The highest level of nursing is the doctoral degree, which comes in two forms: the Doctor of Nursing Practice (DNP) and the PhD in Nursing. Both are terminal degrees, meaning there is no higher academic credential in the field. The DNP focuses on clinical practice and leadership, while the PhD focuses on research. Which one represents “the highest level” depends on whether you’re talking about patient care, academic research, or executive leadership.
Two Doctoral Degrees, Two Different Paths
The DNP is a practice doctorate. It prepares nurses for careers in clinical leadership, hospital administration, and advanced patient care. DNP students learn to translate existing research into real-world improvements in healthcare delivery, and they complete a scholarly project as their capstone requirement.
The PhD in Nursing is a research doctorate. It prepares nurses to become scientists who design studies, analyze data, and publish findings that shape the profession’s knowledge base. PhD students defend a traditional dissertation. Most go on to hold faculty positions at research universities, where they conduct independent studies, teach, and mentor the next generation of nurses. Others work as clinical scientists in hospitals or health systems, solving large-scale problems through research. Some move into government or public health organizations to influence policy.
In practical terms: a DNP-prepared nurse might lead a team redesigning how a hospital manages chronic pain, while a PhD-prepared nurse might run the study that determines which pain management approach works best.
Advanced Practice Registered Nurses
Below the doctoral level (or sometimes alongside it), the most clinically advanced nurses are Advanced Practice Registered Nurses, or APRNs. There are four recognized APRN roles:
- Nurse Practitioner (NP): Provides primary or specialty care across settings like pediatrics, geriatrics, family medicine, and acute care. In many states, NPs practice autonomously as primary care providers. In others, they work under physician supervision.
- Certified Registered Nurse Anesthetist (CRNA): Administers anesthesia to patients of all ages during surgery. CRNAs can work independently or under the supervision of anesthesiologists, depending on state regulations.
- Certified Nurse-Midwife (CNM): Provides reproductive, prenatal, and postpartum care, including delivering babies.
- Clinical Nurse Specialist (CNS): Focuses on improving care quality within a specific patient population or clinical area, often working at the systems level within hospitals.
These roles have traditionally required a Master of Science in Nursing (MSN), but that’s changing. The Council on Accreditation of Nurse Anesthesia Educational Programs now requires doctoral preparation for entry into CRNA practice. As of January 2022, every student entering an accredited CRNA program is enrolled in a doctoral program. The National Organization of Nurse Practitioner Faculties has similarly called for making the DNP the entry-level degree for nurse practitioners by 2025. The broader trend across the profession is moving advanced practice preparation from the master’s level to the doctorate.
The Bureau of Labor Statistics groups nurse anesthetists, nurse midwives, and nurse practitioners together with a median annual salary of $132,050 as of 2024.
The Executive Track: Chief Nursing Officer
The highest administrative position a nurse can hold within a hospital or health system is typically the Chief Nursing Officer (CNO). This is the person responsible for all nursing operations, staffing, patient care standards, and strategic decisions across an entire organization.
Most CNOs start with a Bachelor of Science in Nursing, move through a master’s degree to build leadership skills, and increasingly hold a DNP. The median annual salary for a CNO was about $140,500 as of mid-2023. Several board certifications signal readiness for this level, including the Certified in Executive Nursing Practice (CENP) credential, the Certified Nurse Manager and Leader (CNML), and the Nurse Executive Board Certified (NE-BC) from the American Nurses Credentialing Center. Earning the NE-BC requires at least 2,000 hours of experience in a leadership or administrative role within the prior three years, plus 30 hours of continuing education in management.
How Long It Takes to Reach the Top
The path from entry-level nurse to the highest credential is long but clearly structured. A BSN takes four years. An MSN adds another two to three. A DNP program requires a minimum of 1,000 supervised clinical practice hours beyond the bachelor’s level, and most programs take three to four years from a BSN starting point (less if you already hold an MSN). A PhD in Nursing typically takes four to five years of full-time study.
Adding it all together, a nurse pursuing a doctorate is looking at roughly eight to ten years of post-secondary education, not counting the clinical experience most programs expect before admission. The investment is real, but so is the payoff in autonomy, earning potential, and influence over how healthcare is delivered.
Which Path Is “Highest” for You
If your goal is to provide the most advanced patient care, the DNP paired with an APRN specialty like nurse anesthesia or acute care NP puts you at the clinical ceiling. If you want to generate new knowledge and shape nursing science, the PhD is the pinnacle. If you want to run a hospital’s nursing division, the DNP with executive certifications and years of leadership experience leads to the CNO role.
All three paths end at the doctoral level. The difference is what you do once you get there: treat patients, conduct research, or lead organizations. The nursing profession’s steady push toward requiring doctorates for advanced roles means these distinctions will only become more defined in the years ahead.