Managing hospital hierarchy — not ‘just a student nurse’

Abstract

Hierarchy is defined as a system within a society or organisation where people are organised into different levels of importance, from highest to lowest. In this article, hierarchy refers to the power structure in the health system with doctors at the top, followed by RNs, and then student nurses and health-care assistants (HCAs). Good relationships across hierarchies in the hospital setting can help the student nurse develop skills and knowledge. If there is a sense of trust in the relationship, then students feel safe asking questions and practising their nursing skills. Good leadership An essential aspect of the hierarchy in health care is the quality of leadership on the part of those with more authority and experience. Effective management and leadership by health-care professionals enhances the quality of patient care. Good leadership creates daily organisation and structure in the health-care setting and ensures that health-care staff know their responsibilities, and those of their colleagues. Struggling with self-advocacy However, the hospital hierarchy may lead to students struggling with self-advocacy. Research has shown that a common adverse effect of seniority-based hierarchy is a decrease in junior nurses' willingness to speak up. when student nurses come into placements, they aim to apply the clinical skills they have learnt in their education programme.