There are six levels of nursing in the United States, each requiring a different degree, license, and scope of practice. Whether you’re starting from scratch or already working in healthcare, understanding the full picture — from certified nursing assistant all the way to doctorate — helps you plan the most direct path to your goal.
The 6 levels of nursing at a glance
| Level | Credential | Education required | Median annual salary |
|---|---|---|---|
| Nursing Assistant | CNA | 4–12 weeks certificate | $39,430 |
| Licensed Practical Nurse | LPN/LVN | ~1 year certificate | $62,340 |
| Registered Nurse (ADN) | RN | 2 years | $93,600 |
| Registered Nurse (BSN) | RN | 4 years | $93,600 |
| Advanced Practice Registered Nurse | APRN | Master’s degree (6+ years) | $132,050 |
| Doctorate in Nursing | DNP or PhD | Doctoral degree (8–10 years) | $150,000+ |
Salary figures from the U.S. Bureau of Labor Statistics, 2024.
Certification — Certified Nursing Assistant (CNA)
Nursing assistants are often called Nursing Aides or Certified Nursing Assistants (CNAs). This is the entry point into the nursing profession and requires the least amount of education.
CNAs are usually the primary point of contact between patients and medical staff. They provide basic care in settings like nursing homes, hospitals, and community health centers. Typical duties include:
- Measuring vital signs
- Helping patients eat, bathe, and dress
- Assisting with mobility and patient transfers
- Documenting changes in patient condition
Median annual salary: $39,430 (BLS, 2024)
How to become a CNA
With a high school diploma or GED, you can complete a state-approved CNA program at a community college in as little as four weeks (most programs run four to twelve weeks). After completing the program, you must pass a state competency exam to earn your CNA certification.
Once certified and experienced, some CNAs advance to become Certified Medication Aides (CMAs), who are responsible for administering daily medications to patients under nurse supervision.
Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)
The Licensed Practical Nurse is the second rung on the nursing ladder — a critical level that many students overlook when planning their career. LPNs (called LVNs in California and Texas) work under the supervision of RNs and physicians and carry a broader scope of practice than CNAs.
LPNs are responsible for:
- Monitoring patient health and vital signs
- Inserting catheters and starting IVs
- Changing wound dressings and bandages
- Administering medications (scope varies by state)
- Communicating between the patient and the care team
LPNs work in nursing homes, long-term care facilities, outpatient clinics, and increasingly in home health settings.
Median annual salary: $62,340 (BLS, 2024)
How to become an LPN
LPN programs typically take 12 to 15 months to complete and are offered at community colleges and vocational schools. The curriculum covers nursing fundamentals, anatomy and physiology, and pharmacology, plus supervised clinical hours. After completing the program, candidates must pass the NCLEX-PN licensing exam.
Many LPNs use their credential as a stepping stone to an RN license through LPN-to-ADN bridge programs.
Associate Degree in Nursing (ADN)
The Associate Degree in Nursing (ADN) is the fastest path to becoming a Registered Nurse. ADN programs take approximately two years to complete and are offered at community colleges and vocational schools, often through flexible evening and weekend schedules.
ADN programs focus on technical nursing skills rather than theory-heavy coursework, making them well-suited for students with work or family obligations. After graduating, ADN nurses sit for the NCLEX-RN to earn their RN license.
Median annual salary (RN): $93,600 (BLS, 2024)
Around 30% of ADN graduates go on to pursue a Bachelor of Science in Nursing (BSN) through an RN-to-BSN bridge program.
LPN-to-ADN
Licensed practical nurses can often accelerate an ADN by receiving credit for prior coursework and clinical experience. Some employers offer tuition reimbursement to LPNs pursuing RN licensure.
Diploma in Registered Nursing
Hospital-based diploma programs are less common than they once were but still exist. A diploma in nursing functions similarly to an apprenticeship — it emphasizes clinical hours over general education and theory.
Programs typically take 18 to 32 months and are offered directly through hospital systems. Graduates are eligible to take the NCLEX-RN and earn full RN licensure.
Bachelor of Science in Nursing (BSN)
The BSN is the degree most associated with career stability and advancement in nursing. It takes four years to complete as a first-time student and includes coursework in evidence-based practice, leadership, public health, and research — areas not covered as deeply in ADN programs.
Most hospitals seeking Magnet status require or strongly prefer BSN-prepared nurses for leadership roles. A BSN also opens the door to faster admission to MSN programs.
Median annual salary (RN): $93,600 (BLS, 2024)
RN-to-BSN
If you’re already an RN with an ADN, the RN-to-BSN program is designed for you. These programs recognize your prior nursing credits and clinical experience, allowing most working nurses to complete the degree in about two years — often online.
Second Degree BSN
Non-nurses who already hold a bachelor’s degree in another field can pursue an accelerated Second Degree BSN. These programs apply liberal arts credits from your existing degree toward the BSN requirements and can be completed in two years or less.
LPN-to-BSN
This bridge program allows LPNs to skip the ADN step entirely and proceed directly to BSN-level education, typically completing the degree in about two years of full-time study.
Master of Science in Nursing (MSN)
A Master of Science in Nursing (MSN) prepares nurses for advanced clinical practice, leadership, education, and administration. Traditional MSN programs take 18 to 24 months of full-time study beyond a BSN.
MSN graduates can qualify as one of four Advanced Practice Registered Nurse (APRN) roles:
- Nurse Practitioner (NP) — provides primary or specialty care with prescriptive authority
- Certified Registered Nurse Anesthetist (CRNA) — administers anesthesia for surgical procedures
- Certified Nurse Midwife (CNM) — manages obstetric and gynecological care
- Clinical Nurse Specialist (CNS) — serves as an expert resource and consultant in a specialty area
APRN median annual salary: $132,050 (BLS, 2024)
Highest-paying APRN specialties:
- CRNAs: $231,700/year
- Nurse midwives: $128,110/year
- Nurse practitioners: $132,000/year
RN-to-MSN
RNs with an ADN can enter an RN-to-MSN program directly, skipping the stand-alone BSN degree. These programs typically take three to four years and lead directly to an advanced practice specialty.
Many MSN programs are available in hybrid or fully online formats, and employers frequently offer tuition reimbursement for nurses pursuing advanced credentials.
Highest level of nursing — Doctorate (DNP or PhD)
The highest levels of nursing education are the Doctor of Nursing Practice (DNP) and the Doctor of Philosophy (PhD) in nursing. Both are terminal degrees, but they serve different purposes.
Doctor of Nursing Practice (DNP)
The DNP is a practice-focused doctorate designed for nurses who want to operate at the highest level of clinical care, lead health systems, or shape healthcare policy. Most DNP programs take three to four years of full-time study beyond a master’s degree, or four to six years from a BSN through BSN-to-DNP pathways.
The doctor of nursing practice curriculum emphasizes evidence-based practice, systems leadership, quality improvement, and health informatics.
Doctor of Nursing Science (DNS)
DNS graduates are nurse scientists with investigative skills and strong clinical and leadership capabilities. The degree is similar in scope to a DNP but with more emphasis on systems-level research. Full-time programs typically take five years to complete.
Many DNS graduates go on to serve as chief nursing officers in public and private health systems.
Doctor of Philosophy (PhD) in nursing
The PhD is a research-focused doctorate that advances the theoretical foundation of nursing science. PhD programs take four to five years of full-time study and require an original dissertation. Unlike DNP and DNS programs, PhD students are not required to complete clinical hours — their work is primarily academic and scientific.
Most PhD students receive scholarships or grants. Graduates typically pursue careers in academia, research, or health policy.
Frequently asked questions
What are the different levels of nursing?
There are six levels of nursing in the US: Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN/LVN), Registered Nurse with an ADN, Registered Nurse with a BSN, Advanced Practice Registered Nurse (APRN) with an MSN, and Doctorate-prepared nurse (DNP or PhD).
What is the highest level of nursing?
The highest level of nursing is a doctorate — either the Doctor of Nursing Practice (DNP) for clinical and systems leadership, or the Doctor of Philosophy (PhD) for research and academia. Both require at least eight to ten years of post-secondary education.
What is the difference between an LPN and an RN?
LPNs complete a one-year certificate program and work under RN or physician supervision with a narrower scope of practice. RNs complete a two- or four-year degree and hold an independent license with a broader scope of practice, including care planning and complex clinical assessment.
Can you go from CNA to RN?
Yes. Many CNAs advance to RN by completing an ADN program (two years). Some programs give credit for healthcare work experience, which can shorten the path. From there, an RN-to-BSN bridge program can follow.
What level of nursing makes the most money?
Certified Registered Nurse Anesthetists (CRNAs) are typically the highest-paid nurses, with a median annual salary of $231,700 according to BLS data. CRNAs require a DNP degree in most states.
Nursing career progression overview
The levels of nursing build on each other. Most nurses start at the CNA or LPN level to gain clinical experience, then advance through RN licensure and onto specialized degrees. Each step up adds clinical responsibility, autonomy, and earning potential.
Check out our guide on how long it takes to become a nurse for a detailed timeline at each level.