If you’ve researched a career in nursing, you’ve probably seen acronyms like LVN, RN, and BSN and wondered what they all mean. The nursing hierarchy can help you make sense of the different levels of nursing and how each role builds on the next. In this article, we’ll break down the nursing hierarchy to show you what your future career can look like.
What Is the Nursing Hierarchy?
The nursing hierarchy refers to the different levels of nursing in the healthcare field, based on education, experience, and scope of care.
In many healthcare facilities, the chain of command in nursing follows this hierarchy. For example, registered nurses (RNs) may supervise licensed vocational nurses, while nurse administrators manage entire nursing teams or departments.
Entry-Level Roles in the Nursing Hierarchy
Entry-level nursing roles focus on providing basic care. These positions require less education and training than others, so they’re a good option if you want to start working and gaining experience quickly.
Medical Assistant
While medical assistants (MAs) aren’t officially part of the nursing hierarchy, this role offers a pathway into healthcare so you can get clinical experience. It can be a great starting point to help you get comfortable with patient care before you move into nursing.
Medical assistants split their time between handling administrative duties and providing patient care. During their shifts, they may:
- Take patients’ medical histories
- Check vital signs
- Assist doctors with medical exams
- Schedule appointments
- Update patient records
- Manage other front-office responsibilities
Becoming a medical assistant is one of the most streamlined ways to enter the healthcare field. You can typically earn a medical assistant diploma or certificate in about 1 year. At American Career College, our Medical Assistant program takes approximately 9 months to complete.
Certified Nursing Assistant
The nursing hierarchy starts with certified nursing assistants (CNAs), who provide basic patient care, often in nursing homes or long-term care facilities. CNAs work under the supervision of licensed vocational nurses or registered nurses.
In their day-to-day jobs, CNAs may handle these tasks:
- Help patients with daily tasks, like bathing, eating, and dressing
- Monitor patients’ vital signs
- Observe patients for changes in their conditions
- Communicate with other nurses about patients’ health
- Provide emotional support to patients and their families
To become a CNA, you can complete a state-approved program at a vocational or technical school. Some healthcare providers also offer CNA programs. Depending on your state, you may need to pass a certification exam.
Mid-Level Nursing Roles
Mid-level nursing roles expand beyond basic patient care with more clinical responsibilities. Many nurses actually begin their careers at this level after finishing nursing school and becoming licensed.
Licensed Vocational Nurse
Licensed vocational nurses (LVNs) are the next step in the nursing hierarchy. They provide direct care to patients while working under the supervision of registered nurses or physicians.
This nursing role involves a range of tasks, including:
- Measure patients’ vital signs and monitor conditions
- Provide basic treatment, such as changing bandages
- Collect samples for lab tests
- Maintain patients’ health records
- Collaborate with other nurses and physicians about patient care
To become an LVN (also known as a licensed practical nurse in some states), you can complete a vocational nursing program, which takes around 1 year. At ACC, you can complete the traditional Vocational Nursing program in as few as 12 months, or you can enroll in the Evenings and Weekends program for the flexibility to earn your diploma in approximately 18 months.
After graduating with your diploma, you’ll also need to take and pass the National Council Licensure Exam for Practical Nurses (NCLEX-PN) to earn your nursing license.
Registered Nurse
Compared to LVNs, registered nurses have a broader role in coordinating patient care. They can work in many healthcare facilities, and some RNs specialize in a particular type of care, such as critical care or pediatrics.
An RN’s daily responsibilities usually include:
- Evaluate patients’ conditions and monitor vital signs
- Administer medications to patients
- Conduct basic diagnostic tests
- Manage medical equipment
- Collaborate with physicians and other nurses about patient care
- Educate patients and families about care plans
There are a few paths you can take to become an RN. You can earn a nursing diploma, though those programs are becoming less common. Instead, many nurses choose to earn an associate degree in nursing (ADN) or a bachelor of science in nursing (BSN).
Both ADN and BSN programs offer foundational coursework and supervised clinical training. An ADN program offers a more streamlined path to becoming a nurse, enabling you to graduate in around 2 years, while a BSN takes about 4 years. ACC’s ADN program is blended and can be completed in as little as 20 months. This program offers 800+ hours of real-world clinical experience, and career services support.
Whether you graduate from an ADN or a BSN program, you’ll take the NCLEX for registered nurses after graduation to become licensed in your state.
Advanced Nursing Roles
As you gain more experience and complete additional education, you can move into advanced nursing roles. At this level, some positions involve more patient care responsibilities, while others focus on administration and management.
Nurse Practitioner
Nurse practitioners, also known as advanced practice registered nurses (APRNs), use their years of clinical experience to provide advanced patient care. They often specialize in a clinical area, such as psychiatric and mental health.
This role involves diagnosing, treating, and managing patient care. A nurse practitioner's responsibilities may include:
- Perform exams and order diagnostic tests
- Diagnose medical conditions
- Develop and implement treatment plans for patients
- Prescribe and administer medications
- Evaluate patients and make changes to treatment plans as needed
To become a nurse practitioner, you’ll need to earn a graduate degree, such as a master of science in nursing (MSN), a doctor of nursing practice (DNP), or a Ph.D. You’ll also need a certification and license to practice.
Nurse Administrator
After providing bedside care for many years, some RNs choose to move into an administrative role. Nurse administrators oversee nursing teams and help manage operations in healthcare facilities.
While their duties can vary, nurse administrators commonly do these tasks:
- Hire and onboard new nurses
- Create and manage budgets for nursing departments
- Schedule nursing shifts
- Develop and enforce nursing policies
- Represent and advocate for nurses at an organizational level
A nurse administrator isn’t an entry-level role. You can pursue this career path by gaining experience as an RN and earning an MSN or a DNP. Once you move into nursing administration, you’ll also have to complete continuing education to keep your credentials current.
Pursue A Nursing Path at ACC
Knowing the nursing hierarchy can help you understand how each step may fit into your future career path. As you move through the different nursing levels, you can build on your skills, knowledge, and experience to keep growing in your career.
If you’re ready to begin your journey in nursing, American Career College can help you get started. We offer diploma programs in medical assisting and vocational nursing, as well as an Associate Degree in Nursing program. Reach out today to request more information and take the first step toward your career in nursing!
