Nurse Levels & Ranks Explained

7 Min Read Published November 1, 2023
Nursing hierarchy | what are the levels in nursing?

Whether you are becoming a nurse or you're an APRN with several years of experience, understanding the nursing definition and the levels and ranks within the field is crucial for realizing the full scope of your career options. Typically, a nurse's educational and experiential background aligns with their education level.

Between starting as a novice nurse and the highest ranks of nursing, there is a wide range of positions. Read on to understand the ranks and levels of nursing.

Levels of Nursing Credentials (Ranked From Lowest to Highest)

Nursing levels explained

1. Certified Nursing Assistant (CNA)

A certified nursing assistant, or CNA, helps patients with activities of daily living and other healthcare needs under the direct supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN). 

CNA Education

Certified nursing assistants must complete a state-approved training program. These programs are generally found at local community colleges, high schools, vocational or technical schools, or local hospitals.

  • 4-12 week program 
  • CNA certification exam
  • Earn a state license

CNA Salary

  • $35,760 per year, $17.19 per hour per BLS

Job Outlook

  • 4% growth per BLS

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2. Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)

LVNs and LPNs are interchangeable titles depending on where you work in the US. California and Texas use the title LVN, and the rest of the US uses LPN.

LPNs and LVNs work in hospitals, nursing homes, and other medical facilities and are typically responsible for more basic kinds of patient care and comfort measures. Usually, they work under the guidance of an RN or MD.

LPN Education

To become an LVN/LPN, you need a high school diploma or GED and to graduate from an accredited LVN/LPN program and pass the National Council Licensure Exam. LPN programs typically include one year of coursework and training at a hospital, community college, or technical school. There are also LPN to RN programs where LPNs can go back to school to become either an ADN RN or a BSN RN through accelerated programs.

  • 1-year program 
  • NCLEX-PN licensing exam
  • Earn a state license

LPN Salary

  • $54,620 per year, $26.26 per hour per BLS

Job Outlook

  • 5% growth per BLS

3. Registered Nurse (RN)

A registered nurse administers hands-on patient care in a variety of settings, including hospitals, medical offices, nursing homes, and other facilities.

RNs work with physicians and other members of the health care team to provide the best course of treatment possible. They also help to educate patients and their families about health issues.

RN Education

To become an RN, you'll need to complete either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) degree, followed by your NCLEX-RN. 

  • Associate Degree in Nursing (ADN)
    • 2-3 year program
  • Bachelor of Science in Nursing (BSN)
    • 4-year program

RN Salary

  • $81,220 per year, $39.05 per hour per BLS

Job Outlook

  • 6% growth per BLS

4. Advanced Practice Registered Nurse (APRN)

An APRN is a master’s degree-prepared RN with a post-masters certificate or a DNP in one of the following four roles:

APRNs are licensed through the state board of nursing in which they practice. In many states, APRNs can prescribe medication and practice independently, while in other states, they do so under the oversight of a Medical Doctor (MD).

Many nurses who are APRNs also have a DNP, but you can have one without the other. An APRN with a DNP is considered a practicing doctorate.

APRN Education

  • Master of Science in Nursing (MSN)
    • 2-3 year post-graduate program 
    • APRN roles must also complete in-person clinical hours and pass a certification exam in the area of specialization

OR

  • Doctor of Nursing Practice (DNP)
    • 3-4 year post-graduate program
    • Requires capstone DNP project

APRN Salaries

  • Nurse Practitioner (NP)- $121,6101
  • Clinical Nurse Leader (CNL) - $95,959 (Salary.com)
  • Clinical Nurse Specialist (CNS) - $140,849 (Indeed)
  • Certified Registered Nurse Anesthetist (CRNA) - $203,0901
  • Certified Nurse Midwife (CNM) - $120,8801

1Source: U.S. Bureau of Labor Statistics

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5. Non-Clinical Advanced Nursing Specialties

Nurses can increase their earning potential and advance their careers away from the bedside by pursuing a non-clinical advanced nursing career. 

Education

  • MSN
  • DNP
  • PhD

Salaries

Levels of Nursing Degrees (Ranked from Lowest to Highest)

1. RN Diploma

An RN diploma is another route to becoming a registered nurse. Like the ADN, these programs typically take around two years to complete, and they both prepare students to take the NCLEX-RN. The main difference is that the ADN is a college degree while the diploma is not. Diploma programs are typically offered at hospitals but may also be available at technical or vocational schools. 

2. Associate Degree in Nursing (ADN)

An ADN is a 2-year degree and is the minimum amount of education required to obtain a license to work as an RN, other than an RN diploma (See next section).  

Most RNs begin their careers working at the bedside performing direct patient care. This experience is usually preferred for nurses who wish to advance their careers and eventually earn a BSN, MSN, APRN, or DNP. However, there are also many career paths that an RN can take outside of the hospital setting, including case management or aesthetic nursing.

3. Bachelor of Science in Nursing (BSN)

BSN is a 4-year nursing degree for students who want to be registered nurses (RN) or for RNs who currently only have an associate degree in nursing (ADN). Many nurses who start their careers with an ADN eventually advance their careers by achieving a BSN. 

Bachelor’s trained nurses work in nursing specialties throughout the hospital setting. For example, cardiac, neuro, pediatrics, labor & delivery, emergency room, and ICU, to name a few.

Nurses are encouraged to become certified within their chosen specialty after they have gained at least one or more years of direct nursing experience. For example, a nurse in an ICU neuro/trauma can study and sit for the Certified Neuroscience Registered Nurses Certification (CNRN). Achieving certification within your chosen specialty shows that you are an expert nurse in a particular nursing field. In addition, many institutions will pay nurses more when they are certified within their specialty.

Both ADN and BSN graduates must pass the NCLEX-RN examination to become licensed to work as an RN.

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4. Master of Science in Nursing (MSN)

There are several types of master's degrees in nursing. Advanced practice registered nurse degrees prepare a registered nurse for an advanced clinical role. Other types of MSN degrees focus on preparing nurses for non-clinical roles such as public health or nursing informatics.

It takes about 2-3 years to earn a master’s in nursing, but online options are available.

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5. Doctor Of Nursing Practice (DNP)

Doctorate Of Nursing Practice (DNP) is the highest level of nursing education and expertise within the nursing profession. DNPs work in nursing administration or direct patient care as advanced practice registered nurses (APRN). As thought leaders, DNPs also implement health policy and influence healthcare outcomes.  

In the healthcare setting, DNPs work in:

  • Organizational leadership
  • Nurse management
  • State and national health policy
  • Health informatics

Education to obtain a DNP requires three to six years of study, depending on what level of nursing education you currently have. Most DNP programs require that you have a master’s degree in nursing, although some will start at the BSN level and require more years of study.

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Opportunities for Career Advancement in Nursing

There will be more opportunities than ever for nursing career advancement in the coming years. Nationwide employment of RNs is projected to grow 6 percent from 2022 to 2032. This is partially due to an increased emphasis on preventative care, higher rates of chronic conditions such as obesity and type 2 diabetes, and an aging baby boomer population.  

Advancing your education has never been more attainable, especially with the rise of online learning. A few educational opportunities you may want to consider are RN to BSN, BSN to MSN, and MSN to DNP programs.  

Nursing Levels FAQs

  • What are the different levels of nurses? 

    • The levels of nurses range from diploma-prepared and vocational nurses to LPNs to RNs to advanced practice registered nurses (APRNs) to a doctor of nursing (DNP). 
  • What is the highest level of nurses? 

    • The highest level of clinical nursing is an advanced practice registered nurse (APRN), which is a nurse-midwife, nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist. RNs may also pursue a doctorate in nursing (DNP), but a DNP is an educational degree, not necessarily a clinical advancement. 
  • What comes first, RN or BSN?

    • It’s possible to pursue both your RN and BSN at the same time through a Bachelor’s degree nursing program. However, you can also take an associate’s degree level program in nursing (ADN) first to receive your RN license, then pursue your Bachelor's later. 
  • What degree is higher than an RN?

    • Being an RN refers to having a license as a Registered Nurse. It is not a degree but is instead a license granted after passing a state board exam (the NCLEX). You can become eligible to take the NCLEX to become an RN by enrolling in an associate’s degree program in nursing (ADN) or a Bachelor of Science in Nursing program (BSN).  
  • Who is higher, RN or LPN? 

    • An RN has more responsibility than an LPN. An LPN has some clinical practice limits, such as not being able to push IV medication. 

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Sarah Jividen
RN, BSN
Sarah Jividen
Nurse.org Contributor

Sarah Jividen, RN, BSN, is a trained neuro/trauma and emergency room nurse turned freelance healthcare writer/editor. As a journalism major, she combined her love for writing with her passion for high-level patient care. Sarah is the creator of Health Writing Solutions, LLC, specializing in writing about healthcare topics, including health journalism, education, and evidence-based health and wellness trends. She lives in Northern California with her husband and two children. 

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