The short answer
A nursing home is run by a licensed administrator. Nursing care is directed by the director of nursing, a registered nurse, and delivered by registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs), who give most hands-on care. A medical director and attending physicians oversee medical care. Social workers, dietitians, therapists, activities staff and an infection preventionist round out the team.
Leadership
- Administrator: licensed by New York State; runs the whole facility, including budget, staffing levels and compliance. The person to escalate to when nursing leadership does not fix a problem.
- Director of nursing (DON): a registered nurse in charge of all nursing care and nursing staff.
- Assistant director of nursing (ADON): supports the DON, often responsible for staffing, education or specific units.
- Medical director: a physician responsible for the facility's medical care policies.
Nursing staff on the unit
- Unit manager or nurse manager: an RN who oversees one unit or floor. Usually the best first contact for a specific concern.
- Nursing supervisor: an RN in charge of the building on evenings, nights and weekends.
- Charge nurse, RN or LPN: gives medications and treatments, assesses residents and supervises the nursing assistants on the shift.
- Certified nursing assistant (CNA): provides most hands-on care: bathing, dressing, feeding, toileting, turning and transfers.
- Wound care nurse: in many facilities, a nurse with special training who assesses and treats pressure injuries.
- MDS coordinator: a nurse who completes the federally required assessments.
- Infection preventionist: responsible for the infection control program; required by federal rules.
Other professionals
- Social worker: admission, discharge planning, family communication, grievances and emotional needs.
- Dietitian: assesses nutrition and weight loss and recommends supplements and diet changes.
- Physical, occupational and speech therapists: rehabilitation, mobility, safe transfers and swallowing (speech therapists evaluate choking and aspiration risk).
- Activities director: recreation and engagement programs.
- Attending physician, nurse practitioner or physician assistant: the resident's medical provider.
Not facility staff
The Long Term Care Ombudsman is an independent advocate for residents, reachable at 1-855-582-6769. Ombudsmen do not work for the facility.
Who to call about what
- Day-to-day care: the charge nurse, then the unit manager
- A pattern of problems or a serious event: the director of nursing
- Staffing, unresolved complaints or threats of discharge: the administrator
- Meetings, family communication or discharge: the social worker
- Medical decisions and medication changes: the attending physician or nurse practitioner
The rules behind this
- 42 C.F.R. § 483.35 (nursing services)
- 42 C.F.R. § 483.70 (administration)
Related questions
This guide provides general information, not medical or legal advice. Rules change; confirm current requirements with the facility, the New York State Department of Health or a professional. Attorney Advertising.