Nursing

Different Levels of Nursing Explained

Written by: University of Tulsa • Aug 12, 2024

Nurses talking and looking at a chart in a hallway of a medical facility.

Different Levels of Nursing Explained

For nurses seeking career advancement and leadership opportunities or those just starting out in nursing, learning the different positions and how to attain each one can help determine next steps in education, training, and job searching. The levels of nursing range from assisting medical teams to working at an advanced level in certain specialties to contributing significantly to the field. The training and education required for each level ranges from a few months to many years.

By setting sights on a particular level, nurses can figure out how to best make progress toward career goals. This includes finding the right nursing program that can empower them at each level to reach for the next.

5 Different Levels of Nursing, With Training Requirements and Job Outlook

While health care organizations may have slightly different requirements or job titles for each level, nurses can generally pursue particular levels and find applicable roles within them upon completion of the requirements. Career growth isn’t limited, either: Many nurses expand their practices throughout their careers, taking on increased responsibility, earning higher wages, and contributing to the field in advanced ways.

When examining the five levels of nursing, it’s helpful to break down each level by key categories that define its role:

Education and experience
Scope and responsibilities
Specialties
Average pay
Job outlook

Reviewing these categories helps determine which level may be the best fit for the next stage of a nurse’s career. Considerations include desired timeline, budget for education, interest in responsibility and leadership, and interest in a given medical specialty.

1. Certified Nursing Assistant

The first level of nursing is to assist nursing teams. Certified nursing assistants (CNAs) can start their journey in the nursing field by working in many health care settings, such as hospitals, long-term care facilities, and even patients’ homes. They support nurses with routine activities that keep patients well cared for, such as assisting them with washing, eating, and getting up and moving. They communicate any major changes in patients’ temperament or vital signs to the presiding nurse.

With this support, nurses can focus on the more clinical side of patient care. Assisting is one way to get started in the medical industry by observing more experienced professionals in the field and contributing in meaningful but less clinical ways.

Training requirements and level specifications, according to the U.S. Bureau of Labor Statistics (BLS) as of May 2023, include the following:

Education: Completion of a relevant, state-approved education program
Certification: Pass the relevant state’s competency exam
Roles: CNA
Specialties: Requires additional vocational training
Median Pay: $38,130 annually or $18.33 per hour
Job Outlook: 4% expected growth (as fast as average)

Becoming a CNA

Vocational training is a form of education that’s hyperfocused on the trade that students plan to enter. It doesn’t focus on broader or more academic subjects but rather zooms in on the knowledge and skills that students need to know to get started in an industry. While vocational training is the main form of education in some industries, it’s become more routine for nurses to earn higher-level degrees to qualify for more clinical levels of nursing. With the decreased training requirements needed to be a CNA comes lower pay and less opportunity for advancement in this role.

For those who know they want to enter the field at a higher level but are beginning their nursing careers, becoming a licensed practical nurse (LPN) is the next option.

2. Licensed Practical Nurse

Current CNAs or aspiring nurses looking to enter the field at a higher level can consider a role as an LPN. LPNs can work across health care settings, including hospitals and long-term care facilities. At this level of nursing, LPNs take care of the daily well-being of patients, similar to the responsibilities of a CNA, but their scope includes additional duties that are more clinical.

They can handle medications, administer them to patients, and take vital signs. They can also act as communication liaisons between medical teams and patients to ensure that the patients and their families understand what daily self-care should look like at home. To prepare aspiring nurses to handle those responsibilities, the requirements for LPNs are slightly longer and more clinical in nature but still provide a relatively quick entry into the field.

Training requirements and level specifications, according to the BLS as of May 2023, include the following:

Education: Completion of a relevant, state-approved education program
Certification: Pass the relevant state’s competency exam
Roles: LPN; licensed vocational nurse (LVN)
Specialties: Requires additional vocational training
Median Pay: $59,730 annually or $28.72 per hour
Job Outlook: 5% expected growth (faster than average)

Becoming an LPN

Though pay is higher than at the CNA level, the scope of the role for LPNs remains limited, and career advancement almost always requires more education and training. Because the education requirement is only one year for LPNs, those seeking to work in specialties such as IV therapy, gerontology, or hospice generally need additional vocational training beyond that time frame.

For those nurses seeking increased job opportunities, pay, and responsibilities, entering the field as registered nurses (RNs) can be attractive.

3. Registered Nurse

RNs represent the largest segment of health care workers and one of the largest professions in the United States, according to a 2023 report by the American Association of Colleges and Nursing (AACN). Why might this be the case when compared to the levels of nursing for CNAs and LPNs? Becoming an RN requires more education and up-front investment of time and budget, but RNs ultimately have more job prospects and opportunities for career growth. RNs can work in a wide variety of care settings — not only hospitals and long-term care facilities, but also schools, clinics, physicians’ offices, and more.

The responsibilities of an RN typically include the following:

Overseeing CNAs and LPNs during a shift
Conducting full medical assessments of patients
Communicating any significant changes in the patient to the medical team
Handling and administering medications, including IV therapy and pain relief
Maintaining high standards of practice and care

The role of an RN isn’t to assist physicians but to operate independently and collaboratively as a core member of the medical team. This is why RNs can work independently of physicians in many care settings, such as home health or schools.

Training requirements and level specifications, according to the BLS as of May 2023, include the following:

Education: Postsecondary degree
Roles: RN
Certification: Pass the relevant state’s National Council Licensure Examination for Registered Nurses (NCLEX-RN) and obtain an RN license
Specialties: Possible without additional education or training
Median Pay: $86,070 annually or $41.38 per hour
Job Outlook: 5% expected growth (faster than average)

Becoming an RN

A postsecondary degree is a degree that a student obtains beyond a high school or GED diploma. There are two educational pathways to earning RN licensure. The first educational pathway is for those who already hold a bachelor’s degree in a non nursing-related field: They can pursue an Associate Degree in Nursing (ADN) or an Accelerated Bachelor of Science in Nursing (ABSN).

Both degrees can be completed in about a year and a half, significantly less time than a traditional bachelor’s degree. Graduates of these programs are then eligible to take the RN licensure exam and begin working as RNs upon passing — a step up for CNAs or LPNs in responsibility, opportunity, and pay.

The second educational pathway is for those who don’t hold a bachelor’s degree of any kind: That degree program is a Bachelor of Science in Nursing (BSN). Current nurses who’ve already earned their RN license through an ADN can also pursue an RN to BSN program .

The benefits of holding a BSN are numerous for RNs:

Preference by nearly 70% of RN employers for new hires with at least a BSN degree, according to a 2023 study by AACN
Improved patient outcomes due to increased knowledge and skills
Greater earning potential and educational possibilities
More career growth and leadership opportunities

Another reason many current and aspiring nurses pursue this level of nursing is that the standard educational requirement for RNs enables them to pursue work in medical specialties , such as critical care, labor and delivery, and pediatrics. Working in a specialty is attractive to many nurses because they may be interested in a certain type of medicine or want to provide care to a certain demographic. For example, an RN can support critically ill patients, pregnant women, or children, exercising all the clinical knowledge and skill that comes with that specialty.

RNs hold a main clinical care role on medical teams while maintaining close communication and interpersonal support for patients and their families. This is the last level of nursing considered entry level, as individuals without prior nursing experience can earn an ABSN or a BSN degree and enter the field as RNs after passing the licensure exam.

Higher levels of nursing require not only education but also years of experience and advanced degrees. They offer increased rewards and opportunities for that expertise.

4. Advanced Practice Registered Nurse

Advanced practice registered nurses (APRNs) aren’t entry-level nurses. To qualify for APRN roles, a nurse must already have a bachelor’s degree in nursing, continue on in their education to earn a master’s degree, and have at least a few years’ experience.

Only 17.4% of nurses hold a master’s degree, according to a recent report from AACN. Importantly, the demand for nurses with a master’s degree is far greater than the supply. This, coupled with the need for greater medical expertise among nonphysicians, is the reason that this level of nursing is projected to see much faster than average growth over the coming years.

The responsibilities of an APRN typically include the following:

Administering medications and vaccinations
Prescribing and analyzing lab results
Diagnosing conditions
Creating and communicating patient care plans
Providing referrals

Historically, APRNs have rounded out primary care medical teams by fulfilling a lot of the same patient care duties as primary care physicians, making it more possible to deliver quality primary care in the United States. However, there’s a growing trend toward specialties, with more APRNs seeking roles with higher pay and more advancement opportunities; this is leading to increased expectations for the growth of the APRN role and concerns about a possible scarcity among primary care providers.

Training requirements and level specifications, according to the BLS, include the following:

Education: Master’s or doctoral degree in nursing plus field training and certifications
Roles: Nurse practitioner (NP), certified nurse midwife (CNM), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA)
Certification: Pass the national certification exam, and obtain the relevant state’s APRN license
Specialties: Common without additional education or training
Median Pay: $129,480 annually or $62.25 per hour
Job Outlook: 38% expected growth (much faster than average)

Educational pathways to reach this level include BSN and MSN combined programs, MSN programs , RN to MSN pathway programs , or doctoral degree programs.

Depending on their role and organization, APRNs may work in specialties such as:

Family nurse practitioner (FNP)
Adult-gerontology nurse practitioner (AGNP; both acute and primary care)
Women’s health nurse practitioner (WHNP)
Pediatric nurse practitioner (PNP)
Neonatal nurse practitioner (NNP)
Psychiatric mental health nurse practitioner (PMHNP)

While a nurse must attain an MSN degree to reach the APRN level, another educational pathway to reach it is a doctoral degree in nursing. However, within the levels of nursing, obtaining a Doctor of Nursing Practice (DNP) or a PhD in Nursing is often considered a separate level from that of APRNs because they’re a doctoral degree.

5. DNP or PhD in Nursing

Among the five levels of nursing, the DNP and PhD represent the highest level. Education is the defining factor, as doctoral students study for several years beyond a bachelor’s degree. A DNP is a type of degree similar to a PhD, but it focuses more on practice methods than research. DNP candidates complete capstone projects, while PhD candidates complete research-based dissertations as their final assessment.

Many nurses with DNP degrees work in similar roles as APRNs and stay in active practice with patients. For this reason, the median pay and job outlook are the same for this level as for APRNs — $129,480 annually with 38% expected growth. This may be why DNP programs have shown consistent year-over-year increases in enrollment since the mid-2000s, according to a recent report by AACN.

PhD graduates, on the other hand, gain expertise in the academic and research sides of nursing. They may be more likely to work in nonclinical roles, such as nurse education, academia, research, or government. Both degrees can prepare graduates for high-level leadership positions in the field.

How to Choose the Right Level of Nursing

For aspiring nurses looking to begin their journey and experienced nurses looking to elevate and expand their careers and practices, understanding the different levels of nursing helps to determine which pathway may be the right one. Many nurses move through the levels over many years as they go deeper into clinical work, gain experience with meaningful scenarios with patients, and learn what areas of medicine they may be most interested in.

When you’re looking to take the next step in your nursing career, consider:

Where you are now.
- What nursing experience do you have?
- What types of degrees do you have?
What you want your nursing career to look like in the short term.
- Do you need or want to enter the field quickly?
- Do you want to prioritize learning and development or getting to work with patients more quickly?
What you want your career to look like in the long term.
- Decades from now, do you see yourself readily engaged in patient-facing care?
- Decades from now, do you see yourself leading patient-care teams from an executive office?
- Do you aspire to work in research, academics, or policy settings outside a health care facility?
- If you’re unsure, which degree pathway would set you up for the most flexible future?
What financial investment you’re prepared to make.
- Do you have a tight budget and the need to make money as soon as possible?

Answering each of these questions can help determine which pathway is the right one for you. There are no right or wrong answers or strict timelines — just possibilities.

Reach for Your Next Level With the Online Nursing Programs at The University of Tulsa

For anyone looking to advance in the nursing field, taking that next step along the educational journey of nurses opens up new levels of nursing and career paths that often include higher pay and broadened career possibilities.

The University of Tulsa offers flexible, manageable online nursing programs that support people along this journey from just getting started to advancing to higher levels of practice. With the ABSN , RN to BSN , RN to MSN , and MSN degree programs, as well as the Post-Master’s Adult Gerontology Acute Care Nurse Practitioner (AGACNP) certificate program, TU can help you reach your new level of nursing.

Explore TU’s online nursing programs today to take your next step in nursing.

Recommended Readings

Becoming a Nurse Executive

6 Tips for New Nurses

Chief Nursing Informatics Officer Career Overview

Sources:

American Association of Colleges of Nursing, Fact Sheet: The Doctor of Nursing Practice (DNP)

American Association of Colleges of Nursing, New Graduate Employment Data: 2023 Employment Research Brief

American Association of Colleges of Nursing, Nursing Workforce Fact Sheet

American Association of Colleges of Nursing, The State of Doctor of Nursing Practice Education in 2022

American Nurses Association, How to Go From Registered Nurse (RN) to Nurse Practitioner (NP)

Indeed, PhD in Nursing: Definition, Benefits, and How to Earn One