Student Nursing Hierarchy Explained

Practice Nurse, Debbie, gives a detailed account of her experience of the Nursing Hierarchy or as she terms it ‘Nursing Structure’, advising on where you can fit in as a Student Nurse.

Hello, my name is Debbie and I'm a Practice Nurse in London.

Today I'm going to be discussing how student Nurses can overcome the hierarchical system in Nursing.

Now, as a disclaimer, this is not to bash the system or to put down anybody because people work really hard to get to the position that they get to.

But just to help student Nurses who feel that they're not too sure where they fit in, into the hierarchy.

Hierarchy Is Another Word For Structure

Before I go onto the student Nursing side, I'm just going to explain how the hierarchy system works mainly in the hospital setting and pretty much in Nursing in general.

And I know hierarchy can sometimes seem like a bad word but it's just a word for structure of the way the Nursing system works.

Understanding the ‘Band’ System

So it really works in Bands, the majority of the time, you start with Healthcare Assistants, which start about Band two, Band three, no qualifications per se, needed, just a passion and a drive for Healthcare and everything else you learn on the job and you can do a Care Certificate.

Band 2 & 3 – Healthcare Assistants

So that is something that you can get out of being a Healthcare Assistant. So that's about Band two, Band three.

Band 4 – Nursing Associate

And then you go to Band four, which is the new role as a Nursing Associate.

So they are there to help the Nursing team and they also go on to getting a qualification to become a Nursing Associate.

Band 5 – Staff Nurse

And then you start Band five as a Staff Nurse.

This is the entry level for Nurses.

You've qualified, you've gone to University or whatever route you've decided to take into Nursing and you are now a Band five Nurse.

Band 6 – Junior Sister

Then there's Band six, which is Junior Sister.

So they are in charge of you. They're almost like Team Managers, Team Leaders who are in charge of the team on the floor.

They generally don't always have patients to look after.

They're making sure that the teams are working effectively together.

Band 7 – Senior Sister

And you have Band sevens who are Senior Sisters.

So this is more of a Managerial Role, so you're less patient focused, more staff focused.

You are making sure there's enough staffing you're making sure things like annual leave, just management in general.

And then within Band seven, of course there are other patient focused roles, such as specialist roles, Diabetes Nurse specialists, Respiratory Nurses, Hematology Nurses and nursing role where you have specialised, those are also Band seven roles, infection control, which within those roles you can then progress and become Band eight.

Band 8 – Matron

In ward setting, for example Band eights will be the Matrons.

So they attend the meetings.

This is serious managerial positions where they oversee not just one ward, they could be overseeing a whole wing of a hospital.

And then after Band eight, you have more of the Director roles, the Nurse Lead, the head of nursing roles, Clinical Mead roles and things like that.

So there's a lot going on.

Where Do Student Nurses Fit In?

And then you have Student Nurses and you almost think, where do I fit into this whole system?

Because you know that you are training so you know you're not a Band two, you're not a Band three, you're not really getting paid for what you do so you don't really fit into the banding system.

And sometimes, at least for me, I felt like I didn't really have a say because I'm not per se employed.

And it can be a bit frustrating because you have for example, Healthcare Assistants who have been in their role for 10, 20 years and they could pretty much do the Nursing role to be honest.

If not, they don't have the qualification that they need to do the nursing role.

And you know, you're in Uni and you're learning but they pretty much know more than you.

Learning To Find Your Place

So it's almost like having to know your place in terms of yes, you are studying to become a Band five and then more but at the same time there are people there who know a bit more than you.

So I think when you're a Student Nurse you learn things like delegation, you learn to understand that no, you're not a Healthcare Assistant.

This is something that I struggled with when I was doing my nursing course, and I wasn't too sure what I was supposed to do.

Was I supposed to work as a Healthcare Assistant?

Was I supposed to work as a Nurse?

Like there was this middle grey ground that I wasn't too sure about.

Do I make the beds or do I give medication?

And as a Student Nurse, that can be very frustrating and very difficult to know your place.

Your Place In The Team

But as you go on in this, you'll realise that it's a whole team effort.

There will be times where you have to make the bed and there'll be times where you're gonna give the medication, it's almost like not seeing, you have to try and make a blurred line in terms of, the hierarchy of, yes, I am band this, I am band that, and see that you are there to learn as a student.

It's there that you become more affirm, that when you know you're supposed to be doing the medication rounds and Healthcare Assistant says, oh, can you do the bed?

It's being able to stand your ground and say that I understand that this needs to be done.

However, my role at the moment is to give medication or to shadow the Nurse.

So things like that, it teaches you to be firm, it teaches you to delegate and it teaches you to remember what your position is as a Student Nurse.

That you're not there to be a Healthcare Assistant, to be a runner, but you are there to learn from the Nurses.

Another thing is that because of the hierarchal system, sometimes you can feel a bit distant from management.

Your Role In Management As A Nurse

And for me, I had to intentionally take those steps and be able to ask for time with management where I can also have a management day. And to understand what it is to be in management as a Nurse.

Because in Uni, although we are taught leadership, once you become a Band five, you're already a leader.

You lead the Nursing Associates, you lead the Healthcare Assistants, and you can even lead a team for example.

But at Band five, you're not the leader of the ward per se.

And so being able to sit down with the Band seven, the Senior Sister or the Junior Sister and able to learn how they allocate the shifts in the day and it trains you to desire leadership.

A lot of Nurses have kudos to them, it's not by force to progress and become a Band seven, but they stay at Band five.

Do You Want A Leadership Role?

And sometimes, from what I've experienced and people who I've spoken to, it's not because they don't want to lead but they don't feel adequate enough.

They didn't feel like they can take that leadership role.

And I think that as a Nurse, anyone can take a leadership role, as long as they desire for it.

But as a student that's remembering that you can be more than a Band five, you can progress to a leadership role, you can be head of nursing, you can attain for those levels.

Getting Involved Will Benefit

And so as a Student Nurse, sometimes you can feel a bit lost like I mentioned before in the midst of everything.

And I think one thing that really helped me was to always be part of the meetings.

Whatever meeting is going on, don't feel like, oh I'm a Student Nurse, so therefore I don't really have a say.

You do have a say, you are part of the workforce.

And so, you're counted in the numbers.

And so, when there are meetings, whether it's the multidisciplinary team meeting, whether it's just a ward meeting, whether it's a meeting to discuss the patients, whatever the case may be, wherever there's a huddle, always try and be involved because then it helps you to even be able to reflect and see where you fit in.

Sometimes I remember being a Student Nurse and I'd be counted in the numbers or the Senior Sister would say, oh yeah, no, don't worry, Debbie can do it.

She's been around long enough.

And it shows what leadership thinks of you in the team, because if you find yourself, you're not always counted in or you're forgotten about.

It's something to evaluate on and am I making an impact in the team?

And so that's just a little bit of advice on how as a Student Nurse, you can make sure that you don't get lost in the hierarchical system in Nursing.