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A nursing career has something for everyone. This healthcare profession offers a well-defined career ladder with options to suit a range of aspirations and ongoing opportunities for advancement. If you complete the requisite education and pass the appropriate exam, you can move up to a higher level of job responsibility, which typically offers more autonomy and higher pay.
Vivian Health explores the primary five levels of nursing practice and the nursing degrees that make them possible to help you understand your career progression opportunities.
Initial Considerations for the Various Nursing Levels
On the lower level, such as certified nursing assistants (CNAs) and licensed practical nurses (LPNs), you can start working sooner via certificate-based education programs. Such pathways can be useful if you need to start earning income quickly or don’t have the time, financing or desire to pursue more advanced education. You get to work directly with patients but without some of the added responsibilities of a registered nurse (RN). Yet, the door remains open to pursuing further education and a higher-level job later, which will likely offer better pay.
Meanwhile, roles at the RN level and above often have hourly pay or annual salaries above the national average income. These positions usually offer nurses more autonomy and potentially a path to supervisor or management positions. Higher-level nurses take on much more responsibility in patient care. These roles require a considerable investment in time and money to complete rigorous academic training, especially for those pursuing a master’s degree or higher for advanced practice (AP) roles, such as nurse practitioners or other APRNs.
Defining the 5 Levels of Nursing
1. Certified Nursing Assistant
CNA positions represent an entry-level role that’s vital to the healthcare system. These healthcare professionals (HCPs) provide basic care to patients and assist them with activities of daily living (ADLs), including bathing, grooming, dressing, eating, toileting and general mobility. CNAs also measure and record patient vital signs and observe patient conditions throughout the day. Informally, they provide ongoing emotional support and companionship and tend to the general comfort of patients.
CNAs work in various healthcare settings, including hospitals, nursing homes, assisted living facilities and home healthcare. RNs or LPNs supervise CNAs who have a narrower scope of care.
CNA Education and Job Prospects
CNAs must typically complete a state-approved certificate program through a community college before seeking employment. Alternatively, they may complete a program through their future employer, such as a hospital or nursing home. Online CNA training programs also exist but still require students to complete in-person clinical practice.
- Duration: Typically a few weeks to a few months
- Requirements: High school diploma or equivalent
- Outcome: Prepares students to pass the state’s written and manual skills test to become certified and assist nurses in providing basic care to patients
RELATED: CNA Reciprocity and Certification Requirements by State
CNAs can quickly start working directly with patients without undergoing a more rigorous, lengthy academic program. However, with fewer responsibilities comes lower pay. The average CNA wage based on all jobs posted to Vivian in early July 2024, was $18.39 an hour.
The Bureau of Labor Statistics (BLS) groups CNAs together with hospital orderlies and estimated that there were 1.4 million combined jobs in the U.S. as of 2022. The BLS also estimates that both professions are growing at an average rate of about 4% between 2022 and 2032.
CNAs looking to level up to more responsibility and potentially higher pay have two options. They can explore CNA-to-LPN bridge programs, which generally require about a year of additional training but are usually shorter than programs for those new to nursing. Alternatively, a CNA can enroll in a two-year or four-year degree program to become an RN.
2. Licensed Practical Nurse
LPNs provide essential nursing care under the supervision of RNs and doctors. Although they’re called licensed vocational nurses (LVNs) in Texas and California, LPNs and LVNs have the same roles and perform similar duties.
LPN/LVN duties may vary slightly from state to state. However, in addition to carrying out the duties a CNA might perform, LPNs also typically administer oral, intramuscular and intravenous medications that doctors prescribe. They clean and dress wounds and change bandages. They also record patient data, treatment plans and progress. LPNs can also provide patients with education and care instructions to follow after being discharged.
Related: LPN Programs: From Curriculum to Opportunities
LPN Education and Job Prospects
Aspiring nurses must complete an appropriate certificate program to become an LPN and then pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN). Community colleges and vocational schools typically offer practical nursing programs.
- Duration: 12 months to 18 months
- Requirements: High school diploma or equivalent
- Outcome: Prepares students to pass the NCLEX-PN exam to become licensed and safely provide direct patient care
LPNs can work directly with patients with more responsibility and pay than CNAs and more quickly than pursuing an RN education. The average LPN pay based on jobs posted to Vivian during the same period was $23.32 per hour.
The BLS estimated there were about 650,000 LPN roles as of 2022, and jobs in this role would experience above-average growth of 5% between 2022 and 2032.
Experienced LPNs can level up to RNs by completing an LPN-to-RN bridge program in as little as one year to earn an associate degree or about two years to earn a bachelor’s degree – both are entry points to working as an RN.
3. Registered Nurse
RNs have a broad scope of practice and play a crucial role in patient care across various healthcare settings. While diagnosing patients and prescribing medications is left to doctors and advanced practice registered nurses (APRNs), RNs have a fair range of autonomy to manage a patient’s care. In addition to performing care generally performed by CNAs and LPNs, RNs may do the following:
- Assessment: Complete comprehensive physical assessments of patients, including taking medical histories and performing physical examinations.
- Care Planning: Develop, implement and evaluate individualized care plans based on patient needs and medical conditions.
- Treatment Administration: Administer medications, treatments and procedures as physicians prescribe.
- Education and Discharge: Educate patients and their families about medical conditions, treatment plans, medications and lifestyle changes to manage health and assist with discharge planning to ensure patients have the necessary resources and follow-up care.
- Support: Provide emotional support and counseling to patients and their families, helping them cope with illness and treatment.
- Specialty Areas: Work in specialized areas such as emergency care, critical care, pediatrics, oncology, surgery and maternity.
- Advanced Procedures: Perform advanced procedures such as starting intravenous (IV) lines, inserting catheters and administering advanced life support.
RN Education Pathways
To become an RN, aspiring nurses must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to earn licensure in their state. To take the exam, you must earn a minimum of an Associate of Science in Nursing (ASN) degree or its functional equivalent, the Associate Degree in Nursing (ADN).
However, many RNs opt for a lengthier education course to earn the Bachelor of Science in Nursing (BSN), as many employers today prefer bachelor-trained RNs. This requirement is particularly relevant for certain higher-paying RN specialties or supervisory roles like charge nurse and nurse manager.
A variety of pathways lead to these degrees depending on your previous educational attainment and your prior nursing experience.
Associate Degree in Nursing:
- Duration: 2-3 years, or as little as one year through an LPN-to-RN bridge program
- Requirements: High school diploma or equivalent, often with science prerequisites or LPN experience for a bridge program
- Outcome: Eligible to take the NCLEX-RN exam to obtain RN licensure
Bachelor of Science in Nursing:
- Duration: Four years or as little as two years through an LPN-to-BSN bridge program
- Requirements: High school diploma or equivalent, often with science prerequisites or LPN experience for a bridge program
- Outcome: Eligible to take the NCLEX-RN exam and often have more opportunities for advancement and leadership roles than graduates with an ADN or ASN
Accelerated BSN Programs:
- Duration: 12-18 months
- Requirements: Bachelor’s degree in a non-nursing field
- Outcome: Eligible to take the NCLEX-RN and supports college graduates seeking an expedited path to becoming an RN
RN-to-BSN Programs:
- Duration: 1-2 years (part-time or full-time)
- Requirements: An ADN or ASN and an active RN license
- Outcome: Earn a BSN, often online or through flexible learning options quicker than traditional routes
Although RNs must confront the time, expense and academic vigor of earning at least an associate’s degree, they have more autonomy than CNAs and LPNs and significantly higher pay. Based on jobs posted to Vivian in early July 2024, the average staff RN wage was $52.63 per hour.
RNs are the backbone of day-to-day patient care in a wide variety of settings, and as such, there are many more RN jobs than at other levels of nursing. The BLS estimated there were 3.2 million RN roles as of 2022, and jobs will experience above-average growth of 6% between 2022 and 2032.
RNs can move up the career ladder through various advanced degrees to pursue specialized medical duties and open doors to managerial roles.
4. Advanced Practice Registered Nurse
APRNs have a higher level of education and training than RNs and perform more advanced and specialized healthcare duties. Their responsibilities often overlap with those of medical doctors (MDs) and physician assistants (PAs), particularly in primary care. The growth of this career type has helped to fill healthcare staffing gaps due to doctor shortages in areas like primary care and anesthesia.
A common type of APRN is the registered nurse practitioner (NP). Rather than focusing on day-to-day patient care like ADLs or administering medication, NPs focus on diagnosis and treatment. NPs can take patient histories and order tests, interpret test results, develop a diagnosis and then prescribe a treatment plan, including referrals to specialist physicians as needed and medications if they hold prescriptive authority based on state rules. Numerous NP certifications offer specialization in fields like:
- Dermatology
- Adult to Geriatrics Acute Care
- Psychiatric Mental Health
- Oncology
- Primary Care Pediatrics
- Urology
In addition to NPs, other APRN roles include:
- Clinical Nurse Specialist (CNS): Provide expert consultation to nursing staff and other healthcare team members in their area of specialty. They engage in research to improve patient outcomes and educate nursing staff on best practices and new evidence-based care protocols. Like NPs, CNSs can earn professional certifications in various specialties and patient populations, from pediatrics to geriatrics.
- Certified Nurse Midwives (CNM) Provide comprehensive reproductive healthcare, including prenatal, postnatal and gynecological care, with family planning and contraceptive services. They manage labor and delivery, caring for mothers and newborns during childbirth. Becoming a CNM requires certification through the American Midwifery Certification Board.
- Certified Registered Nurse Anesthetist (CRNA): Administers anesthesia for surgical, diagnostic and therapeutic procedures and monitors patients during surgery to ensure patient safety and comfort. Becoming a CRNA requires a substantial 2,000 hours of clinical practice.
APRN Education Pathway and Job Prospects
The path to becoming an APRN involves considerable education, including a BSN with RN licensure followed by a Master of Science in Nursing (MSN) degree. For this reason, many APRNs first work as an RN for a number of years to gain experience and finance their education before pursuing the MSN.
Master of Science in Nursing (MSN):
- Duration: 1.5-2 years (post-BSN)
- Requirements: BSN and active RN license
- Outcome: Prepares RNs for APRN roles after passage of a rigorous exam in their particular field of practice and several 100 hours of clinical practice
Depending on the individual state regulations, APRNs may be able to operate with relative autonomy, while in other states, they must be supervised, often indirectly, by an MD. In either case, APRNs have among the highest levels of responsibility in the nursing field and, in turn, excellent pay.
Based on Vivian’s salary data in early July, the average NP wage was $86.96 hourly. Meanwhile, the average CNS salary was $88.15 and a CNM’s average pay was $86.96. However, certified nurse anesthetists typically have the best-paying nursing jobs, with CRNA’s average salary at $120.05 per hour during this period.
The BLS estimated that there were over 300,000 APRN roles as of 2022 and that this career will experience tremendous growth of 38% between 2022 and 2032 for all roles combined. However, NPs alone should experience a significant spike in jobs of 45% during this decade. Healthcare facilities often see APRNs as a way to provide various types of quality care at a lower cost than physicians, helping to drive job growth.
5. Doctoral Level Nurse Degrees and Careers
Although not strictly required for nurses to practice at any level, nurses may obtain various doctorate degrees, particularly if they’re interested in roles in nurse education, academic research or high-level administration.
The Doctor of Nursing Practice (DNP) is the most popular option, focused on nurses who plan to remain clinicians, often in a role supervising other clinical nurses. Nurses can also pursue a Doctor of Nursing Science (DNS or DNSc), which is more focused on research and academic careers. Meanwhile, some nurses pursue a Doctor of Nursing Philosophy (PhD in nursing) to move into university research or teaching jobs.
Where Will Your Career Take You?
Vivian provides nationwide job listings for careers at all five levels of nursing, no matter what kind of nursing school you attend or degree program you’ve completed. See what kinds of jobs and pay rates are available in your desired specialty and location with our job search tool.
