According to the World Health Organization (WHO, 2024), nurses represent nearly 50% of the global healthcare workforce. Nursing is an in-demand career that will always be necessary, making it a stable career to enter. Essential qualities for the nursing role include compassion, patience, communication skills, physical stamina, critical thinking, and good judgment.

In the United States, individuals who are interested in becoming nurses have many options. They can start in entry-level roles such as a nursing assistant, and, if desired, work their way through higher degree programs and certifications to gain additional responsibilities in the healthcare field. There are also multiple terminal doctoral degrees and advanced practice areas in nursing, with many roles in between. This progression is often called the “nursing ladder,” as many nurses build on each step of their educational training to move upward in the field. You can also have a fulfilling career without advancing further, especially if you find a specialty that suits you.

The job of a nurse can vary, so this section will focus on the three levels of nursing education: certificate, associate, and bachelor’s degrees. We will highlight the differences in scopes of practice between nursing assistants (NAs), licensed practical nurses (LPNs) and registered nurses (RNs).

Certified Nursing Assistants

Certified nursing assistants (CNAs) complete training to provide basic care to patients, assisting with activities of daily living (ADLs). ADLs are activities that we do everyday, such as basic hygiene, eating, ambulation, exercise, getting dressed, using the restroom, and bathing. CNAs may also collect patients’ vital signs. Depending on state requirements, they may also administer medications and perform other duties.

Licensed Practical Nurses

Licensed practical nurses (LPNs), also referred to as licensed vocational nurses (LVNs) in some settings, have a wider scope of practice than CNAs. LPNs/LVNs can monitor patient health, administer care (such as dressing changes, medication administration, and urinary catheter insertions), and report patient status to healthcare providers. They may also reinforce care plans or educational instructions provided by RNs, help collect laboratory samples, and, depending on their training, perform additional tasks such as starting intravenous (IV) medications. LPNs work under the supervision of other healthcare professionals, including RNs, MDs, and NPs.

Registered Nurses

The scope of practice for registered nurses (RNs) is broader than that of other nursing roles. RNs are responsible for physical assessments of patient conditions and may also be responsible for triaging services. In addition to the tasks mentioned above, they develop plans of care for patients and families – this is distinct from prescribing or diagnosing patients – which often includes teaching patients how to manage illnesses or injuries. Additional duties, titles, responsibilities, and skills vary depending on the healthcare setting and any additional certifications or post-RN licensure training.

Employment Opportunities for Nurses

Employment opportunities for nurses are vast. Nurses can work in hospitals, long-term care facilities, clinics, and a variety of other settings, including employee offices, schools, jails, non-profit organizations, and within the community. As mentioned previously, the location and scope of practice for nurses depend on their level of education, training, certification, and licensure.

Employment opportunities abound for nurses at all levels. According to the U.S. Bureau of Labor Statistics (2024), the job growth for nursing careers ranges from 5% for NAs to 6% for LPNs and RNs.

As mentioned previously, education and scope of practice can determine where CNAs, LPNs, and RNs work. In the past, RNs and CNAs were more commonly found in hospitals or acute care settings. However, in recent years, LPNs have become more common in acute care/hospital settings due to staffing shortages. While CNAs are usually less involved in autonomous roles, such as home health or public health, they can work in these areas if the organization can afford to employ them. Long term-care and assisted living facilities commonly employ CNAs and LPNs, although these facilities can employ any level of nurse.

Nurses also have additional opportunities available to them after earning higher-level degrees. Education within the hospital setting or at the college level is an optional path for RNs. RNs may also choose to further their careers by entering hospital administration, conducting research, or exploring roles that measure the quality of hospital care, to name a few.

Requirements and Qualifications

In most states, nursing education, certification, and licensure are highly regulated by the state’s department of health and/or nursing commission, as well as by national standards for each educational pathway. Most states require pre-certification or pre-licensure training and examination. Below, we will discuss the requirements for NAs, LPNs, and RNs.

Nursing Assistant Education Requirements and Qualifications

To become a nursing assistant, individuals typically need to complete a course or program lasting 1 to 3 months. Nursing assistant programs include instruction on basic skills, along with a lab and/or clinical work component. These programs can be offered on the job at hospitals and nursing homes, at colleges, and even in high schools.

Depending on the state, there may be additional requirements, such as a state-issued certification, which often includes a competency exam and skills assessment. Individuals are typically referred to as certified nursing assistants (CNAs) or nursing assistants certified (NACs). However, the term “CNA” is commonly used informally to refer to all nursing assistants, even those without certification. Additional certifications may also be available on the job, or with continued training, that allow nurses to acquire more skills, such as medication administration.

Licensed Practical/Vocational Nurse Requirements and Qualifications

To become an LPN/LVN, students must complete an approved educational program, which typically takes about 1 year, although it may take longer with prerequisite coursework. An LPN/LVN, must have a license to practice, and upon completion of their educational program, they should be eligible to sit for the National Council Licensure Examination for Practical Nurses (NCLEX-PN). LPN/LVN programs typically include prerequisite coursework in anatomy, physiology, nutrition, and general education, and the program coursework covers topics such as nursing, patient safety, and pharmacology.

Registered Nurse Requirements and Qualifications

The pathway to licensure as an RN can be through diploma programs (hospital-based training), associate degree programs, and bachelor’s degree programs. However, diploma programs have become rare, and many states now require an associate or bachelor’s degree in nursing to practice.

An associate degree in nursing (ADN) typically takes 2 years to complete, following 1 year of prerequisites, while the bachelor’s degree in nursing (BSN) is a four-year program that includes 2 years of prerequisites, and 2 years of nursing coursework. The biggest distinction between the BSN and ADN programs is that BSN coursework includes a focus on research, public/community health, humanities, leadership and management, health policy and finance, in addition to direct nursing care and clinical judgment. This additional training helps prepare RNs for roles in management, leadership, policy and public/community health.

Whatever the pathway to the RN, students should attend a college or university that is nationally accredited either by the Commission on Collegiate Nursing Education (CCNE), the National League for Nursing Commission for Nursing Accreditation (NLN CNEA) or Accreditation Commission for Education in Nursing (ACEN).

RN programs are typically highly competitive due to the limited number of nursing educators and clinical sites available to meet the demand for both student enrollment and RN job openings in the community. While a 4.0 GPA is not required for admission to an RN program, it can be beneficial. Once admitted, students will complete coursework in nursing concepts, pharmacology, and clinical judgment, as well as skills labs and clinical experiences, usually every quarter or semester.

Once the necessary coursework has been completed, students can sit for the National Council Licensure Exam for Registered Nurses (NCLEX-RN) examination. This is a computer-adaptive exam that needs to be completed at a testing center. Once you pass the NCLEX-RN, you are not required to retake the exam, even if you pursue further education or certification.

Continuing Medical Education

Licensed nurses must meet annual education and practice requirements, which vary slightly by state. In Washington State, both RNs and LPNs must complete eight continuing education hours each year. Practice hours are also required to maintain licensure, which can be earned by working in a clinical environment.

Attributions

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3. Figure 5.8: Collaboration and best in class care: blood cancer by U.S. Department of Veterans Affairs in the Public Domain
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