Levels of nursing: a complete guide to every degree and role

The United States has six distinct levels of nursing, each with its own degree requirement, license, scope of practice, and salary range. This guide — reviewed by Lindsay Smith, AGPCNP, a practicing Adult-Gerontology Primary Care Nurse Practitioner — walks through every level from Certified Nursing Assistant to Doctor of Nursing Practice, with comparison tables, bridge program options, and current Bureau of Labor Statistics salary data so you can plan the most direct path to your goal.

The nursing career ladder is designed so you can enter at any point and advance without starting over. Bridge programs connect nearly every level to the next one, and many employers offer tuition reimbursement to help you move up. Below, we break down the education, salary, licensing requirements, and scope of practice at each level of nursing.

The 6 levels of nursing at a glance

All salary figures from the U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2024.

Levels of nursing compared: time, cost, and scope

Tuition ranges vary widely by institution type (community college vs. private university) and state. Many employers offer tuition reimbursement, and federal financial aid covers most accredited programs. For a detailed look at how long nursing school takes, see our complete timeline guide.

Certified Nursing Assistant (CNA)

Nursing assistants — also called Nursing Aides or Certified Nursing Assistants (CNAs) — are the entry point into the nursing profession. CNAs require the least amount of education of any nursing credential and serve as the primary point of contact between patients and the rest of the care team.

CNAs work in nursing homes, hospitals, assisted living facilities, and community health centers. Their day-to-day responsibilities include:

• Measuring and recording vital signs (blood pressure, pulse, temperature, respirations)
• Helping patients with activities of daily living: eating, bathing, dressing, and toileting
• Assisting with mobility, repositioning, and patient transfers
• Documenting changes in patient condition and reporting to the supervising RN
• Maintaining infection control protocols and a clean patient environment

Median annual salary: $39,430 (BLS, May 2024) 10th–90th percentile range: $30,020–$48,780 Job outlook: 4% growth through 2032, with approximately 192,800 openings projected per year (BLS Nursing Assistants)

How to become a CNA

With a high school diploma or GED, you can complete a state-approved CNA program at a community college or vocational school in as little as four weeks. Most programs run four to twelve weeks and include both classroom instruction and supervised clinical hours. After completing the program, you must pass a state competency exam (written and skills components) to earn your CNA certification.

CNA certification requirements are regulated at the state level through each state’s Board of Nursing or Department of Health. The federal requirement, established by the Omnibus Budget Reconciliation Act (OBRA), mandates a minimum of 75 hours of training for CNAs working in Medicare- or Medicaid-certified facilities, though most states exceed this minimum.

Once certified and experienced, some CNAs advance to become Certified Medication Aides (CMAs), who are authorized to administer daily medications to patients under nurse supervision.

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

The Licensed Practical Nurse is the second level of nursing — a critical credential 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.

LPN responsibilities include:

• Monitoring patient health and recording vital signs
• Inserting catheters and starting IVs (where state scope permits)
• Changing wound dressings and bandages
• Administering medications including injections (scope varies by state)
• Performing basic diagnostic tests
• Communicating patient status updates to the RN or physician

LPNs work in nursing homes, long-term care facilities, outpatient clinics, home health agencies, and physician offices. Long-term care and skilled nursing facilities employ the highest number of LPNs, according to BLS data.

Median annual salary: $62,340 (BLS, May 2024) 10th–90th percentile range: $45,600–$77,860 Job outlook: 5% growth through 2032, with roughly 58,400 openings per year (BLS Licensed Practical Nurses)

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, pharmacology, nutrition, and medical-surgical nursing, plus supervised clinical hours in healthcare settings. After completing the program, candidates must pass the NCLEX-PN licensing exam, administered by the National Council of State Boards of Nursing (NCSBN).

Many LPNs use their credential as a stepping stone to RN licensure through LPN-to-ADN or LPN-to-BSN 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 that accommodate working students.

ADN programs focus on clinical nursing skills — patient assessment, medication administration, care planning, and hands-on bedside practice. The curriculum is more concentrated than a BSN program, with fewer general education requirements. After graduating, ADN students sit for the NCLEX-RN exam to earn their RN license.

ADN-prepared RNs hold the same license and pass the same NCLEX-RN as BSN-prepared RNs. The scope of practice is identical. The difference is in career mobility: many Magnet-designated hospitals and large healthcare systems prefer or require a BSN for leadership, charge nurse, and specialty roles.

Median annual salary (RN): $93,600 (BLS, May 2024) 10th–90th percentile range: $63,720–$132,680 Job outlook: 6% growth through 2032, with approximately 193,100 RN openings per year — the largest volume of any healthcare occupation (BLS Registered Nurses)

Around 30% of ADN graduates go on to pursue a Bachelor of Science in Nursing (BSN) through an RN-to-BSN bridge program, often while working full-time as an RN.

LPN-to-ADN

Licensed practical nurses can accelerate an ADN by receiving credit for prior coursework and clinical experience. LPN-to-ADN bridge programs typically take 12 to 18 months, compared to two years for a traditional ADN. 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 — only about 60 programs remain in the United States — but they still produce well-prepared RNs. A diploma in nursing functions similarly to an apprenticeship, emphasizing 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. Diploma-prepared RNs have the same scope of practice as ADN and BSN nurses.

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, nursing leadership, public health, community health, research methods, and health policy — areas not covered in depth by ADN programs.

The American Association of Colleges of Nursing (AACN) has long advocated for the BSN as the minimum entry-level degree for professional nursing. Their position is supported by research linking BSN-prepared nurses to improved patient outcomes. A landmark study published in The Lancet found that every 10% increase in BSN-prepared nurses on a hospital unit was associated with a 7% decrease in patient mortality.

Most hospitals seeking Magnet status — the gold standard designation from the American Nurses Credentialing Center (ANCC) — require or strongly prefer BSN-prepared nurses. A BSN also opens the door to faster admission to MSN programs and advanced practice roles.

Median annual salary (RN): $93,600 (BLS, May 2024) Job outlook: The same 6% growth rate applies to all RNs. However, BSN-prepared nurses are disproportionately favored in hiring. A 2024 AACN survey found that 41.2% of hospitals and healthcare facilities require new hires to hold a BSN.

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 12 to 18 months — often entirely online. Many employers cover the full cost of RN-to-BSN tuition through education benefits.

Second Degree BSN (accelerated 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 and science credits from your existing degree toward the BSN requirements. Most accelerated BSN programs run 12 to 18 months of intensive, full-time study including clinical rotations.

LPN-to-BSN

This bridge program allows LPNs to skip the ADN step entirely and advance directly to BSN-level education, typically completing the degree in about three years of full-time study. LPN-to-BSN students receive credit for their prior LPN coursework and clinical hours.

Master of Science in Nursing (MSN)

A Master of Science in Nursing (MSN) prepares nurses for advanced clinical practice, leadership, education, and healthcare administration. Traditional MSN programs take 18 to 24 months of full-time study beyond a BSN, though part-time and online options extend the timeline to three to four years.

An MSN is the gateway to becoming an Advanced Practice Registered Nurse (APRN). The Consensus Model for APRN Regulation, endorsed by the NCSBN, defines four APRN roles:

• Nurse Practitioner (NP) — provides primary or specialty care, diagnoses conditions, orders tests, and prescribes medications. NPs practice in over 20 specialty areas including family, pediatric, psychiatric-mental health, and acute care. As of 2026, 27 states plus DC grant NPs full practice authority without physician oversight.
• Certified Registered Nurse Anesthetist (CRNA) — administers anesthesia for surgical, obstetric, and diagnostic procedures. CRNAs provide over 80% of all anesthetics in rural America, according to the American Association of Nurse Anesthesiology (AANA). CRNA programs now require a doctoral degree (DNP or DNAP) for entry as of 2025.
• Certified Nurse Midwife (CNM) — manages pregnancy, labor and delivery, and postpartum care, plus gynecological and reproductive health services. CNMs attend approximately 12% of all U.S. births.
• Clinical Nurse Specialist (CNS) — serves as an expert clinical resource in a specialty area (cardiac, oncology, pediatrics, etc.), driving evidence-based practice and quality improvement at the unit or system level.

APRN salary by specialty

Source: BLS Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, May 2024

RN-to-MSN

RNs with an ADN can enter an RN-to-MSN program directly, bypassing the stand-alone BSN degree. These programs typically take three to four years and award both a BSN (en route) and an MSN upon completion. They lead directly to an advanced practice specialty or a leadership/education concentration.

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, meaning they represent the furthest academic achievement in their respective tracks.

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 through BSN-to-DNP pathways.

The DNP curriculum emphasizes evidence-based practice, organizational and systems leadership, quality improvement, health informatics, and healthcare economics. DNP students complete a scholarly project (sometimes called a DNP project) that addresses a real clinical or systems problem — this replaces the traditional dissertation required in PhD programs.

The AACN has recommended the DNP as the entry-level degree for all APRN roles. While this recommendation has not been universally adopted, CRNA programs transitioned to doctoral-level education (DNP or DNAP) as a requirement starting in 2025, and several other APRN specialties are moving in the same direction.

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 places additional emphasis on systems-level research and healthcare delivery science. 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 contributing new knowledge to the field. 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, fellowships, or research assistantships. Graduates typically pursue careers in academia (as nursing faculty), research institutions, or health policy organizations. The AACN reports a significant national shortage of PhD-prepared nursing faculty, which limits the number of students nursing schools can admit each year.

Salary by level of nursing

All data: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2024. Salary varies by state, employer type, years of experience, and specialty certifications.

Bridge programs: how to advance between levels of nursing

One of the most practical features of the nursing career ladder is the network of bridge programs connecting each level to the next. These programs grant credit for prior coursework and clinical experience, reducing both time and cost.

Bridge programs make it possible to reach the highest level of nursing even if you start as a CNA. A nurse who begins with a CNA certificate and advances through LPN, ADN, BSN, MSN, and DNP would complete approximately 10 to 12 years of education — but would be earning income from the CNA stage onward, often with employer-funded tuition at each step.

For a detailed breakdown of every pathway timeline, see our guide on how long nursing school takes.

How to choose the right level of nursing for you

Picking the right entry point depends on three factors: how much time you can invest upfront, what clinical role you want long-term, and your financial situation. The levels of nursing are designed as a ladder, so choosing a starting point does not lock you into a ceiling.

If you want to start working as soon as possible, a CNA certificate (four to twelve weeks) gets you into patient care immediately. From there you can pursue LPN or ADN programs while earning income.

If you want a full nursing career with room to grow, a BSN provides the strongest foundation. Most Magnet-designated hospitals prefer or require BSN-prepared nurses, and a BSN shortens the path to an MSN or DNP.

If you already have a degree in another field, an accelerated Second Degree BSN lets you transition into nursing in 12 to 18 months of intensive study, including clinical rotations.

If you want the highest clinical autonomy and earning potential, plan for at least a master’s degree. APRN roles (NP, CRNA, CNM, CNS) require an MSN at minimum, and the profession is shifting toward requiring a DNP for new APRN graduates. CRNAs already require doctoral preparation as of 2025.

If cost is a primary concern, community college ADN programs offer the most affordable path to RN licensure. You can start earning an RN salary — median $93,600/year — within two years and pursue an RN-to-BSN online while working. Many employers will cover the full tuition cost.

Job outlook across levels of nursing

The U.S. Bureau of Labor Statistics projects strong growth across nursing roles through 2032:

Source: BLS Occupational Outlook Handbook, 2024–2025 edition.

These projections reflect an aging U.S. population, a wave of RN retirements (the median RN age is 46), and expanding scope-of-practice laws that allow nurse practitioners to fill primary care gaps in underserved communities. Every level of nursing faces a shortage, with the demand sharpest at the APRN level — where 38% growth far outpaces the national average of 3% for all occupations.

For students weighing which level to enter, the takeaway is straightforward: nursing employment is stable at every credential tier, and upward mobility is built into the profession’s structure. Starting as a CNA or LPN does not mean staying there — bridge programs exist at every transition point, and how long nursing school takes depends largely on which bridges you use.

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 roles. Each step up adds clinical responsibility, autonomy, and earning potential.

A common progression through the levels of nursing:

1. CNA (4–12 weeks) — gain patient care experience and earn while deciding on your next step
2. LPN (12–15 months) — expand your clinical scope and earning potential to a median $62,340/year
3. ADN or BSN (2–4 years) — earn full RN licensure and access to most nursing specialties at a median $93,600/year
4. MSN (18–24 months post-BSN) — qualify for APRN roles with prescriptive authority at a median $132,050/year
5. DNP (3–4 years post-MSN) — reach the highest level of clinical practice, systems leadership, or health policy influence

Bridge programs — LPN-to-ADN, RN-to-BSN, RN-to-MSN, and BSN-to-DNP — let you move between levels without repeating prior work. If you’re wondering whether nursing school is worth the investment, our guide on is nursing school hard gives an honest assessment of what to expect.

Check out our guide on how long it takes to become a nurse for a detailed timeline at each level.

Use our interactive nursing salary comparison tool to sort and filter all nursing roles by median pay, entry-level salary, and job growth — all sourced from BLS data.

Frequently asked questions

What are the different levels of nursing?

There are six levels of nursing in the United States: Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN/LVN), Registered Nurse with an Associate Degree in Nursing (ADN), Registered Nurse with a Bachelor of Science in Nursing (BSN), Advanced Practice Registered Nurse (APRN) with a Master of Science in Nursing (MSN), and Doctorate-prepared nurse (DNP or PhD). Each level requires progressively more education, carries a broader scope of practice, and commands a higher salary.

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 are terminal degrees requiring at least eight to ten years of post-secondary education. Among clinical roles, CRNAs hold the highest-paying position with a median salary of $231,700/year (BLS, 2024).

What is the difference between an LPN and an RN?

LPNs complete a 12- to 15-month certificate program and pass the NCLEX-PN. They work under the supervision of an RN or physician and have a narrower scope of practice that varies by state. RNs complete either a two-year ADN or four-year BSN and pass the NCLEX-RN. RNs hold an independent license with a broader scope of practice that includes care planning, complex clinical assessment, medication administration, patient education, and delegation of tasks to LPNs and CNAs.

What is the difference between ADN and BSN nurses?

Both ADN and BSN graduates earn the same RN license by passing the NCLEX-RN, and their legal scope of practice is identical. The difference is in education depth: a BSN includes coursework in research methods, public health, community health, leadership, and evidence-based practice that an ADN program does not cover. In practice, BSN-prepared nurses have access to more leadership roles, Magnet-designated hospitals, and faster admission to graduate programs. A 2024 AACN survey found that 41.2% of hospitals require new hires to hold a BSN.

What is the fastest way to become a nurse?

The fastest path to RN licensure is an accelerated BSN program (12 to 18 months) for students who already hold a bachelor’s degree in another field. For students starting without a prior degree, an ADN program (about two years at a community college) is the quickest route. If you want to enter patient care even sooner, a CNA certificate can be completed in as little as four weeks.

Do nurses need a BSN?

No — you can become a registered nurse with an associate degree in nursing (ADN) and pass the NCLEX-RN. Many hospitals hire ADN nurses, especially in rural and community settings. However, an increasing number of employers prefer BSN-prepared nurses. Some states are considering legislation to require a BSN within a set timeframe after initial RN licensure. The AACN recommends the BSN as the minimum entry-level degree for professional nursing, and Magnet-designated hospitals typically require it for advancement.

What does a DNP do?

A Doctor of Nursing Practice (DNP) is a practice-focused doctoral degree. DNP-prepared nurses work in the highest levels of clinical care, healthcare administration, health policy, and systems leadership. Many DNPs practice as nurse practitioners, CRNAs, or nurse midwives with full prescriptive authority. Others lead quality improvement initiatives, serve as chief nursing officers, or shape healthcare policy at the state and federal level. The DNP is the terminal practice degree in nursing, distinct from the PhD, which focuses on research.

Can you go from CNA to RN?

Yes. Many CNAs advance to RN by completing an ADN program (about two years). Some programs grant credit for healthcare work experience, which can shorten the path. From there, an RN-to-BSN bridge program can follow. The full CNA-to-RN pathway typically takes two to three years depending on prerequisite courses and the specific program.

How long does it take to go through all the levels of nursing?

Going from no healthcare experience to a doctoral degree takes roughly ten to twelve years of full-time education: four to twelve weeks for a CNA, one year for an LPN, two years for an ADN or four for a BSN, two more for an MSN, and three to four additional years for a DNP or PhD. Bridge programs can shorten the timeline at each step. Importantly, you are earning income from the very first credential — most nurses fund their advancement through a combination of employer tuition reimbursement, federal financial aid, and working while in school.

What level of nursing makes the most money?

Certified Registered Nurse Anesthetists (CRNAs) are the highest-paid nursing professionals, with a median annual salary of $231,700 according to BLS 2024 data. CRNAs require doctoral-level education (DNP or DNAP) as of 2025. Among non-doctoral roles, nurse practitioners earn a median of $132,050/year and certified nurse midwives earn $128,110/year.