How far do you want to go with your nursing career? Whether you want to focus on patient care or rise to a top position in a healthcare organization, many doors are open to you. But which doors open, and when, depends on your nursing degree and professional experience. Additionally, there are specialties, state-mandated exams, and varying job titles within each level of nursing that you should consider when applying to programs and planning your healthcare career.
This article will give you an in-depth understanding of the different levels of nursing and which types of degrees and exam certifications are required for each, starting with entry-level nursing positions and up to master’s and doctoral-level roles.
1. Certified Nursing Assistant
Position description: Certified nursing assistants (CNAs) typically work in home care and long-term care settings. Also referred to as “nursing assistants” and “nursing aides,” CNAs often serve as the primary point of contact between the patient’s family members and the healthcare organization. They assist with the patient’s daily activities such as bathing, dressing, eating, and ambulating. CNAs provide companionship for their patients as well as compassionate care. Depending on state regulations and training, they may administer medication, take vital signs, fill out patient charts using electronic medical record software, and other tasks that don’t require advanced training.
Requirements: Becoming a CNA typically requires a high school diploma or GED, as well as completion of a state-approved CNA program.1 These programs usually take 3 to 8 weeks to complete and require a specified number of training hours, classroom hours, and lab or clinical practice. Once program requirements are completed, aspiring CNAs must pass a state-approved exam to earn their CNA title and become state-certified.
CNA median annual salary (2019): $14.25/hour, $29,640/year
Projected growth (2019–2029): Much faster than average (8% or higher), with 119,500 expected job openings.2
2. Licensed Practical Nurse
Position description: Licensed practical nurses (LPNs), also known as licensed vocational nurses (LVNs), are responsible for providing patient care by acting as the primary communicator between the care team and patient. They also may be responsible for communicating with the patient’s family. LPNs monitor patients’ health and do some physical care tasks, such as taking blood pressure, inserting catheters, starting IVs, and changing bandages. Whether or not the LPN needs supervision to perform these tasks varies by state.
Requirements: Becoming an LPN does not require an associate or bachelor’s degree, but rather, the successful completion of a Practical Nursing Program. These programs can be completed within one year and are designed for people who are working while attending the program. To receive your state license, which grants you the ability to practice, you must pass the National Council Licensure Examination for Practical Nurse (NCLEX-PN).
LPN median annual salary (2019): $22.83/hour, $47,480/year
Projected employment growth (2019–2029): Much faster than average (9% or higher), with 65,700 expected job openings.3
3. Registered Nurse
Position description: Most people equate the word “nurse” with the role of a registered nurse (RN). RNs have a broad range of responsibilities, including administering medication, contributing to a patient’s plan of care, and collaborating with medical doctors. In some workplaces, RNs oversee CNAs and LPNs. Once you reach the RN level of nursing, more specialized positions open up, such as cardiac care nurse, case management nurse, and flight nurse.4
To become an RN, you must earn either an Associate of Science in Nursing (ASN) or a Bachelor of Science in Nursing (BSN). After successfully graduating from either type of program, you must then take and pass the NCLEX-RN exam, not to be confused with the NCLEX-PN for practical nurses.
RN median annual salary (2019): $35.24/hour, $73,300/year
Projected growth (2019–2029): Faster than average (7% or higher) with 221,900 expected job openings.5
In most states, an ASN and BSN degree, along with passing the NCLEX-RN exam, will qualify you to work as an RN. However, some states are looking to push legislation that requires RNs to have a BSN. The State of New York did so in 2018, requiring a bachelor’s degree within the next 10 years to practice as an RN.6 Below, you will find more information on how the two degrees differ and the degrees’ long-term effects on your career path.
Associate of Science in Nursing
Becoming an RN through an associate program is ideal for those who do not want to attend a four-year program. In the past, these programs were typically offered through community colleges. Now, however, some four-year institutions are offering ASN programs, and hybrid programs (which combine online and in-person learning) are also becoming increasingly popular.7
Bachelor of Science in Nursing
In today’s job market, the BSN degree leads, in general, to better salaries and more open doors.8 BSN programs typically take four years to complete and may require full-time immersion. However, hybrid BSN programs are available for those who need to work while earning their degree.
Do note, though, that it is becoming increasingly mandatory for RNs to complete BSN degree programs. Some states now require RNs with ASNs to return to school for further teaching and training. One driver for this trend is that several studies have demonstrated better patient outcomes when RNs have a BSN.9
4. Advanced Practice Registered Nurse
Position description: To become an advanced practice registered nurse (APRN), you must be an RN ready to take on more of a leadership role in patient care. While RNs often focus on implementing a plan of care, APRNs focus on directing a plan of care. Becoming an APRN often requires further education, such as a Master of Science in Nursing (MSN). Types of APRNs include nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists.
The University of St. Augustine for Health Sciences (USAHS) offers an MSN program with a Family Nurse Practitioner (FNP) role specialty, which leads to becoming a nurse practitioner (and therefore an APRN). NPs perform all the typical duties of an RN, as well as diagnose and treat illnesses, prescribe medication (with physician supervision in some states), advise on public health issues, and provide more advanced interventions. NPs with an MSN degree work not only in hospitals and long-term care settings but also in private practice and community clinics.10
Requirements: If you want to study to become an APRN, you must have an RN license and usually at least one year of experience working as an RN. After you earn your degree, you must pass a certification exam from an accredited national organization, such as the American Academy of Nurse Practitioners Certification Board.
APRN median annual salary (2019): $55.67/hour, $115,800/year
Projected employment growth (2019–2029): Much faster than average (45% increase) with 117,700 expected job openings.11
5. Master of Science in Nursing
Position description: A Master of Science in Nursing (MSN) is not a role but a degree—the degree you need to become a nurse practitioner (NP) or to choose another role specialty.
USAHS offers three specialties within its MSN program: Family Nurse Practitioner, Nurse Educator, and Nurse Executive. Earning your master’s degree is a chance for you to advance your education in your area of greatest interest, whether that’s providing better patient care, educating the next generation of practitioners, or running an organization.
Requirements: Most MSN programs require candidates to have practiced as an RN with a BSN for at least one year. Other admissions requirements for MSN programs may include a background check, a resume or curriculum vitae, and professional references. Within USAHS’ MSN curriculum, the number of credit and contact hours needed depends on the role specialty.
APRN median annual salary (2019): $55.67/hour, $115,800/year
Projected employment growth (2019–2029): Much faster than average (45% increase) with 117,700 expected job openings.12
6. Doctor of Nursing Practice
Position description: Like the MSN, the Doctor of Nursing Practice (DNP) is not a role but a degree, and doctoral-level preparation can be considered as the next level of nursing above the MSN. DNP programs are for those who want to reach one of the highest levels of nursing, along with the PhD. DNPs have a doctoral-level knowledge of healthcare policy, nursing practice, health information systems, and organizational leadership. Attending a DNP program is best for experienced nurses who enjoy creative problem-solving and turning strategy into practice.
Requirements: You can apply for a DNP nursing program with either a BSN or an MSN. BSN-entry students will have a longer plan of study. Two common DNP role specialties are Family Nurse Practitioner (FNP) and Nurse Executive. Similar to MSN programs, a DNP typically requires you to have worked at least one year as an RN or APRN. If you are an RN, you will likely need to have a BSN rather than an ASN degree. USAHS’ DNP curriculum consists of 42–71 credits and 540–1035 practicum hours, depending on which degree you enter with and which role specialty you choose.
APRN median annual salary (2019): $55.67/hour, $115,800/year
Projected employment growth (2019–2029): Much faster than average (45% increase) with 117,700 expected job openings.13
7. Nurse Managers and Executives
Position description: Nurse managers and nurse executives can help run clinics, or they may work for a hospital system at the C-suite level by helping strategize and plan care for hundreds of patients. If you aspire to the top levels of administration, you will be less involved with direct patient care, but your decisions may have a broad impact on patients. You will need to cultivate qualities such as integrity and flexibility, and skills such as communication, critical thinking, and leadership.
Requirements: To become a nurse manager or executive, you will likely need an MSN or DNP with a role specialty in executive leadership.
How to Choose Your Level of Nursing
When considering which level of nursing is best for you, think about your short and long-term career goals, and what environment excites you most. Do you thrive when working with patients or do you want to influence larger organizational decisions? Consider where you thrive best, so as not to experience nurse burnout. Regardless of which nursing level you strive for, remember that more education is available to help you further your career.
The University of St. Augustine for Health Sciences (USAHS) offers Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), and Post-Graduate Nursing Certificates designed for working nurses. Our degrees are offered online, with optional on-campus immersions* (currently postponed due to COVID-19). Role specialties include Family Nurse Practitioner (FNP), Nurse Educator,** and Nurse Executive. The MSN has several options to accelerate your time to degree completion. Complete coursework when and where you want—and earn your advanced nursing degree while keeping your work and life in balance.
*The FNP role specialty includes two required hands-on clinical intensives as part of the curriculum.
**The Nurse Educator role specialty is not available for the DNP program.
- Registered Nursing, “CNA Certification Requirements”: https://www.registerednursing.org/certified-nursing-assistant/certification/ [↩]
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Nursing Assistants and Orderlies,” last modified Sept. 1, 2020: https://www.bls.gov/ooh/healthcare/nursing-assistants.htm [↩]
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Licensed Practical and Licensed Vocational Nurses,” last modified Sept. 1, 2020: https://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm [↩]
- Johnson & Johnson, “Nursing Specialties”: https://nursing.jnj.com/specialty [↩]
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Registered Nurses,” last modified Sept. 1, 2020: https://www.bls.gov/ooh/healthcare/registered-nurses.htm [↩]
- Senate Bill 6728, State of New York. Cong. (2017–2018) Regular Session (Sen. John J. Flanagan): https://www.nysenate.gov/legislation/bills/2017/s6768 [↩]
- Theresa Granger (reviewer), “RN Diploma vs. ADN vs. BSN Degree: What’s the Difference?” Nurse Journal, Dec. 18, 2020: https://nursejournal.org/degrees/bsn/rn-and-bsn-degree-differences [↩]
- Nurse Journal, “Top 9 Advantages of a BSN Degree,” Dec. 3, 2020: https://nursejournal.org/degrees/bsn/top-advantages-of-a-bsn-degree/ [↩]
- American Association of Colleges of Nursing, “Fact Sheet: The Impact of Education on Nursing Practice,” last updated April 2019: https://www.aacnnursing.org/Portals/42/News/Factsheets/Education-Impact-Fact-Sheet.pdf [↩]
- American Nurses Association, “Advanced Practice Registered Nurse (APRN)”: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn [↩]
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners,” last updated April 2020: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm [↩]
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners,” last updated April 2020: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm [↩]
- Ibid. [↩]
