In the nursing chain of command, who is typically at the top?

• A. Administrator
• B. CNA/MA
• C. Charge nurse
• D. Staff nurse

Answer: (A)

Understanding how the nursing chain of command works helps you see who holds the ultimate authority in a facility. In a hospital, the top of that hierarchy is the Administrator, who heads the overall operations, policy-making, budgeting, and compliance for the facility. Nursing leaders—such as the charge nurse on a shift, the nurse manager, and higher nursing leadership—work under this administration and report up through the administrative structure. Frontline staff like CNAs/medical assistants provide direct patient care and report to nurse leaders or supervisors, but they do not sit at the top of the chain. The staff nurse also provides patient care and operates within the nursing leadership framework, not at the highest level. So, the person typically at the top of the nursing chain of command is the Administrator.