Types of Nurses: All Nursing Titles and Rankings You Need to Know
LPN, RN, APRN, DONS, CNO. The nursing world is an alphabet soup of acronyms and titles. Figuring out what the titles mean, much less how they all relate to one another in the hierarchy, can be difficult. To help demystify nursing titles and ranks, we’ve rounded up 25 of the most common nursing roles and defined what each of them means below.
Nursing Aid and Nursing Assistant
While they may wear nursing scrubs and have the word “nursing” in their titles, nursing aids aren’t actually nurses. Nursing aids and nursing assistants assist patients with daily activities such as eating, bathing and dressing. They may also engage in some medical activities, such as measuring vital signs and administering medication, depending on the state they work in and their education. Nursing aids may also receive training and get a license to become a certified 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 are actually the same position. California and Texas use the title Licensed Vocational Nurse, while the rest of the United States use Licensed Practical Nurse. These nurses communicate the care plan to patients and their families and handle basic medical 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 and administrative tasks in many different settings. They assist physicians, record medical history, monitor patient symptoms, administer medicine, perform diagnostic tasks and much more. They may oversee other medical professions such as CNAs and LPNs. RNs can take on lots of different specialized roles, and we’ll get 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 the name). Staff Nurses may work in many different units and execute many different tasks, and some facilities give nurses the option of whether they’d like to practice as a generalist or a specialist. Some Staff Nurses may also decide to pursue further training and become certified in one particular specialty, taking on a new title (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 Staff Nurse. 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. Most Charge Nurses are RNs, though in a few select cases they may be LPNs instead. They report to the Nurse Manager or Supervisor.
Nurse Manager or Nurse Supervisor
While Charge Nurses manage one shift of nurses, Nurse Supervisors manage an entire unit (and sometimes more than one), assuming 24/7 responsibility for their operation and patient care. They have the power to hire and fire employees and oversee scheduling and operating budget duties. They also coordinate with physicians and other non-nurses on patient care. A master’s degree is recommended though not always required. Nurse Managers 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 and report 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 report directly to the top leader in the organization, the Chief Executive Officer (CEO). The CNO is responsible for making strategic administrative decisions and for guiding the direction of the organization. CNOs have many 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 to specialists and ordering or evaluating test results. Like RNs, APRNs may manage a team of people and/or work in specialized settings. There are four main types of APRNs—nurse anesthetists, nurse midwives, certified nurse practitioners and clinical nurse specialists—and some MSN degree programs even offer concentrations in each of these paths.
Certified registered nurse anesthetists (CRNAs) work to ensure the safe and effective administration of anesthesia during a variety of medical procedures. They may work in hospitals, dental practices and other environments that require the use of anesthesia. Depending on the position, they may also have duties outside of the surgery itself, such as overseeing patient recovery or assisting with pain management.
According to the American Association for Nurse Practitioners, Certified Nurse Practitioners (CNPs) are “clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management.” CNPs may diagnose and treat conditions, prescribe medications, order and interpret diagnostic tests and much more. They may work with many diverse populations and also focus on one particular specialty (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 many forms, including population (pediatrics, geriatrics, women’s health), setting (critical care, emergency room), disease or medical subspecialty (diabetes, oncology), type of care (psychiatric, rehabilitation) and type of health problem (pain, wounds, stress). Not all MSN programs offer all certifications, so an aspirational CNS student should choose a program carefully.
Certified nurse midwives (CNMs) combine their RN with specialized training in pregnancy, labor and postpartum concerns. 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 and educate new parents on caring for infants. While CNMs do provide clinical and medical care, they may call in an 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 a family 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 to practice independently. Many FNPs choose to work with underserved populations. In fact, part of the reason some states allow them to practice independently is because of the shortage of physicians, especially in underserved areas.
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 helps facilities manage their staffing. Travel nursing isn’t for everyone, but if you don’t have many commitments and want to see more of the country (or the world), travel nursing can be a great way to combine work and moving around.
Nurse Care Manager
Nurse Case Managers research, plan and schedule long-term patient care plans, usually with the ultimate goal of prevention (or at least keeping patients out of the hospital). All nurses are patient advocates, but Nurse 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 to specialize 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 for patients with serious injuries or illnesses. ICU nurses may treat patients of all ages and conditions, or choose to work in specialty hospitals or units (i.e., the pediatric ICU). Because of the complexity and severity 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 Registered Nurse. These nurses work with infants who are premature or critically ill and thus kept in the neonatal intensive care unit (NICU). They monitor the babies and their life-saving technology and comfort them when they can.
Emergency Room Registered Nurse
Nurses who excel at staying calm and mastering chaos often thrive in the emergency room (ER), where you never know what case might walk through the door. ER nurses help patients experiencing serious illnesses and injuries, many of them acute. Since no two shifts are ever the same, ER nurses must be adept at stabilizing patients and treating a variety of conditions.
Operating Room Nurse
Sometimes called perioperative nurses, Operating Room (OR) nurses care for patients before, during and after surgery. They also serve as a bridge between the surgical team and patients and their families. OR nurses work 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 anesthesia post-procedure. Also referred to as peri-anesthesia nurses, they are trained to handle patients who wake up confused or in pain or otherwise react adversely to the anesthesia. PACU nurses comfort patients as they wake up and offer tips for recovery.
Medical-Surgical Registered Nurse
The largest nursing specialty in the United States, Med-Surg Nurses treat adult patients with a wide range of injuries and 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-educated on 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 the patient’s condition and administer treatments such as chemotherapy. Nurses support the patient and their loved ones through the difficult diagnosis and treatment process. Oncology is a challenging but rewarding specialty, 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 or other 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 often work with elderly adults or young children or people with developmental or mobility issues. These nurses pack up their nursing bags to visit patients in their homes as well as other residences such as senior living centers. Those looking to work 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 many different titles depending on their specialty (or lack thereof). Refer back to this list whenever you need a quick refresher on the many nursing titles and rankings out there.