Nursing has four main levels: Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN), Registered Nurse (RN), and Advanced Practice Registered Nurse (APRN). Each level requires more education, carries greater clinical responsibility, and comes with higher pay. Understanding how these levels connect can help you plan a realistic path into the profession or figure out your next step if you’re already working in healthcare.
Certified Nursing Assistant (CNA)
CNAs are the hands-on foundation of patient care. They help patients with daily activities like bathing, dressing, eating, and moving around. They also take vital signs and report changes in a patient’s condition to the nurses supervising them. CNA training programs are short, often lasting four to twelve weeks, and include both classroom instruction and supervised clinical hours. After completing a state-approved program, you take a competency exam to earn your certification.
Because the barrier to entry is low, many people use CNA work as a proving ground. It gives you direct patient contact and a realistic look at what nursing demands before you commit to longer, more expensive schooling.
Licensed Practical Nurse (LPN)
LPNs (called Licensed Vocational Nurses, or LVNs, in California and Texas) take on more clinical responsibility than CNAs. They monitor patient health, update medical records, administer basic treatments, and assist RNs and physicians with care. LPN programs can be completed in as little as one year through community colleges, technical schools, or vocational programs.
After finishing the program, you must pass the NCLEX-PN exam to earn your license. The NCLEX-PN uses a computerized adaptive format with 85 to 205 questions over a five-hour window, focusing on care coordination, safety, infection control, and pharmacological therapies. Pass rates sit around 90 to 92%. The median annual salary for LPNs was $62,340 in 2024, according to the Bureau of Labor Statistics.
LPNs work under the supervision of RNs or physicians. They don’t independently develop care plans or make high-level clinical decisions, but they’re essential to keeping day-to-day patient care running smoothly in hospitals, nursing homes, and clinics.
Registered Nurse (RN)
RNs are the clinical backbone of most healthcare settings. They assess and monitor patients, develop care plans, administer medications and treatments, and supervise CNAs and LPNs. The median annual salary for RNs was $93,600 in 2024.
Three Paths to Becoming an RN
You can become an RN through three different educational routes, and all three qualify you to take the same licensing exam:
- Nursing diploma: A two-year program offered through hospitals, technical schools, or vocational schools. These are less common today but still exist.
- Associate Degree in Nursing (ADN): A two- to three-year program, typically at a community college. Some schools offer accelerated versions you can finish in 18 months.
- Bachelor of Science in Nursing (BSN): A four-year university degree that includes broader training and more clinical experience than an ADN.
All three pathways lead to the NCLEX-RN exam, which has 75 to 265 questions over six hours. It emphasizes assessment, management of care, and ethical and legal decision-making, and it tests knowledge of therapies like IV administration and blood transfusions. Pass rates range from 85 to 90%.
Why the BSN Matters for Advancement
While ADN and BSN graduates take the same exam and hold the same RN license, the BSN opens more doors. Many employers prefer or require a BSN, and it’s a prerequisite for any graduate nursing program. BSN holders also have a slight edge on the licensing exam: 82.3% pass the NCLEX-RN on their first attempt compared to 77.9% of ADN holders, according to the National Council of State Boards of Nursing.
If you start with an ADN and later want to advance, RN-to-BSN bridge programs let you complete the bachelor’s degree without starting from scratch. Similarly, LPN-to-RN bridge programs exist for licensed practical nurses ready to move up. These programs typically require prerequisite courses in anatomy, physiology, and math, along with a minimum GPA and entrance test scores. LPNs who meet the requirements can often skip the first-semester foundational courses and enter the program at an advanced point.
Advanced Practice Registered Nurse (APRN)
APRNs hold the highest clinical authority in nursing. They diagnose illnesses, prescribe medications, order tests, and manage patient care independently or with minimal physician oversight, depending on state laws. The median annual salary for APRNs was $132,050 in 2024. There are four distinct APRN roles, each with its own specialty focus:
- Nurse Practitioner (NP): Provides primary, acute, and specialty care across the lifespan, including assessment, diagnosis, and treatment of illnesses and injuries.
- Certified Nurse-Midwife (CNM): Provides primary care along with gynecological and reproductive health services, including prenatal care and childbirth support.
- Clinical Nurse Specialist (CNS): Focuses on diagnosis and treatment within a specific patient population while also driving practice improvements and evidence-based care across an organization.
- Certified Registered Nurse Anesthetist (CRNA): Provides the full range of anesthesia and pain management services for surgeries and procedures.
Becoming an APRN requires at minimum a Master of Science in Nursing (MSN), though a growing number of programs and employers now expect a Doctor of Nursing Practice (DNP). The total timeline from the start of your education depends on the specialty. Nurse practitioners and certified nurse-midwives typically need six to ten years of combined education and training. CRNAs require eight to ten years because of the additional clinical experience required before entering an anesthesia program.
Doctoral Degrees: DNP vs. PhD
A doctorate is the highest level of nursing education, and there are two distinct tracks with very different purposes.
The Doctor of Nursing Practice (DNP) is a practice-focused degree. It prepares nurses for leadership in clinical settings, hospital administration, and health policy. DNP students learn to translate existing research into better patient care, and their final requirement is a scholarly project related to quality improvement, evidence-based practice, or policy. Graduates work as nurse practitioners, administrators, or healthcare executives.
The PhD in Nursing is a research degree. It trains nurse scientists to conduct original research, develop nursing theory, and publish scholarly work. The culminating requirement is a traditional dissertation. PhD graduates typically work in academic settings, lead research teams, or hold leadership positions in research institutions. If you want to teach at a university or run clinical studies, the PhD is the more fitting path. If you want to lead clinical teams or shape healthcare delivery at an organizational level, the DNP aligns better.
How the Levels Connect
One of nursing’s biggest advantages as a career is that the levels build on each other. You don’t have to map out a decade of education before you start working. Many nurses begin as CNAs while still in school, move into LPN or RN roles, and pursue advanced degrees later, often while employed. Bridge programs at every transition point (LPN to RN, ADN to BSN, BSN to MSN) are designed for working nurses and frequently offer evening, weekend, or online formats.
The salary jumps between levels are substantial. Moving from LPN ($62,340) to RN ($93,600) represents a roughly 50% increase in median pay, and the leap from RN to APRN ($132,050) adds another 40%. Each step requires more education and responsibility, but the profession is structured so you can advance at your own pace without ever having to start over.