Nursing: the career ladder

The steps at a glance

• Nursing assistants provide basic care and help patients with activities of daily living. [2]
• Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) provide basic medical care. [3]
• Registered nurses (RNs) provide and coordinate patient care and educate patients and the public about various health conditions. [1]
• Nurse anesthetists, nurse midwives and nurse practitioners coordinate patient care and may provide primary and specialty healthcare. [4]

The ladder, step by step

Here is each step, with the training, exam and pay its sources describe. Where a cited source describes a bridge program to the next step, it is shown.

National figures from the U.S. Bureau of Labor Statistics. Pay varies by state, setting and experience. This is not a promise of pay or a job.

1. Step 1 Nursing assistant (CNA in some states)

   Nursing assistants often need to complete a state-approved education program, and these programs are available in places including high schools, community colleges, and vocational and technical schools. [2]

   After completing an approved education program, nursing assistants often must pass a competency exam, and those who pass are placed on a state registry. [2]

   In some states a nursing assistant is called a Certified Nursing Assistant (CNA), but titles vary by state. [2]

   Median annual pay, May 2025$42,260

   The median annual wage for nursing assistants was $42,260 in May 2025. [2]

   Projected job growth, 2025–353%

   Overall employment of nursing assistants and orderlies is projected to grow 3 percent from 2025 to 2035. [2]

2. Step 2 Licensed practical or vocational nurse (LPN / LVN)

   LPNs and LVNs must complete a state-approved educational program, and these programs typically take about 1 year to complete. [3]

   Certificate and diploma programs are commonly found in community colleges and technical schools, including some high schools. [3]

   Prospective LPNs and LVNs must pass an exam to become licensed and enter the occupation. [3]

   The NCLEX-PN measures the competencies needed to perform safely and effectively as a licensed practical/vocational nurse, and member board jurisdictions use it to assist in making licensure decisions. [5]

   Median annual pay, May 2025$64,400

   The median annual wage for licensed practical and licensed vocational nurses was $64,400 in May 2025. [3]

   Projected job growth, 2025–353%

   Employment of licensed practical and licensed vocational nurses is projected to grow 3 percent from 2025 to 2035. [3]

   Typical entry-level educationPostsecondary nondegree award

   The typical entry-level education is a postsecondary nondegree award. [3]

   Bridge to the next step

   An LPN may complete an LPN-to-RN education program to become a registered nurse. [3]

3. Step 3 Registered nurse (RN): ADN, diploma or BSN

   Registered nurses usually take one of three education paths: a bachelor's degree in nursing, an associate's degree in nursing, or a diploma from an approved nursing program. [1]

   Bachelor of science in nursing (BSN) degree programs typically take 4 years to complete. [1]

   Diploma programs, usually offered by hospitals or medical centers, typically take 2 to 3 years to complete, and there are far fewer diploma programs than there are BSN, ADN and ASN programs. [1]

   Nursing education programs usually include courses in anatomy, physiology, microbiology, psychology, and social and behavioral sciences, and all programs include supervised clinical experience. [1]

   Employers, particularly those in hospitals, may require a bachelor's degree. [1]

   Registered nurses must have a nursing license issued by the state in which they work, and to become licensed, nurses must graduate from an approved nursing program and pass a qualifying exam. [1]

   The NCLEX-RN measures the competencies needed to perform safely and effectively as a newly licensed, entry-level registered nurse. [6]

   All RN candidates must answer a minimum of 85 items, and an RN candidate may answer a maximum of 150 items during the allotted five-hour period. [6]

   Median annual pay, May 2025$97,550

   The median annual wage for registered nurses was $97,550 in May 2025. [1]

   Projected job growth, 2025–356%

   Employment of registered nurses is projected to grow 6 percent from 2025 to 2035, faster than the average for all occupations. [1]

   Typical entry-level educationBachelor's degree

   The typical entry-level education is a bachelor's degree. [1]

   Bridge to the next step

   Registered nurses with an ADN, ASN or diploma may go back to school to earn a bachelor's degree through an RN-to-BSN program. [1]

4. Step 4 Advanced practice registered nurse (APRN): nurse practitioner, nurse anesthetist, nurse midwife

   An APRN (advanced practice registered nurse) must have a registered nursing (RN) license before pursuing education in one of the advanced practice roles, and a strong background in science is helpful. [4]

   Nurse anesthetists, nurse midwives and nurse practitioners typically need at least a master's degree in an advanced practice nursing field, and APRNs may choose to earn a Doctor of Nursing Practice (DNP) or a Ph.D. [4]

   Most APRN programs prefer candidates who have a bachelor's degree in nursing, but some schools offer bridge programs for registered nurses with an associate's degree or diploma in nursing. [4]

   States’ requirements for APRNs vary, but in general APRNs must have a registered nursing license, complete an accredited graduate-level program, pass a national certification exam, and have an APRN license. [4]

   All NPs must complete a master's or doctoral degree program, and NPs are licensed in all states and the District of Columbia. [7]

   Applicants to nurse anesthesia programs need a baccalaureate or graduate degree in nursing or an appropriate major, an unencumbered license as a registered professional nurse and a minimum of 1 year of full-time critical care experience, and programs range from 36 to 51 months, depending on university requirements. [8]

   All U.S. nurse anesthesia educational programs are at the doctoral degree level. [9]

   After graduation a nurse anesthetist must successfully complete the National Certification Examination (NCE) administered by the NBCRNA. [9]

   In May 2025 the median annual wages were $236,590 for nurse anesthetists, $134,040 for nurse midwives and $132,300 for nurse practitioners. [4]

   Median annual pay, May 2025$134,920

   The median annual wage for nurse anesthetists, nurse midwives and nurse practitioners was $134,920 in May 2025. [4]

   Projected job growth, 2025–3536%

   Overall employment of nurse anesthetists, nurse midwives and nurse practitioners is projected to grow 36 percent from 2025 to 2035, much faster than the average for all occupations. [4]

   Typical entry-level educationMaster's degree

   The typical entry-level education is a master's degree. [4]

Typical high school preparation

• Applicants to the University of Pennsylvania School of Nursing should have a strong preparation in the sciences, particularly in chemistry and biology. [10]
• Nursing assistants often need to complete a state-approved education program, and these programs are available in places including high schools, community colleges, and vocational and technical schools. [2]
• Certificate and diploma programs are commonly found in community colleges and technical schools, including some high schools. [3]

Only what a cited source states is listed here.

Pre-Health Foundations: coming soon

Sources

1. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Registered Nurses. https://www.bls.gov/ooh/healthcare/registered-nurses.htm. OOH page last modified October 29, 2026 (pay data May 2025; projections 2025–35). Checked November 4, 2026.
2. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Nursing Assistants and Orderlies. https://www.bls.gov/ooh/healthcare/nursing-assistants.htm. OOH page last modified August 27, 2026 (pay data May 2025; projections 2025–35). Checked November 4, 2026.
3. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Licensed Practical and Licensed Vocational Nurses. https://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm. OOH page last modified September 14, 2026 (pay data May 2025; projections 2025–35). Checked November 4, 2026.
4. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm. OOH page last modified October 29, 2026 (pay data May 2025; projections 2025–35). Checked November 4, 2026.
5. National Council of State Boards of Nursing (NCSBN). 2026 NCLEX-PN Test Plan. https://ncsbn.org/public-files/2026_PN_Test%20Plan-F.pdf. Effective April 2026. Checked November 4, 2026.
6. National Council of State Boards of Nursing (NCSBN). 2026 NCLEX-RN Test Plan. https://ncsbn.org/public-files/2026_RN_Test-Plan_English-F.pdf. Effective April 2026. Checked November 4, 2026.
7. American Association of Nurse Practitioners (AANP). What's a Nurse Practitioner (NP)? https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner. no edition stated (footer © 2012–2026). Checked November 4, 2026.
8. American Association of Nurse Anesthesiology (AANA). Become a CRNA. https://www.aana.com/membership/become-a-crna/. page says "Last Updated: 9/21/2026". Checked November 4, 2026.
9. Council on Accreditation of Nurse Anesthesia Educational Programs (COA). Requirements to Practice as a Nurse Anesthetist in the United States. https://www.coacrna.org/about-coa/requirements-to-practice-as-a-nurse-anesthetist-in-the-united-states/. no edition stated (page metadata modified July 14, 2023; footer © 2025). Checked November 4, 2026.
10. University of Pennsylvania, Penn Admissions. Academics (Preparing Your Application). https://admissions.upenn.edu/how-to-apply/preparing-your-application/academics. no edition stated. Checked November 4, 2026.

Format: Publisher. Page title. URL. Edition or catalog year. Checked date.