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Nursing professionals provide care, monitor vital signs, administer medicine, and advocate for their patients.
Have you ever considered a career in nursing but felt intimidated by the complex relationships between education, training, and certification in the field? We're here to help.
Aspiring nurses can use this guide to research the different levels, roles, and specialties available for nurses, along with education and training requirements.
What Are the Different Levels of Nursing?
For healthcare facilities to run properly, each level of nurse has to handle different patient care responsibilities. Nurses start their careers by earning nursing diplomas and performing basic caregiving tasks for patients, which allows them to accumulate clinical experience. Responsibilities can include designing and implementing treatment plans, administering medications, and recording vital signs. Nursing roles at the beginning level include nursing assistants or practical/vocational nurses.
Eventually, after gaining hundreds of hours of clinical experience and associate or bachelor's degrees from accredited schools, they can work as registered nurses (RNs). Many RNs go on to gain even more experience, along with master's degrees, and become advanced practice registered nurses (APRNs).
Once a nurse reaches the highest level, they can pursue specific roles in the nursing field or continue their education to pursue careers in education, administration, or policy advocacy.
Nursing Levels in Order by Education and Experience
Certified nursing assistants (CNAs) are not nurses. Instead, they are professionals who help nurses by providing basic care to patients, such as bed transfers, feeding, and changing clothes.
CNA certification does not require a college degree. Instead, aspiring CNAs must complete a 3-8 week CNA program, which includes 75 hours of clinical experience. Candidates then apply with their state boards to take the CNA exam and gain certification.
Licensed practical nurses (LPNs), also known as licensed vocational nurses (LVNs), have more high-level caregiving responsibilities than CNAs, such as administering medication and taking patients' vital signs. They communicate daily with doctors and nurses, usually working in hospitals, residential facilities, and clinics.
The position requires 500-750 clinical hours completed through a state-approved program, then passing the National Council Licensure Examination (NCLEX) through the National Council of State Boards of Nursing (NCSBN).
Registered nurses (RNs) uphold a high standard of patient care by performing health evaluations, providing consultations, and delivering treatment for various illnesses. They usually work in hospitals, physician's offices, and nursing care facilities. In some states, they must work under the supervision of an APRN or a physician.
RNs need at least an associate degree in nursing (ADN), though some employers prefer candidates with a bachelor of science in nursing (BSN). Clinical hour requirements vary by state, but most RNs complete 200-400 clinical hours. They must then take the NCLEX-RN exam to qualify for licensure.
APRNs have more responsibilities than RNs, often functioning independently and creating treatment plans. They also generally see more patients in hospitals, physician's offices, and other healthcare facilities.
Becoming an APRN requires a master of science in nursing (MSN) and 500 clinical hours, along with passing an exam from the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP). The specific exam depends on the specialization, which could include one of the following:
- Nurse practitioner
- Clinical nurse specialist
- Certified registered nurse anesthetist
- Certified nurse-midwife
Nursing Degrees in Order by Type and Required Education
The various types of nursing degrees give learners different options for their careers.
The lowest level of degree, a nursing diploma, can take as little as four weeks to complete and prepares graduates for entry-level pre-RN work. Meanwhile, an MSN typically takes two years to earn on top of the time it takes to earn a bachelor's. A master's-level education provides more options for employment at higher pay rates than a nursing diploma.
The "best" type of nursing degree is the one that fits your learning needs and meets your professional and personal goals.
Types of Nursing Degrees
Nursing diplomas typically take less than a year to complete, with some offering timelines of only a few weeks. Most nursing diploma programs include under 100 hours of clinical experience. Earning a diploma prepares a candidate for work as CNAs or LPN/LVNs, handling basic caregiving duties and serving as a bridge between patients and nurses. Nurses at this level usually work in hospitals, residential care, or nursing homes.
An ADN takes at least two years to complete and requires learners to complete around 300 hours of clinical experience. This degree provides the minimum level of education required for working as an RN in hospitals, clinics, and schools. Associate-level education qualifies individuals to handle more responsibilities in patient care than a diploma.
A BSN takes around four years to complete, though some programs allow students to complete their studies at an accelerated two-year pace. Programs usually require 300-400 clinical hours. Having a BSN is a competitive edge when seeking work as an RN, especially in a job market where many employers prefer candidates with four-year degrees. Nurses with BSNs usually work in hospitals, doctor's offices, and health clinics.
An MSN generally takes at least two years to complete. As part of an MSN program, students complete at least 500 hours of clinical experience. An MSN prepares graduates to work as APRNs, which encompasses specialized roles like nurse practitioner (NP) or certified nurse-midwife (CNM). Master's-level nurses are usually employed in hospitals, doctor's offices, or specialized settings. In some states, they can open private practices.
A doctor of nursing practice (DNP) takes 3-6 years and 1,000 clinical hours to complete. This degree qualifies graduates to work as APRNs, professors, or nurse researchers. DNPs generally work in hospitals, health clinics, or their own autonomous practices, but they can also work as educators and researchers in higher education and healthcare policy organizations.
A doctor of philosophy in nursing (Ph.D.) takes 3-6 years to complete. As part of the degree, students also complete 1,000 clinical hours. These nurses work as educators, researchers, and policymakers. A Ph.D-level nurse can commonly find specialized employment in colleges, universities, and healthcare policy organizations.
Common Types of Nursing Certifications
Professionals can use nursing certifications to pursue specialty nursing careers and patient focuses. Most nursing certifications are tailored to APRNs, but some certifications only require a BSN or RN license.
Below are some of the most common types of nursing certifications, including both job-related and specialty-related certifications.
The HIV/AIDS Nursing Certification Board (HANCB) offers certifications for RNs who provide physical and emotional care for HIV/AIDS patients. The certification covers basics such as laboratory evaluations, disease prevention, and the HIV life cycle.
RNs working to care for patients with HIV/AIDS can pursue the AACRN credential, also offered by HANCB. This certification emphasizes emotional and mental support for HIV/AIDS patients.
The CDN credential certifies RNs who hold 2,000 hours of clinical experience in nephrology nursing (kidney care), primarily caring for dialysis patients. The CDN exam comprises 150 questions.
The CHPCA is a credential for nurses in administrative roles in hospice or palliative care. However, this certification is currently offered only through recertification, meaning that new nurses cannot earn the credential.
Aspiring nursing assistants often pursue this credential. It certifies the bearer to perform basic caregiving duties for patients in most healthcare settings.
The CNE certification is for doctoral nursing students who wish to teach nursing in colleges or universities. Nurses with the CNE designation have skills in curriculum design, teaching, and advisement as well as the normal nursing skills.
The CNL certification for clinical APRNs demonstrates skills in quality improvement, risk assessment, and care coordination. CNL-credentialed nurses use their leadership skills to strive for quality improvement in healthcare.
CENP, sometimes referred to as chief nursing officer certification (CNO), is a credential available to APRNs with extensive experience in executive managerial roles.
The CRNA certification provides credentials for APRNs who administer anesthesia for patients undergoing surgical, obstetrical, or trauma procedures.
The OCN designation certifies RNs to provide care and counseling to cancer patients. The certification requires RNs to accumulate 1,000 clinical hours in oncology practice.
Types of Nursing Specialties
Nurses commonly choose a population or health field specialty, such as obstetrics or hospice care. Finding a focus in your nursing career can lead to higher earnings and more job offers, especially if you earn a related professional certification. The following list represents some of the more common types of nursing specialties pursued, though it is not comprehensive.
- Critical care
- Community health
- Coronary care
- Emergency room
- Hospice care
- Post-anesthesia care
- Psychiatric-mental health
Possible Pathways to Becoming an RN
Prospective RNs can take several routes to entering the workforce. They can transition directly from earning ADNs to sitting for the RN exam or they can transfer to online, hybrid, and on-campus bachelor's programs. Many students take the traditional route, simply completing BSN programs as their preparation for the exam and certification.
Other students may work as CNAs, allowing them to gain experience in the workplace. They can later apply to CNA-to-BSN programs to prepare for more advanced certification.
National Council of State Boards of Nursing's NCLEX Exam
All RNs and higher must take the NCLEX-RN exam at some point in their nursing journey. The NCLEX is a comprehensive exam required to gain RN certification. The NCSBN administers the exam through each state's board of nursing, which may also have their own eligibility requirements for sitting to take the exam.
Possible Pathways to Becoming an APRN
APRNs can pursue many different roles within nursing, often with advanced salary prospects. The most common specialized careers available to APRNs are nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse midwife (CNM), and certified registered nurse anesthetist (CRNA). These careers all offer high wages and career specialization.
Licensure requirements for each of the following roles vary by state, and only some states maintain reciprocity agreements.
NPs help create care plans for patients. Their duties include prescribing medication, interpreting medical tests, and diagnosing illnesses. NPs usually work in hospitals, office practices, and private clinics. To work as a licensed NP, you need to pass an AANP exam.
CRNAs administer anesthesia to patients undergoing surgical, obstetrical, and trauma procedures. They work in collaboration with anesthesiologists, surgeons, and other highly skilled specialists in office practices, hospitals, and inpatient care clinics. These professionals need CRNA certification, which commonly requires at least a master's degree.
CNMs help women prepare for and give birth by providing prenatal and postpartum care, assisting obstetricians, and delivering babies. Their work settings can include midwifery clinics, women's health centers, and even people's private homes. These specialized APRNs need CNM certification from the American Midwifery Certification Board for licensed practice.
A CNS works to improve health care delivery systems through research. They work in managerial positions, providing consultation and overseeing the development of practice studies. To work as a licensed CNS, you need certification from ANCC.
Popular Acronyms in Nursing
The following list includes some common acronyms in nursing, but does not represent every certification or title used in the nursing field.
- AACRN - Advanced HIV/AIDS certified registered nurse
- ACNP - Acute care nurse practitioner
- ACRN - HIV/AIDS certified registered nurse
- ADN - Associate degree in nursing
- ALNC - Advanced legal nurse consultant
- ANP - Adult nurse practitioner
- APRN - Advanced practice registered nurse
- ASN - Associate of science in nursing
- BSN - Bachelor of science in nursing
- CBCN - Certified breast cancer care nurse
- CDN - Certified dialysis nurse
- CHPCA - Certified hospice and palliative care administrator
- CNA - Certified nursing assistant
- CNE - Certified nurse educator
- CNL - Clinical nurse leader
- CNO - Chief nursing officer
- CNS - Clinical nurse specialist
- CRN - Certified radiologic nurses
- CRNA - Certified registered nurse anesthetist
- DNP - Doctor of nursing practice
- FNP - Family nurse practitioner
- GNP - Gerontological nurse practitioner
- LPN - Licensed practical nurse
- LVN - Licensed vocational nurse
- MSN - Master of science in nursing
- NA - Nursing assistant
- NCLEX–RN - National Council Licensure Examination for registered nurses
- NP - Nurse practitioner
- OCN - Oncology certified nurse
- PNP - Pediatric nurse practitioner
- RN - Registered nurse
- TCRN - Trauma certified registered nurse
Frequently Asked Questions
Within the nursing profession, the highest level of education is a DNP. APRNs hold the highest level of certification in the field, though nurses can also earn specialization credentials.
A clinical nurse is an APRN who works in a research and quality improvement role and performs less direct patient care than an RN.
The lowest level of nursing is working as a nursing assistant, which usually requires CNA certification, though exact requirements depend on the state. Regarding education, the lowest level of nursing comes from a diploma.
People usually abbreviate "nurse" with "RN" or "registered nurse." RNs are the middle and most common level of education and training for nurses.
Header Image Credit: The Good Brigade | Getty Images
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