Question

as an APN what is your line of authority according to the table of organization for the nursing department? agency? academic institution?

Answer 1

Line authority is a direct supervisory authority from supervisor to subordinates.

Chain of Command – unbroken line of reporting relationships that extends through the entire organization. The line defines the chain of command and the formal decision making structure.

Unity of Command – within the chin states that, each person in the organization should take orders and reports only to one person.

Span of Control – refers to the number of employees that should be placed under the direction of one leader-manager.


A nurse who uses the chain of command correctly protects the nurse, the patient, and ultimately, the hospital. The following steps will assure that you, the nurse, are exercising all of her patient advocacy muscles:First, call on your head nurse or charge nurse, who can use their position to accelerate a response or get the necessary authorization. Keep in mind that different hospitals have slight variances on the nursing chain of command.

Second, should this fail, or if for some reason there is no head nurse or charge nurse available, look to the Unit or Department Director of Nursing (DON). Typically DONs hold a 9 to 5 position, yet they can be asked to intervene at any time should the need arise.

Third, if your scenario involves a physician and a patient is in jeopardy, know and use your chain of command. Remember that the Chief Nursing Officer (CNO) is your top advocate. In the organizational structure, the CNO is usually directly beneath the hospital administrator, and therefore, has a great deal of authority to assist in finding a positive solution to the problem. If the CNO is not responsive, then the next step is to contact the medical director or the hospital administrator or CEO, depending on the issue.

Fourth, always remember to document. If you are having trouble getting the appropriate authorization to administer medication, or perform a procedure, be sure to notate this in the chart. If necessary and appropriate, you can also complete an incident report as defined by your hospital’s policies and procedures.