Levels of Nursing in the U.S.: LPN, RN, APRN — and What Each Earns

U.S. nursing has three legally distinct license tiers. Each has its own educational pathway, scope of practice, and pay band. If you trained abroad, picking the right tier — and the right bridge to it — is one of the highest-leverage early decisions you'll make.

The three tiers, in plain English

LPN — Licensed Practical Nurse (also called LVN in TX and CA)

The entry-level license. LPNs work under an RN's direction. Scope is real but limited: vital signs, dressing changes, basic medication administration, patient hygiene, charting. LPNs are common in long-term care and clinics; less common in acute hospitals.

• Education: ~12-month diploma or certificate program.
• License exam: NCLEX-PN.
• Typical setting: Skilled nursing facilities (SNF), home health, outpatient clinics.

RN — Registered Nurse

The professional anchor of U.S. nursing. RNs assess, plan, intervene, and evaluate — they're the nurse you see at the bedside in any U.S. hospital. There are two routes to RN licensure:

• ADN — Associate Degree in Nursing: ~2-year community college program. Faster, cheaper, but increasingly hard to land hospital jobs at Magnet-track health systems (see our Magnet article).
• BSN — Bachelor of Science in Nursing: 4-year degree (or accelerated 12–18 months for second-degree students). Required by most hospitals for new hires; mandated by some states within 10 years of licensure.

Both routes take the same exam: NCLEX-RN. The license is identical; the degree behind it isn't.

APRN — Advanced Practice Registered Nurse

A graduate-level role. APRNs can diagnose, prescribe, and (in many states) practice independently. Four subtypes:

• NP — Nurse Practitioner: primary, acute, family, pediatric, and several specialty foci.

• CRNA — Certified Registered Nurse Anesthetist: highest-paid APRN role; demanding 3-year doctorate-level program.

• CNS — Clinical Nurse Specialist: focused on a population or specialty; often in education and quality improvement roles.

• CNM — Certified Nurse-Midwife: pregnancy, birth, and women's health.

• Education: MSN or DNP.

• License exam: National certification through ANCC, AANP, NBCRNA, or AMCB depending on track.

What each earns

Median annual wages from the U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (May 2024 release). Your actual offer depends on geography, setting, shift differential, and experience.

Role	Median annual pay	Education	License exam
LPN / LVN	$62,340	12-month diploma	NCLEX-PN
RN	$93,600	ADN or BSN	NCLEX-RN
Nurse Practitioner	$132,050	MSN/DNP	National cert
Nurse-Midwife	$128,110	MSN/DNP	AMCB
CRNA	$231,700	DNP	NBCRNA

The career ladder, visually

The path most internationally-trained RNs take

If you're already a registered nurse in your home country, your route to U.S. RN licensure usually looks like this:

1. Pick a U.S. state and apply to its Board of Nursing.
2. Submit a credential evaluation (CGFNS).
3. Pass NCLEX-RN.
4. Resolve visa/sponsorship (EB-3 + Schedule A is the dominant pathway).
5. Start at the RN tier — your home credential plus NCLEX-RN gets you there.

Want to advance to APRN? You'll typically need a U.S. BSN before applying to MSN programs, even if your foreign credential is BSN-equivalent. RN-to-BSN bridge programs are short and online-friendly.

Bottom line

The three tiers are a real ladder. Pay scales meaningfully with each step, but so does education time. Most international RNs land at RN-with-BSN and either stay there comfortably or use that as a launchpad into APRN if they want autonomy and higher pay.