A colleague friend and I were talking the other day about the unspoken but clearly defined hierarchy in nursing, which is arranged according to specialty. This is quite funny as theoretically we nurses are all equal, but in reality the opposite is true. My friend believes status depends on some equation related on the knowledge we need in order to competently fulfill our positions plus actual autonomy plus perceived crustiness.* My own, simpler theory is that status is intimately linked to the number of tubes and wires we can fiddle with at once: the more IVs running and monitors beeping, the higher we are. In short, we’re talking patient acuity.
Here’s my take on it. Your mileage may vary, though I think everyone might agree that the poor nursing home nurses, regardless of individual merit, are near the bottom.
1. At the top of the food chain, the hyper-specialized, like NICU nurses, or neuro ICU. And the NPs and clinical nurse specialists.
2. Then the generalist ICU nurses and the Emergency nurses.
3. Then the PACU and OR nurses and the paeds nurses. Home Care case managers would be somewhere near here, mostly because they get to wear street clothes and keep banker’s hours.
4. L & D nurses, nursery nurses, dialysis nurses.
5. Then the day surgery nurses and the medical outpatient nurses.
7. Then the surgery ward nurses.
8. The medical ward nurses.
9. The psych nurses.
10. The home care nurses.
11. And at the bottom of the food chain, the nursing home nurses and “private duty” nurses.
*Emerg nurses score pretty high on the perceived crustiness scale, when actually we are all gentle, misunderstood souls yearning to be loved.