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Recognizing Hierarchy in Healthcare

Most healthcare organizations are based on hierarchical systems. That means that each person is ranked within the healthcare organization based on their own particular skill sets or abilities. Even within professions, such as nursing, a hierarchy exists. This hierarchy is determined by the positions themselves and also by levels of education and experience. State licensing requirements also establish assignments based on abilities, training and expertise and scope of practice.

For example, the nursing profession has its own hierarchy. This is based on level of training and experience. Certified nursing assistants (CNAs)  report to nurses.The nurse may be a licensed practical nurse (LPN) or a registered nurse (RN). The LPN has approximately 18 months training, whereas an RN has to two to four years of training. An LPN often reports directly to an RN. Within the RN's, there is also a hierarchy.  Registered nurses may either hold an Associates Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). Individuals with an ADN may report to a BSN. According to the Robert Wood Johnson foundation, better outcomes in nursing were directly correlated with higher degrees. Nurses may also pursue a Master of Science in Nursing, which is a graduate program that prepares nurses for specialized areas in the field of nursing. These areas may include nursing administration, nurse practitioner, health education specialist, or nurse midwife. Doctoral programs in nursing also exist, such as the Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) in Nursing. Each level of nursing education enhances the nurse's level of skills and expertise and is recognized within the nursing profession.
Photo by Olivier Collet on Unsplash

Many nurses, with the exception of those at the doctoral level and some at the ARNP level, work under the supervision of physicians. Physicians also have their own hierarchy based on education and experience.

Unfortunately, not all levels of education are viewed the same within a healthcare organization and are not valued as much as they should be.  Many times, someone will hear "nurses are as smart as doctors." Yes, that is true. There are nurses who could be doctors but simply are not.  However, nurses are not doctors because of their scope of practice and level of education and expertise. The same issues arises with nurses and those with other advanced degrees, such as an MBA, MA, MS, MHA, MPH, or MSN. Nurses holding an ADN may say they have the same level of training and experience as those individuals. However, the level of training is not equivalent. An ADN has two years of training.  Although those individuals holding degrees outside of nursing may or may not have clinical training, they are, nevertheless, experts in their fields. To diminish their education and training is a disservice to the healthcare professions in which they specialize and a disservice to their healthcare organizations.

Since nursing retention has become a larger issue within healthcare, it has become increasingly important to place nurses in different occupations within the healthcare organization.  However, an ADN should not occupy a position that requires the same level of skill and expertise as an MSN, MPH, MHA or MBA, just as it would not be appropriate for a CNA to claim to have the skills of an ADN or BSN. Further education and training should be promoted for the advancement of nursing into traditionally non-nursing and non-clinical positions. Moreover, recognizing the talents and skills of non-clinical staff is essential to ensure qualified personnel fill the appropriate positions and best meet the needs of the organization as a whole.