Nurse Hierarchy | What Are the Levels of Nursing?

Different levels within the field of nursing vary in terms of skills, responsibilities, education and licensing requirements. The hierarchy of nursing refers to the organizational structure of nurses within an organization, based on education and work experience.

Whether you’re new to nursing or looking to advance within your existing nursing career, this guide is intended to help you explore different career paths. Discover entry-level, advanced and senior nursing positions, as well as how these different types of nurses interact with one another.

What Is the Hierarchy of Nursing?

Nursing hierarchy is the idea that within traditional healthcare settings, nurses tend to follow an organizational structure based on their credentials and work experience. The hierarchy begins with nursing assistants and goes all the way up to chief nursing officer. 

Prospective nurses may use the hierarchy of nursing to find a role that fits their personal career goals, while those already working in the field may use the hierarchy to identify potential new career paths. 

What Are the Different Levels of Nursing?

The different levels of nursing found within the nursing hierarchy are defined by several factors, such as education, experience and certification. Lower-level roles tend to require less education to enter, whereas higher levels of nursing require more education and work experience. 

A typical nursing hierarchy includes entry-level roles, advanced-level roles and senior-level roles. While there are similarities between many levels of nursing, there are also key differences. For example, registered nurses and nurse practitioners both provide and coordinate patient care, but nurse practitioners have pursued further education and licensure to be able to obtain potential leadership roles. Becoming a nurse practitioner requires a master’s degree in nursing, whereas becoming a registered nurse requires a bachelor’s or associate degree. 

Entry-Level Positions in the Nursing Hierarchy

Entry-level positions within nursing still require a certain level of education. While the time commitment necessary to enter these roles is less than that of higher levels of nursing, you will still need to acquire some baseline skills. Most entry-level nursing careers also require state-issued licenses or certifications. These types of requirements vary significantly depending on what type of career you are pursuing and where you live. 

Certified Nursing Assistant (CNA)

Certified nursing assistants are the first level in the hierarchy of nursing. The role involves helping patients with the type of tasks associated with daily life, including eating, dressing and bathing. They may also take and monitor a patient’s vital signs, such as their temperature or blood pressure. CNAs often work in nursing homes, retirement homes or hospitals. CNAs usually work under the supervision of licensed nurses, such as LPNs or RNs. 

The training and educational requirements for becoming a CNA are not as intensive as the requirements for other levels of nursing degrees. CNAs are required to complete a state-approved training program and pass a competency exam. CNA training programs typically require a high school diploma or equivalent as a prerequisite.

The duties of a CNA are primarily focused on providing patients with basic care, while other levels of nursing involve more direct monitoring of patient health.

Licensed Practical Nurse (LPN)

Licensed practical nurses may also be called licensed vocational nurses (LVNs). The role of an LPN includes providing basic medical care to patients. In addition to helping patients eat, bathe and get dressed, LPNs also perform medical tasks such as changing bandages and inserting catheters. Another important aspect of the role is reporting changes in patient condition to supervisors such as RNs or physicians. Unlike RNs, LPNs do not set up care plans for patients. 

To become an LPN, you must complete an approved training program and pass a licensing exam. LPN educational programs typically take one year or more to complete and are often offered by community colleges and technical schools. For those looking to grow within their career and become a registered nurse (RN), becoming an LPN may be a good entry point. There are LPN to RN programs available that are specifically designed to help LPNs transition to the next nursing degree level.

Registered Nurse (RN)

As a registered nurse, you will provide a range of medical services to patients. This includes taking medical histories, assessing a patient’s condition, performing diagnostic tests and administering medications and treatments. Many of the tasks an RN has are determined by the setting in which they work, such as a hospital, clinic, doctor’s office or residential care facility. RNs work as part of a team with other healthcare specialists, and often report to nursing managers. Comparatively, RNs have more responsibilities and more direct control over patient care than CNAs or LPNs do. 

Pathways to becoming a registered nurse include earning an associate degree in nursing (ADN), earning a Bachelor of Science in Nursing (BSN) or earning a diploma from an approved nursing program. While one can become an RN with an associate degree in nursing, some employers may prefer to hire candidates who hold a bachelor’s degree. 

Nurse Manager

A nurse manager is an advanced nursing role that includes both managerial and clinical work. A nurse manager is responsible for ensuring a nursing unit runs properly, overseeing nurses and working with other healthcare professionals as needed. Unlike a nurse practitioner, a nurse manager cannot prescribe medication and usually does not provide direct patient care. Depending on the facility’s structure, a nurse manager may report to the director of nursing or chief nursing officer.

Nurse managers are usually licensed and practicing nurses themselves. Additional educational requirements may include earning a master’s degree and maintaining a nursing license. Strong administrative and leadership skills are also important for those interested in becoming a nurse manager. 

Advanced-Level Positions in the Nursing Hierarchy

Advanced practice registered nurses (APRNs) work in a variety of advanced careers within the nursing field. These roles require more work experience and education than entry-level nursing roles. Becoming an APRN requires earning a Master of Science in Nursing (MSN) and completing clinical experience. There are various types of certification exams for APRNs, depending on your desired speciality. 

While pursuing a career as an APRN, you may choose multiple pathways. These may include nurse educator or nurse practitioner.

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Nurse Educator

A nurse educator is an advanced role within the field of nursing. Unlike other advanced nursing roles, such as nurse practitioners, nurse educators generally do not work directly with patients. Instead, they help train nurses to enter the field by teaching classes, designing curriculum and guiding students in a clinical setting. As a nurse educator, you may work at colleges, universities or on-site at hospitals. If you work in a hospital, you will likely report to senior-level nurses, such as nursing directors. 

Like other types of advanced nursing roles, becoming a nurse educator requires a master’s degree. You may also wish to obtain certification. Nurse educators who have obtained certification are referred to as CNEs—Certified Nurse Educators

Nurse Practitioner (NP)

Nurse practitioners are advanced nursing professionals within the hierarchy of nursing. Unlike nonclinical roles such as nurse educators, nurse practitioners provide direct patient care. They may work independently or alongside a physician, depending on where they work. The daily activities of a nurse practitioner may include performing exams and medical procedures, creating patient care plans, ordering laboratory tests and prescribing medicine. Some nurse practitioners choose to specialize in a certain area, such as pediatric health or psychiatric care. 

To enter this career, you are required to earn a master’s degree and pass a nurse practitioner certification exam. Most nurse practitioner education programs require you to already hold a license as a registered nurse. Other prerequisites may vary from school to school.

Senior-Level Positions in the Nursing Hierarchy

The top nursing level in the hierarchy of nursing is reserved for senior positions. In most cases, these careers are only available to licensed nurses who already have a significant amount of experience working in the field. Senior positions may require a Doctor of Nursing Practice (DNP) degree. 

Nursing Director

Nursing directors play an important administrative and leadership role within healthcare organizations. They do this by leveraging their education, experience and leadership skills to help shape an organization’s nursing programs and improve patient outcomes. This role is similar to that of a chief nursing officer, but nursing directors typically provide leadership for a single department instead of all services.

To become a nursing director, you must hold an MSN or a DNP and have extensive clinical experience. You may consider earning a certification in executive nursing or pursuing a graduate degree that focuses specifically on nursing management and leadership. 

Chief Nursing Officer (CNO)

Chief nursing officers are nursing administrators who work within the leadership team of a healthcare organization. They are considered the highest level of nursing leadership. CNOs oversee the entire nursing program at a healthcare facility and develop policies and procedures that shape how an organization functions. Depending on the structure of the organization, CNOs may work under the CEO of the hospital.

Entering this role typically requires a master’s degree or doctorate and experience as a licensed nurse. Unlike other roles that require a DNP, this is a nonclinical position that involves evaluating patient care procedures as opposed to directly working with patients. The years of work experience required may vary depending on the employer. There are also several certifications you may pursue that are intended to prepare you for work as a nursing executive. 

Doctor of Nursing Practice (DNP)-Prepared Practitioner

The Doctor of Nursing Practice is a terminal nursing degree, meaning that it is the highest possible practice-based degree in nursing. While a DNP may prepare you for administrative senior roles such as chief nursing officer or nursing director, it may also prepare you for nursing roles that involve direct patient care. In fact, nurse practitioners and other APRNs may decide to obtain a DNP degree instead of an MSN. 

Requirements for admission into a DNP degree program vary from school to school. Some programs are intended for students who already hold an MSN, while others are designed to act as a bridge program for students whose highest degree is a BSN. Many schools also offer speciality concentrations that allow you to focus your studies on a particular form of medicine, such as women’s health, pediatric health or gerontological care. Licensing requirements vary depending on what type of career you choose to pursue and where you live. 

Nurse Hierarchy FAQs

With so many career paths available within the field of nursing, it can be difficult to determine the steps to take to meet your career goals. Below, we address some commonly asked questions about levels of nursing. 

[FAQ-Schema] What is the highest level of nursing?

The highest level of nursing education is the doctoral level. Positions that require doctoral nursing degrees include certain types of advanced practice registered nurses (APRNs), as well as leadership positions such as chief nursing officer or director of nursing. In a traditional hospital setting, the chief nursing officer is the topmost nursing position. 

[FAQ-Schema] Why is it important to understand the nursing hierarchy? 

The nursing field has many different entry points and career paths, depending on your career goals. Understanding the nursing hierarchy can help you explore different career possibilities and learn about opportunities for career advancement. The nursing hierarchy also shows how different levels of nurses interact with one another, so you may get a better feel for what to expect in each role. 

[FAQ-Schema] How does nursing education relate to nursing hierarchy?

Generally, positions found at the lower level of the nursing hierarchy require less education, while more advanced roles require master’s degrees or even doctoral degrees. To obtain an entry-level position in nursing, you may only need to complete an approved educational program at a technical college. As you obtain further education, more job opportunities may be available to you. For example, earning a bachelor’s degree could help prepare you to become a registered nurse. 

Last updated in February 2022