The Healthcare Team

     It’s important to know who’s who on the healthcare team anytime you’re interacting with healthcare professionals. Understanding the chain of authority and who handles which type of problems can save you a lot of time and wasted energy. If you attempt to move forward on an issue without this knowledge, you will likely fail to follow the appropriate “rules of healthcare etiquette,” you lose credibility and possible access.

     Here’s a basic lesson on who’s who among healthcare team members. This list won’t be all-inclusive. Healthcare facilities tend to make up titles to fit their needs, but this list will give you a general idea of the primary groups. To find out more about Healthcare professions and regulations, go to the Virginia Board of Health Professionals for additional Information.

Chief of medical staff

Directs Healthcare Team


 Oversee all other members of the medical team in the plan of care for the patient. Makes all the final decisions regarding the patient’s care that are not the patient’s decisions. 

     The healthcare team members referred to as doctors include a larger group than just medical doctors. Medical Doctors, doctors of psychiatry, surgeons, doctors of osteopathy, dentists, etc., are licensed by the state they practice.  They assess your symptoms, order tests to figure out what’s behind those symptoms, hear your story to get clues to what could be causing the problems, and figure out the issues based on that information.  They then make an educated guess regarding the diagnosis (which is why they “practice” medicine) and prescribe a treatment plan for you to include medications and therapies (treatments performed by other health disciplines).

     Before a doctor can practice medicine independently, he/she must go through many years of practicing under the supervision of other doctors with more knowledge and skill in a training hospital (i.e., an academic medical facility). If you are a patient at an academic medical hospital, you will encounter the following additional “doctors.”  


Rounds –

The term used to describe the primarily doctor-types who parade through the halls going from patient to patient talking about them in a “lecture” type of presentation. The circulation process may be completed by one physician checking on just his own patients or by a group of physicians talking together. During rounds, the doctors found out what changed regarding the patient’s condition overnight — new lab results, pain tolerance, nursing concerns, patient complaints, etc.  This information is used to determine what changes to make to patient orders.  Rounds usually occur before doctor’s offices open in the morning.

Residents are considered entry level positions on the healthcare team for the medical staff chain of command.
Residents are considered entry level positions on the healthcare team for the medical staff chain of command.

Physician Extenders

Healthcare professionals with medical training work with physicians and have some of the same training types as physicians concerning identifying conditions, determining a diagnosis, and developing a treatment plan, but their training is not as extensive. Therefore, they must work under the authority and license of a physician.

Physician’s Assistant

A Physician’s Assistant is a graduate from a PA school and licensed to practice under a physician’s supervision. A PA can write prescriptions and administer treatments just like a Nurse Practitioner but cannot do the same things a nurse has the authority to do. The Board of Medicine licenses them.

Nurse Practitioner (NP), Nurse Midwife (NM) (NP’s live in both worlds – nursing and medical staff)

Nurse Practitioner (NP), Nurse Midwife (NM) – Advanced practice registered nurses licensed to practice under a physician’s supervision and authorized to write prescriptions and administer treatments like physicians.

The Healthcare Team Medical Staff Training Hierarchy

The pathway to becoming a doctor: 

Medical Students graduate to become interns who finish their first year of residency and become second-year residents.  They promote 3rd and 4th-year residents before finishing graduate training and becoming eligible to take board certification to practice independently as doctors. If they want to be specialists, they go on to be fellows for a while–how long depends on the specialty. 

Medical Student

Medical Students are not doctors at all. They are in undergraduate training, very green, and just learning about medicine. They will ask you LOTS of questions, and later the attending physician grills the student on what they learned from you when they come back with a lot of other people to see you when they make rounds as a group.


An Intern is a first-year medical resident. An intern is a recent graduate from college and is in the first year of graduate medical school. They work directly under the supervision of a faculty physician to learn to be a doctor. Though they can do the same things as a doctor, all work must be approved by the attending physician before implementation.


A Resident is in graduate medical education (years 2-4). Each year, they gain more experience and independence under the watchful eye of an attending in the hospital. By their fourth year, they practice independently and ready to take their Boards to become “real” doctors. Most have been practicing in a specialized area of training.


Some specialties require an additional 1-2 years of focused practice before they can begin practice independently in that specialty.  The additional years of specialty training are called “fellowships,” and the residents are called “Fellows” while participating.

Chief Nursing Officer

Directs Nursing Healthcare Team

The Nursing Staff is a critical member of the Healthcare team. They provide 24-hour care for the patient and are the physician’s eyes and ears. Without vigilant and perceptive insights, physicians would not have the information they need to make the necessary decisions to treat patients. 

Clinical Administrator

Clinical Administrator -May be called a clinical supervisor in some areas. Oversees larger hospital areas after hours to ensure everything is running well and problem solves after leadership goes home.

Nursing Director


Nursing Director-The Nurse Manager’s supervisor

Nurse Manager

Call the Nurse Manager if you have any issues you can’t resolve with nursing staff while your family member is a patient on a nursing unit. If you cannot resolve a problem with a staff member, contact the Nurse Manager directly with any complaints you may have. If it’s after hours (that’s usually after 5 pm or on weekends) and you have a problem, you want to ask for the Clinical Coordinator on the floor, or you want the Clinical Administrator for the hospital.

Nurse Practitioner (NP), Nurse Midwife (NM)

Nurse Practitioner (NP), Nurse Midwife (NM) – Advanced practice registered nurses licensed to practice under a physician’s supervision and authorized to write prescriptions and administer treatments like a physician.

Registered Nurses

Registered Nurses coordinate nursing care, teach patients, assess patient needs, administer treatments and medications. They perform many roles within the hospital setting.  Some have titles other than registered nurses when performing administrative roles in non-clinical jobs. RNs control everything on the nursing floors and within the hospital’s nursing units. Nurses are a critical part of everything that happens in the hospital. Without them, nothing would happen, and patients would not heal.  They see first hand what is happening and take action to make necessary corrections.  They are the true heroes of patient care. 

Clinical Coordinator

The RN shift leader is usually called the Clinical Coordinator and supervisors the other staff on the floor. If you have a problem with whoever is giving you care, ask for this person to help you get a resolution.

Licensed Practical Nurse (LPN)

Licensed Practical Nurse (LPN) – Licensed technical nurses brings patients into rooms, do vital signs, assist doctors with procedures, helps with room setups and takedowns, may also do what nurses and care partners do. The difference between LPN and RN is in the amount of formal education they have acquired to practice. Most RNs have 2-4 years of intensive clinical education, which helps them be better prepared to assess symptoms, determine a nursing diagnosis, create and implement a nursing treatment plan.

Care Partners

Care Partners (formerly called Nursing Assistants) – Support RN and LPNs in the care and treatment of patients with daily care needs, including hygiene, nutrition, mobility, vital signs, transportation, grooming, toileting, and much more. If you need anything for your comfort, ask a care partner to get it for you. They are your go-to person.”

Student Nurses

Student Nurses – Students participating in clinical training from area nursing programs. Could be from a variety of nursing programs including community colleges, diploma programs, technical training programs, advanced degree programs, or degree seeking programs. 

Other Healthcare Team Members who Provide Services to Patients

Billing Office

When you get your hospital bill, make sure that they have your correct insurance information. If you are paying something, they won’t take you to court; however, they will sue you if you disregard their notices. Hospitals are a business. They need money to run. My recommendation is to contact the billing office if you have a large bill you need to pay and set up a payment plan right away. Set up what you can afford and make those payments on time, perhaps using automatic payments through your bank, so you don’t have to think about it. It’s the safest way to make sure they always get paid.

Registration or Admissions Clerk

Registration or Admissions Clerk – Registers you in each visit, collects co-payments, checks ID, goes over pre-admission paperwork, collects advanced directives, goes over forms for completeness, answers questions, helps you obtain access to others you might need to see. This person, however, does not have a lot of power. If you don’t like something, they tell you, don’t shoot the messenger. They are just passing along a message. It’s not personal. They have little flexibility.  

Discharge Clerk

Discharge Clerk – Schedules appointments, provides copies of discharge paperwork, much like the registration person, has little flexibility. They can be accommodating but are at the mercy of the person on the other end of their calling. They can’t give you what you want in most cases. You need to ask for their supervisor or the Billing Office if the issue is your bill.

Care Coordinator

Care Coordinator – This is the person who works with you to get ready to go home. They coordinate with you to find home health services such as oxygen for home use, a home health agency, transportation home, or whatever you will need to get out of the hospital and home. It would help if you had a case manager assigned to you shortly after admission.  Some hospitals may use a Social Worker instead of a Care Coordinator.  Both can do the same type of coordination.

Chaplain Services

 Religious services for all faiths available regardless of preference. Let the patient relations office know of a desire for religious connection, and they will contact the chaplain’s office to set up a visit. Healthcare facilities recognize the importance of faith in their patients’ lives. Even if they do not have the service available on-site, they have connections with people of faith who can come in from most faith groups to meet with patients for support.  

Physical Therapist

Physical Therapist – Helps persons perform exercises, stretches, warmups, and use equipment to strengthen and restore muscle in hopes of returning individuals to full function.

Respiratory Therapist

Respiratory Therapist – provides breathing treatments, sets up oxygen, draws blood gases, helps with ventilators, helps people cough better, and assists with many other things related to breathing and lung care. Their state of residence registers them. 

Occupational Therapist

Occupational Therapist – Helps people perform exercises and learn to use muscles in such a way as to regain the capacity to perform daily life activities.

Speech Therapist

Evaluates an individual’s capacity to speak clearly, articulate correctly, say what they intend to say, swallow without choking, learn aspiration prevention tips, etc.