The nursing profession follows a clear hierarchical structure defined by education, licensure, and scope of practice. These 5 levels of nursing represent progressive stages of clinical responsibility, autonomy, and leadership in patient care.
1. Certified Nursing Assistant (CNA)
The entry-level role in patient care. CNAs assist with basic needs such as bathing, feeding, and mobility under the supervision of licensed nurses. Certification requires a state-approved training program and competency exam. CNAs do not hold nursing licenses but are essential to daily care delivery.
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, monitor vital signs, and provide wound care. Their scope is limited compared to RNs and they work under the direction of registered nurses or physicians.
3. Registered Nurse (RN)
RNs hold either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) and pass the NCLEX-RN. They assess patients, develop care plans, coordinate care teams, and make clinical judgments. RNs work in hospitals, clinics, schools, and community settings. This is the foundational professional level in nursing.
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 diagnose conditions, prescribe medications, and manage patient care—often independently, depending on state law.
5. Doctor of Nursing Practice (DNP) or PhD in Nursing
The highest academic and professional level in nursing. The DNP focuses on clinical leadership, evidence-based practice, and system improvement. The PhD emphasizes research, theory development, and academia. These roles shape policy, lead healthcare innovation, and educate future nurses.
These 5 levels of nursing form a structured career pathway—from direct care support to executive leadership and research. Each level requires additional education, licensure, and experience. Not all nurses advance through every tier, but each level contributes uniquely to the healthcare system.
The 5 levels of nursing—CNA, LPN/LVN, RN, APRN, and doctoral-prepared nurse—reflect a profession grounded in service, science, and continuous growth. Understanding these tiers helps aspiring nurses plan their education and define long-term career goals with clarity and purpose.