The nursing profession features a structured career ladder with distinct educational, licensure, and responsibility tiers. While titles may vary slightly by state or institution, the 5 levels of nursing generally reflect increasing clinical expertise, scope of practice, and autonomy in patient care.
1. Certified Nursing Assistant (CNA)
The entry point into healthcare, CNAs provide basic patient care under nurse supervision. Duties include bathing, feeding, and monitoring vital signs. Certification requires a short training program and state exam. CNAs do not hold nursing licenses but support the care team.
2. Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)
LPNs (or LVNs in California and Texas) complete a one-year diploma program and pass the NCLEX-PN. They administer medications, perform wound care, and document patient status. However, their scope is limited compared to registered nurses.
3. Registered Nurse (RN)
RNs hold either an associate (ADN) or bachelor’s (BSN) degree and pass the NCLEX-RN. They assess patients, develop care plans, coordinate care, and supervise CNAs and LPNs. RNs work in hospitals, clinics, schools, and community settings.
4. Advanced Practice Registered Nurse (APRN)
APRNs hold a master’s or doctoral degree and national certification in a specialty. This level includes Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse-Midwives (CNMs), and Certified Registered Nurse Anesthetists (CRNAs). APRNs often diagnose conditions, prescribe medications, and manage treatment independently—sometimes without physician oversight, depending on state law.
5. Doctor of Nursing Practice (DNP) or PhD in Nursing
At the highest level, nurses earn terminal degrees. The DNP focuses on clinical leadership, policy, and evidence-based practice. The PhD emphasizes research and academia. These roles shape healthcare systems, educate future nurses, and advance the science of nursing.
These 5 levels of nursing create a clear pathway from direct care support to executive, educational, or autonomous clinical practice. Each level builds on the previous one, requiring additional education, licensure, and clinical judgment.
It is important to note that not all nurses progress through every tier. Many RNs have long, impactful careers without becoming APRNs. Likewise, CNAs and LPNs provide essential, irreplaceable care.
In summary, the 5 levels of nursing—CNA, LPN/LVN, RN, APRN, and doctoral-prepared nurse—reflect a profession that values both hands-on caregiving and advanced clinical leadership. Understanding these tiers helps aspiring nurses plan their education and career trajectory with clarity and purpose.