Understanding Who’s Who in the hospital can be confusing, but each team follows a basic model. Every team in the hospital will have its own hierarchy within it, which is where it can get confusing because it seems like so many people are involved.
Doctors
Hospitals may have different members on the team of doctors, but each team will follow a basic hierarchy with an Attending at the top, flowing down to Residents and sometimes Medical Students. Some teams will also have Nurse Practitioners or Physician Assistants. The Residents typically have the most face to face time with the patient and report back to the rest of the team.
The ICU will follow this pattern of hierarchy as will each team of specialists that is on your child’s team, so your child might have several Residents and Attendings who visit them daily. The ICU team typically serves as the main team caring for your child. They will round on your child daily, taking into consideration input from the specialist teams. They are a good team to start with for any questions or concerns.
Doctor Hierarchy
Most training and experience
Attending
↓
Fellow
↓
Senior Resident
↓
Resident
↓
Intern/Medical Student
Least training and experience
Nursing
There are also several different levels and types of nursing in the hospital. Nurses have the most face to face time with your child and carry out much of your child’s care.
Bedside Nurse A bedside nurse monitors your child throughout the day and provides your child’s care including administering medication and other interventions. Everything they do in your child’s care requires a doctor’s order. They may be assigned to one or more patients at a time. The nurse has the most face to face time with your child and are typically your point person for anything you or your child needs. They are an important asset to your child’s team and can help communicate your questions and concerns with your child’s doctors, as well as advocate for your child’s needs. The nurse can also help you understand medical jargon or other information about your child’s condition or care. They may train you or arrange for training of medical interventions that your child will be receiving at home once discharged.
Certified Nursing Assistant (CNA)/Nurse Assistant/Tech/Aide These roles are not registered nurses, but they are invaluable to your child’s care. They support the nursing staff by completing various tasks such as basic care for patients including taking vitals, changing and bathing patients, repositioning patients, changing linens, and much more. They might also help stock supplies or get needed items for patients and caregivers.
Charge Nurse A charge nurse is responsible for overseeing a particular floor or unit during their shift. Any concerns that need to be escalated, or anything the bedside nurse is unsure of will typically be handled by the charge nurse. Charge nurses can change from day to day. A nurse might be assigned as a bedside nurse one shift and a charge nurse another shift.
Nurse Manager The nurse manager is responsible for overseeing and supervising nursing staff as well as other duties involved with operating a hospital unit.
Common Specialty Teams in the Hospital and What They Treat/Perform
Anesthesiology provides anesthesia to patients undergoing procedures
Cardiology treats conditions related to the heart
Endocrinology treats conditions relating to the endocrine system/hormones
ENT treats conditions relating to the ear, nose, and throat
Gastroenterology treats conditions related to the gastrointestinal system
Genetics looks for genetic or hereditary connections in various conditions
Hematology treats conditions relating to blood
Interventional Radiology treat various conditions using imaging as guidance to provide minimally invasive technologies
Neonatology treats babies in the NICU
Neurology treats conditions related to the brain
Neurosurgery performs surgeries related to the brain
Oncology treats cancer
Ophthalmology treats the eyes
Orthopedist treat bones, muscles, joints
Orthopedic Surgeon – performs surgeries related to bones, muscles, joints
Otology treats conditions related to the ear
Nephrology treats conditions related to the kidneys
Physiatry also known as Physical Medicine and Rehab (PM&R); develops treatment plans including pain management and rehab for conditions relating to the brain
Palliative Care treats patients with serious, life threatening conditions with a focus on quality of life including pain management
Pulmonology treats conditions related to the lungs and respiratory system
Psychiatry treats conditions related to mental, emotional, and behavioral conditions
Other Important people in the hospital
Case Manager Case managers help coordinate care for the patient in the hospital and with their transition to home. They may help set up care for at home including Durable Medical Equipment (DME) companies, therapies, letters for insurance, pharmacy set up, etc.
Chaplain The chaplain is there to help guide and comfort you through any spiritual, religious, or emotional needs, regardless of your beliefs. The chaplain can pray with you or for you, offer support during difficult moments, and offer blessings or other religious rituals. They may also give you information on the hospital chapel, where you can go to pray or to have a quiet, peaceful moment.
Child Life Specialist Child Life Specialists are certified specialists who help children and their families overcome and cope with the stress and understanding of their illness. They use a variety of techniques to educate and to reduce stress, anxiety, fear, and pain. They relate to children using developmentally appropriate language and activities. They provide services to children individually and also plan for more wide-scale events such as games, toy drives, etc.
Dietician The dietician will make sure your child is receiving adequate nutrition while in the hospital and may help develop a nutrition plan for home. They will monitor your child’s lab reports and suggest changes as needed to the doctors.
Nurse Practitioner A NP is a nurse who has gone through advanced medical training in a specialized area.
Pharmacist Your child’s team might include a pharmacist who will offer insight on medications the doctors prescribe and appropriate dosing. They are knowledgeable about medication interactions, side effects, signs of withdrawal, and how to safely wean or increase a dose.
Physician’s Assistant PAs are medical professionals who received specialized medical training and work alongside a Physician.
Respiratory Therapists Respiratory Therapists are trained to support patients who have difficulty breathing or have other respiratory needs. They offer input to doctors and carry out orders related to respiratory needs. They typically handle all machines and interventions that support a patient’s breathing such as ventilators, trachs, intubation tubes, and other breathing treatments and interventions.
Social Worker Social workers work with families to help them understand and cope with an illness and/or treatment plan. They sometimes provide counseling services or support groups. They may also help families connect with other resources in their community. Social workers encourage all hospital team members to work together and can sometimes be utilized as a point person for families who have children with many specialists involved.
Housekeeping This team is typically responsible for cleaning the room and bathroom, taking laundry, emptying the trash, and sanitizing surfaces. Sometimes they clear parts of the room on a rotating schedule. A clutter free room helps them clean more efficiently.
Imaging Technicians Imaging technicians use various technologies to take images for the doctor to review. They are not radiologists or doctors and cannot read or offer information about any test or images they perform on your child.
Transport They take your child to and from procedures, tests, room changes, etc.
Volunteers Some hospitals offer volunteers who will offer services such as sitting with your child or holding them while you take a break from the room, bringing coffee or tea, or bringing activities or toys for your child.
