Nursing, like other professions, has its hierarchies. Unlike the military or a similar field, however, nursing hierarchies are fluid and not well-defined. When you’re trying to determine the highest position in nursing, it’s important to look at several factors. Nurses differ in terms of educational background, income, status in the clinical nursing world and status in the nonclinical nursing world.
All registered nurses graduate from one of three types of nursing programs. A nurse can earn an associate degree, a nursing diploma or a bachelor's degree. In terms of status, the bachelor's degree is more likely to be considered preparation for a professional nursing career, according to the American Nurses Association, and is the first step toward postgraduate education. With a bachelor's degree, a nurse is eligible to enter a master’s degree nursing program. The highest educational attainment for a registered nurse, however, is the doctorate in nursing.
Nurses earn different levels of income according to factors such as education, specialty, geographic location and experience. The average annual salary for a registered nurse in 2012 was $67,930, according to the U.S. Bureau of Labor Statistics. Nurses in different specialties earned more. Nurse educators earned $70,000 to $90,000 in 2013, according to Explore Health Careers, while nurse researchers earned $90,000 to $100,000. Certified nurse anesthetists, however, earned $154,390 in 2012, according to the BLS.
Each state governs nursing practice and determines what registered nurses are allowed to do in a particular state. These responsibilities, called the scope of practice, vary from direct nursing care at the bedside to advanced practice nursing. Advanced practice nurses include certified nurse midwives, clinical nurse specialists, nurse practitioners and certified registered nurse anesthetists, all of whom have a scope of practice that includes many physician responsibilities, such as prescribing medications. Registered nurses might work under the direction of an advanced practice nurse, many of whom can practice independently in some states.
Administration and Other Areas
In nonclinical nursing areas, there is no clear overall hierarchy. Positions in these areas include nursing education, nursing research, nursing administration and positions such as nurse entrepreneurship. Many of the nurses who work in these areas have advanced degrees and may earn salaries in the range of $100,000 or more. Some of these nurses, such as nurse administrators, may supervise the nursing or clinical operations in a large hospital or multi-hospital system. Others, such as nursing researchers, might work with a small team or a few support staff. Nurse entrepreneurs could be small-business owners or run large companies.