What Is the Nursing Hierarchy & Why Is It Important?
The nursing hierarchy refers to levels of nursing care, ranging from entry-level nursing assistants to advanced clinical and non-clinical specialists. Each nurse rank has distinct requirements that justify its scope of practice.
Nurse ranks are essential to providing quality patient care. Understanding your rank and scope of practice allows you to know exactly when you can administer a nursing intervention, delegate tasks, or ask for help from a higher-ranking nurse.
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What Are the Levels of Nursing?
1. Certified Nursing Assistant (CNA) / State Tested Nursing Assistant (STNA)
An STNA and CNA are essentially the same roles with different titles based on your state of practice. CNAs help patients with activities of daily living and other healthcare needs under the direct supervision of a registered nurse (RN) or licensed practical nurse (LPN).They must complete a state-approved training program to earn their licensure.
- Requirements: CNA programs typically have a minimum age requirement of 16-18 years, require a high school diploma or GED equivalent, a criminal background check, and a written competency test
- Education: 4-12 week CNA program, certification exam, and state license
- Annual Salary: $35,760 per year, $17.19 per hour (BLS)
- Career Outlook:4% growth from 2022-2032 (BLS)
>> Click to See the Top 10 Online RN to BSN Programs
2. Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)
LVNs and LPNs are interchangeable titles depending on where you work. California and Texas use LVN, and the rest of the United States uses LPN.
As an LPN/LVN, you can work in hospitals, nursing homes, and other medical facilities. Typical LPN responsibilities include basic patient care and comfort measures, like bathing, bandage changing, and checking vitals. Usually, they work under the guidance of an RN or medical doctor (MD).
- Requirements: To get into an LPN program, you'll need a high school diploma or GED equivalent and be at least 18 years old
- Education: 1-2 year LPN/LVN diploma or degree program, passing NCLEX-PN score, and state licensure
- Salary: $54,620 per year, $26.26 per hour per BLS
- Career Outlook: 5% growth from 2022-2032 (BLS)
3. Registered Nurse (RN)
Registered nurses administer hands-on patient care in various settings like hospitals, medical offices, nursing homes, and other healthcare facilities. As a registered nurse, you'll work with physicians and healthcare team members to administer nursing interventions and provide treatment. You'll also educate patients and families about health issues.
- Requirements:RN programs require a high school diploma or GED equivalent, nursing school prereqs like high school biology and college-preparatory math, and passing entrance exam scores
- Education: 2-year RN diploma program, 2-year Associate Degree in Nursing (ADN) program, or 4-year Bachelor of Science in Nursing (BSN) program, passing NCLEX-RN score, and state licensure
- Salary:$81,220 per year, $39.05 per hour (BLS)
- Career Outlook: 6% growth from 2022-2032 (BLS)
>> Related: Top 10 No Entrance Exam Nursing Schools
4. Advanced Practice Registered Nurse (APRN)
APRNs are highly educated nursing experts who attend specialty programs focused on their practice fields. In many states, APRNs can prescribe medication and practice independently, while in other states, they practice under the oversight of an MD.
The four APRN specialties are:
- Nurse Practitioner (NP)
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
>> Related: What is Full Practice Authority for Nurse Practitioners?
- Requirements:APRN programs require an undergraduate nursing degree with a minimum GPA (often 3.0-3.5), 1-2 years of nursing experience, letters of recommendation, admissions interviews, and prerequisite courses
- Education: 2-3 year MSN degree or 3-4 year DNP degree (CRNAs must have a DNP by 2025), clinical hours, and state board licensure
- Salary: $125,900 per year, $60.53 per hour (BLS)
- Career Outlook: 38% growth from 2022-2032 (BLS)
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5. Non-Clinical Advanced Nursing Specialties
Like APRNs, non-clinical advanced nursing specialties require graduate degrees. However, these degrees focus primarily on leadership, administration, education, or research.
Graduates from non-clinical programs often find jobs as nursing directors and administrators, nurse educators, informatics nurses, and research nurses, which are some of the highest nursing positions.
- Requirements: To get into a non-clinical graduate program, you usually need an undergraduate degree with a minimum GPA (often 3.0-3.5), 1-2 years of nursing experience, letters of recommendation, admissions interviews, and prerequisites
- Education: Non-clinical advanced nursing specialties require an MSN, DNP, or 4-5 year Ph.D. in Nursing
- Salary: $100,000 - $112,000 per year (Payscale1)
- Career Outlook: Varies by job, ranging from 8% to 28% growth from 2022 to 2032 in relevant BLS categories
1Data pulled from Payscale MSN, DNP, and Ph.D. in Nursing salary reports
Nursing Degrees and Diplomas Ranked From Lowest to Highest
Each level of nursing has its own education requirements. The following is a brief overview of nursing degree levels and their corresponding nurse ranks.
You can learn more about each degree and certification in our complete guide to nursing degrees.
1. CNA Certification
- Program Length: 4-12 weeks
- Nurse Rank:Certified Nursing Assistant
As the lowest rank in the nursing hierarchy, CNAs earn the smallest salaries and have the most narrow scope of practice. CNA programs include classroom training and clinical instruction, culminating in a two-part knowledge and skills test.
>> Related: CNA Certification Requirements by State
2. LPN Diploma or Degree
- Program Length:1-2 years
- Nurse Rank: Licensed Practical/Vocational Nurse
You may attend a diploma or associate's degree program to become an LPN. Typically found at community colleges and vocational schools, LPN programs consist of didactic training, hands-on labs, and clinical rotations.
>> Related: RN vs LPN Differences
3. RN Diploma
- Program Length: 2 years
- Nurse Rank: Registered Nurse
RN diplomas are the least common route to becoming a registered nurse. Typically offered at hospitals and vocational schools, the RN diploma isnot a college degree. However, these programs do prepare you for the NCLEX-RN exam and qualify you for state licensure.
4. Associate Degree in Nursing (ADN)
- Program Length: 2 years
- Nurse Rank:Registered Nurse
ADN curriculum focuses on clinical skills and prepares students for direct patient care roles. From a bedside nursing position, ADN-RNs can make several lateral career moves, including working outside hospital settings as nurse case managers or aesthetic nurses.
5. Bachelor of Science in Nursing (BSN)
- Program Length:4 years
- Nurse Rank:Registered Nurse
BSN graduates take the same NCLEX as diploma and ADN-trained nurses. However, an expanded education that includes nursing theory makes BSN-RNs preferred by employers.
>> Show Me Online RN-to-BSN Programs
6. Master of Science in Nursing (MSN)
- Program Length: 2-3years
- Nurse Rank:APRN, Non-Clinical Advanced Specialist
The master's level of nursing education is the first milestone for nurses who want to enter non-clinical specialties, including nursing informatics and public health.Several MSN degrees also bring nurses to the advanced practice registered nursing level. MSN-trained APRNs can become nurse practitioners, clinical nurse specialists, and certified nurse midwives.
>> Show Me Online MSN Programs
7. Doctor Of Nursing Practice (DNP)
- Program Length: 3-4 years
- Nurse Rank:APRN, Non-Clinical Advanced Specialist
The DNP is the highest level of nursing education that prepares nurses for administrative and APRN positions. As thought leaders, DNPs also implement health policy and influence healthcare outcomes. While many DNP programs require a master's degree, you may attend a BSN to DNP program as a registered nurse.
As of 2025, nurse anesthetists must have a DNP degree, as per the updated CRNA guidelines.
>> Show Me DNP Programs
8. Ph.D. in Nursing
- Program Length:4-5 years
- Nurse Rank:Non-Clinical Advanced Specialist
The Ph.D. curriculum prepares nurses for planning, executing, and publishing evidence-based nursing research to improve nursing outcomes. To graduate as a Doctor of Philosophy in Nursing, you'll complete the program curriculum and conduct an independent research dissertation.
>> Related: DNP vs PhD in Nursing - What is the Difference?
What Level of Nursing is Right For Me?
Selecting an appropriate level of nursing for you depends on your professional goals. Several career nurses are happy to remain at the RN level until retirement. Registered nurses alone have so many specialization and lateral career options that moving up the hierarchy doesn't always feel necessary.
However, if you want to work as an APRN or non-clinical specialist, you must move up the nurse rankings. These positions are right for you if you seek to optimize your nursing salary, want a broader scope of practice, or want to work in non-bedside positions.
Ready to advance your career? Rise up the nurse ranks with these Nurse.org education guides:
- How to go From RN to BSN
- RN to BSN Programs Guide
- BSN to NP Programs Guide
- MSN to DNP Programs Guide
Nursing Ranks & Hierarchy FAQs
What are the different levels of nursing?
- Nursing levels start with certified nursing assistants and progress to licensed practical nurses, registered nurses, advanced practice nurses, and non-clinical specialties. Each rank has its own education standards.
What is the highest Nurse Position?
- Advanced practice registered nurses (APRNs) are the highest-level nurses. APRNs include certified nurse midwives (CNMs), clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), and nurse practitioners (NPs).
What comes first, RN or BSN?
- You can become an RN before earning a BSN by attending an accredited RN diploma or Associate Degree in Nursing. But you may start with a BSN to become a registered nurse if you wish.
What degree is higher than an RN?
- Registered nurse (RN) is a license that requires an RN diploma, ADN degree, or BSN degree. To pursue higher nursing positions, you'll need to attend graduate school to earn an MSN, DNP, or Ph.D. in nursing.
Who is higher, RN or LPN?
- An RN has more responsibility than an LPN. An LPN has some clinical practice limits, such as not being able to push IV medication.
