Nursing has five main levels, each with different education requirements, responsibilities, and pay. They range from certified nursing assistants, who can start working after a few months of training, to doctoral-prepared nurses who lead research or run healthcare organizations. Understanding these levels helps whether you’re considering a nursing career or trying to make sense of the roles you encounter in a hospital or clinic.
Certified Nursing Assistant (CNA)
Certified nursing assistants are the entry point into nursing. CNAs help patients with daily activities like bathing, dressing, eating, and moving around. They often work in long-term care facilities and home health settings, where they serve as the primary point of contact between patients, families, and the rest of the healthcare team.
Becoming a CNA requires a high school diploma or GED plus a state-approved training program. These programs vary by state but typically take 4 to 12 weeks and combine classroom instruction with hands-on clinical practice. After finishing the program, you pass a state certification exam to earn the CNA credential. There’s no college degree involved, making this the fastest path into patient care.
Licensed Practical Nurse (LPN)
Licensed practical nurses handle more clinical tasks than CNAs. LPNs monitor vital signs like blood pressure and temperature, change bandages, document patient records, and report status updates to registered nurses and physicians. In some states, LPNs with additional training can administer medication or start IV lines. In nursing facilities, they may also help feed patients who can’t eat independently. The title “licensed vocational nurse” (LVN) is used in California and Texas, but it’s the same role.
LPN programs typically take about one year and cover nursing fundamentals, anatomy, physiology, and pharmacology, along with supervised clinical hours. You don’t need a college degree. After completing the program, you must pass the NCLEX-PN, a computer-adaptive exam that ranges from 75 to 145 questions with a five-hour time limit. Optional specialty certifications are available in areas like wound care, gerontology, and IV therapy. Many employers also require CPR or basic life support certification.
The median annual salary for LPNs and LVNs was $62,340 as of 2024.
Registered Nurse (RN)
Registered nurses carry a much broader scope of responsibility. RNs administer medications, contribute to care plans, collaborate directly with physicians, and in many workplaces oversee CNAs and LPNs. This is the level where most people think of “nursing” as a career, and it’s the largest segment of the profession.
Two Paths to Becoming an RN
You can become an RN through either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). Both lead to the same licensing exam, the NCLEX-RN, but they differ in depth and duration.
An ADN is a two-year program, usually offered at community colleges, with some accelerated options that finish in 18 months. The curriculum covers core prerequisites like chemistry, anatomy, biology, and psychology, then moves into nursing-specific courses: medical-surgical nursing, pediatric nursing, psychiatric nursing, and community health.
A BSN is a four-year program at a university. It includes everything in an ADN program plus coursework in public health, nursing ethics, research methods, and pathophysiology. This broader training opens doors to leadership positions, specialty units, and graduate school. Many hospitals now prefer or require a BSN, and nurses with an ADN can complete an RN-to-BSN bridge program in one to two years while working.
Regardless of which path you take, you must pass the NCLEX-RN to practice. The median annual salary for registered nurses was $93,600 in 2024, and employment is projected to grow 5% over the next decade, faster than average for all occupations. Nurses licensed in one of the 43 states that participate in the Nurse Licensure Compact can practice across state lines without obtaining a separate license in each state.
Specialty Certifications for RNs
After gaining experience, RNs can pursue specialty certifications that signal expertise in a particular area. Critical care nurses, for example, can earn the CCRN credential. Similar certifications exist for emergency nursing, oncology, and dozens of other specialties. These aren’t separate “levels” of nursing, but they boost earning potential and career options within the RN role.
Advanced Practice Registered Nurse (APRN)
Advanced practice registered nurses hold a master’s degree or higher and operate with significantly more autonomy than RNs. While RNs implement care plans, APRNs direct them. They can diagnose conditions, order tests, and in many states prescribe medications independently. The median annual salary for APRNs was $132,050 in 2024.
There are four recognized APRN roles:
- Nurse Practitioner (NP): NPs serve as primary and specialty care providers. They assess patients, manage health conditions, and develop treatment strategies. Most NPs specialize in a population, such as adult and geriatric health, pediatrics, or psychiatric and mental health.
- Certified Registered Nurse Anesthetist (CRNA): CRNAs administer anesthesia before, during, and after surgical and diagnostic procedures. They monitor vital signs throughout a procedure and adjust anesthesia as needed. They also provide pain management and some emergency services.
- Certified Nurse Midwife (CNM): CNMs provide gynecological exams, family planning services, prenatal care, and deliver babies. They manage emergency situations during labor and can assist physicians during cesarean births. Many also serve as primary maternity care providers and offer wellness education on nutrition and disease prevention.
- Clinical Nurse Specialist (CNS): CNSs focus on improving care quality and patient outcomes within a specific specialty area, often combining direct patient care with system-level work like staff education and policy development.
All four roles require a master’s degree at minimum, and each involves its own national certification exam beyond the NCLEX-RN.
Doctoral-Level Nursing
The highest level of nursing education includes two distinct doctoral degrees, each with a different purpose.
The Doctor of Nursing Practice (DNP) is a practice-focused degree. DNP graduates work as administrators, nurse practitioners, or healthcare executives. The program trains nurses to translate existing research into better clinical practice and complete a scholarly project as their capstone. It includes indirect practice hours, keeping graduates connected to patient care settings.
The Doctor of Philosophy in Nursing (PhD) is a research degree. PhD graduates become nurse scientists who design and lead original research studies, develop nursing theory, and publish their findings. They often hold faculty positions at universities or lead research teams. Instead of a scholarly project, PhD students defend a traditional dissertation.
In short: DNP graduates improve how nursing is practiced today, while PhD graduates generate the knowledge that shapes how nursing will be practiced tomorrow. Both are terminal degrees, meaning there’s no higher credential in the field. Nurses pursuing either typically already hold a master’s degree, though some programs accept BSN-prepared nurses directly. RN-to-MSN bridge programs, which generally take up to three years, can serve as a stepping stone toward doctoral study.