on the many nursing titles and rankings out there.
