LPN career path and specialties

The nursing ladder runs from nursing assistant to LPN, registered nurse and nurse practitioner. According to BLS, certified nursing assistants (CNAs) earn a median of $42,260 per year, and LPNs earn $64,400. RNs earn $97,550, and nurse practitioners (NPs) earn $132,300.

CNAs who want a wider scope often train as LPNs, since CNAs are listed on a state registry rather than licensed, and in most states do not give medications. A practical nursing program commonly runs about 12 months. LPNs who move up to RN have two common routes. LPN-to-RN bridge programs commonly run 12 to 18 months, and an associate degree in nursing (ADN) takes about 2 years. Graduates of either route must pass the NCLEX-RN before they can work as RNs.

The NP role sits above the RN level. An NP must first hold an RN license and then complete a graduate degree in nursing, at the master's or doctoral level. Hospitals employ 89,620 LPNs, about half as many as nursing care facilities. What changes in scope and pay at the RN level is the comparison to make before starting a bridge.

LPNs work in many settings, and each setting shapes the daily tasks. Nursing care facilities employ more LPNs than any other setting. In long-term care, LPNs give medications, track residents' health and update care plans. Many facilities also use LPNs as charge nurses who lead a shift of CNAs, where state rules allow.

Home health care services employ 80,990 LPNs. Home health LPNs visit patients at home to give care between doctor visits. Pediatric private duty nurses care for one child with complex medical needs, often at home. Wound care LPNs clean and dress chronic wounds, and some earn a wound care certification. Dialysis LPNs help run treatments for patients with kidney failure. Hospice LPNs give comfort care to patients near the end of life.

Psychiatric and mental health LPNs work in behavioral health units and residential programs. Correctional LPNs care for people held in jails and prisons. Urgent care centers and clinics use LPNs to room patients, give shots and record health histories. Offices of physicians employ 69,250 LPNs. Case management LPNs help coordinate care and follow up with patients by phone. School nurses give medications and handle student health needs during the school day. Oncology clinics use LPNs to support patients during cancer treatment. The military services also train and employ practical nurses.

LPN roles in labor and delivery units and in neonatal intensive care units (NICUs) are limited. Employers in infusion and long-term care settings may ask for IV therapy certification, since state rules on IV tasks for LPNs differ.

LPNs can raise their pay without a new license by changing setting, state or shift. According to BLS, nursing care facilities pay a median of $70,430, while offices of physicians pay $59,520. Outpatient care centers pay a median of $69,900. Staffing agencies also hire LPNs for short-term and per diem shifts, and travel contracts are one form of this work. Agency pay depends on the contract, so LPNs comparing an agency offer with a permanent job weigh the hourly rate and the benefits together.

State differences in pay are wider than setting differences. Washington, Alaska and Oregon have the highest state medians for LPNs. Many employers also pay shift differentials for nights, weekends and holidays. Certifications in IV therapy or wound care can qualify an LPN for roles that some employers pay at a higher rate. Before changing jobs, LPNs can check pay by state and setting for their area.

LPN scope of practice is narrower than RN scope, and each state's board of nursing sets its limits. In many states, LPNs work under RN or doctor supervision and do not complete full patient assessments on their own. Some LPNs find that these limits narrow the roles they can move into. Many use the LPN license as a step toward the RN license, often while they keep working. Workloads can be heavy and shifts can be long in some settings, so working LPNs who plan a bridge often look for part-time or evening formats.

Entry to the career requires a state-approved practical nursing program and a passing NCLEX-PN score. After licensure, pay depends mostly on state and setting, and the RN license is the next step up the ladder. A practical first step is to compare the LPN median in your state with nearby states and check whether your license can transfer under the Nurse Licensure Compact.