Hi everyone and welcome back. So imagine as a new nurse, you're on a unit and you encounter
a situation where you need help and you don't really know where to go or you're having a situation
with a colleague or maybe even with a physician and you're not sure how to resolve it. One tool that
you can use is the Nursing Chain of Command. The Nursing Chain of Command is the line of authority
and responsibility along which orders are passed within the nursing department, the hospital,
and between various departments. Now, every organization is just a little bit different but this
is a great representation of what the average common line of authority might be. If you start
on the nursing unit with the staff members there, if you start with the unlicensed assistive
personnel, the person they would go to next might be the nurse. The nurse then might go to
the charge nurse. The charge nurse then goes to the nurse manager. The nurse manager would go to a
role very similar to what might be called a director of nursing. And finally, the director of
nursing would go to the highest nursing position within the organization, the chief nursing officer.
It's also important to remember that the physicians have their own line of authority and it
escalates all the way to a similar role called the chief medical officer. So let's talk about some
concerning situations which might be a great example of why someone might start the Nursing
Chain of Command. For example, the provide has not responded to a deteriorating patient condition
or the nurse questions or disagrees with the provider's orders, plan, or care. The nurse believes
that the provider's response to a situation doesn't fully address the patient issues. The
nurse's assessment actually differs from the provider's assessment or the nurse witnesses
unprofessional behavior which might jeopardize patient care. A good example of this might be
where you suspect that a provider or another team member could be impaired. Also, a patient's
end-of-life wishes differ from the opinions of the family and/or the provider. The nurse believes
that a patient's discharge is too early. So, what can you do? First, don't remain silent if you are
worried. Review your organization's chain of command policy and procedure very carefully.
Once you've reviewed your organization's chain of command policy, that gives you the opportunity to
know who you should contact and what information will be needed, and very important document
thoroughly. This helps protect you in the case of litigation. So here is a great example. John is a
new nurse on a pediatric unit. A newly admitted child is having increasingly difficulty breathing.
John has placed several calls to the pediatrician but has not received a return call. The charge
nurse for the day has left the unit for lunch and is not responding to John's attempt to reach
her either. Who is the next person in the chain of command that John might call? Would it be
the unlicensed assistive personnel, the nurse manager, a charge nurse, director of nursing,
chief nursing officer, or another nurse? If you selected the nurse manager, that is correct.
Typically, the charge nurse answers to the nurse manager and in this situation the charge
nurse happen to be off the unit for lunch and he could not get in contact with her so the next
best option is to go to the next step in the chain of command which is the nurse manager.
So remember, use the chain of command to advocate for your patients and to protect yourself
from liability. So what do we learn today? Nursing's chain of command may vary slightly from
institution to institution, but the organizational chart of the chain for nursing staff often starts
with the charge nurse and then continues to ascend with the chief nursing officer being the
last person in the nursing hierarchy. The nursing chain also includes the physician and he or she
has a chain of command as well. Often the chief nursing officer and the chief medical officer are
needed to resolve a patient care issue that involves both nursing and physicians. And finally,
the chain of command is extremely important when providing nursing care especially if patient
care is compromised in some way. I hope you've enjoyed this video on the Nursing Chain of Command.
Thank you so much for watching.