An LPN (Licensed Practical Nurse) — called an LVN (Licensed Vocational Nurse) in California and Texas — is a licensed nursing professional who provides basic nursing care under the supervision of a registered nurse (RN) or physician. LPNs are the workhorse of hands-on patient care in long-term care facilities, home health agencies, physician offices, and increasingly in hospitals.
This guide covers what LPNs do, how to become one, the NCLEX-PN licensing exam, scope of practice, salary data, and how LPNs can advance into RN or other higher-level nursing roles.
Licensed Practical Nurses provide direct, hands-on nursing care as a primary member of the patient care team. While RNs hold primary responsibility for patient assessment, care planning, and clinical judgment, LPNs carry out a significant portion of the ongoing nursing work that patients require day to day — making them essential to safe, efficient healthcare delivery.
Core LPN responsibilities vary by setting and state scope of practice but typically include:
LPNs work in nursing homes and long-term care facilities (the largest employer of LPNs), home health agencies, outpatient physician and specialty clinics, dialysis centers, correctional healthcare facilities, and hospice settings. Hospital employment of LPNs is less common than in the past but still exists, particularly in non-acute areas such as medical-surgical units, labor and delivery, and post-partum care.
Understanding how the LPN role fits within the nursing professional hierarchy helps prospective nursing students make informed career decisions about which pathway best aligns with their goals, timeline, and investment tolerance.
Certified Nursing Assistant (CNA) is the entry-level direct care role requiring 4–6 weeks of state-approved training and a competency exam. CNAs perform personal care, basic monitoring, and supportive functions under RN and LPN supervision. CNAs cannot administer medications or perform clinical procedures. Median annual salary: ~$38,200 (BLS 2023).
Licensed Practical Nurse (LPN/LVN) requires a 12–18 month practical nursing program and passing the NCLEX-PN. LPNs can administer medications, perform clinical nursing procedures, and provide more complex care than CNAs. LPNs work under RN supervision for clinical decision-making but often function with considerable day-to-day autonomy in long-term care settings. Median annual salary: ~$59,730.
Registered Nurse (RN) requires an associate degree in nursing (ADN, 2–3 years) or bachelor's degree (BSN, 4 years) plus passing the NCLEX-RN. RNs have full independent assessment and care planning authority, can supervise LPNs and CNAs, and are required in most hospital settings. Median annual salary: ~$86,070 (BLS 2023). For maximum career flexibility and advancement, the BSN is increasingly the employer preference, particularly in Magnet-designated hospitals.
The LPN pathway offers a faster, lower-cost entry into licensed nursing compared to RN programs. Many LPNs subsequently complete an LPN-to-RN bridge program to advance their career and earning potential after gaining clinical experience.
LPN programs are designed for efficient entry into licensed nursing. Offered at community colleges, vocational and technical schools, and some hospital-based programs, LPN training typically takes 12–18 months for full-time students.
Prerequisites: Most LPN programs require a high school diploma or GED, passing entrance tests (TEAS, HESI, or school-specific tests), and basic health requirements (immunization records, TB test, background check). Some programs require prerequisite courses in anatomy, physiology, or English before admission.
Curriculum: LPN programs cover anatomy and physiology, pharmacology and medication administration, medical-surgical nursing, maternal-newborn nursing, pediatric nursing, mental health nursing, geriatric and long-term care nursing, clinical nutrition, and fundamentals of nursing practice. Most programs include 500–900+ hours of supervised clinical rotations in nursing homes, hospitals, clinics, and specialty settings.
Accreditation: Programs should be accredited by the Accreditation Commission for Education in Nursing (ACEN) or the National League for Nursing Commission for Nursing Education Accreditation (CNEA). Attending an accredited program is important for NCLEX-PN eligibility and, later, for acceptance into LPN-to-RN bridge programs.
Online LPN programs: While some theory coursework is available online, clinical rotations require in-person participation. Hybrid programs typically offer online didactic instruction with in-person clinical components at local partner facilities. Fully online LPN programs do not exist for the clinical portions.
After completing an approved LPN program, graduates must pass the NCLEX-PN (National Council Licensure Examination for Practical Nurses) administered by the National Council of State Boards of Nursing (NCSBN). Passing the NCLEX-PN is required for LPN licensure in all 50 states.
As of 2023, the NCSBN transitioned to the Next Generation NCLEX (NGN), which introduces new question types designed to test clinical judgment and higher-order reasoning — not just knowledge recall.
NGN exam format:
Content areas: The NCLEX-PN tests across four Client Needs categories: Safe and Effective Care Environment (Coordinated Care + Safety & Infection Control), Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity (Basic Care & Comfort + Pharmacological Therapies + Reduction of Risk Potential + Physiological Adaptation).
First-attempt pass rates: NCSBN data shows first-attempt NCLEX-PN pass rates for U.S.-educated candidates are approximately 83–87% — somewhat higher than the NCLEX-RN. Candidates who complete accredited programs and use structured review materials consistently outperform the average.
For detailed NCLEX-PN preparation strategies and practice questions, see our LPN certification test guide and explore the LPN patient care and clinical skills practice tests on this site.
Long-term care is the most common work setting for LPNs — approximately 35% of all LPN jobs are in nursing and residential care facilities. In this setting, LPNs often function as charge nurses on their shift, supervising CNAs and coordinating daily care for a caseload of 15–30 residents. Responsibilities include medication passes (typically 2–3x daily), wound care, skilled nursing documentation (Medicare/MDS), family communication, physician order implementation, and coordination with therapy and social work staff. LPN autonomy in this setting is high relative to hospital environments.
Approximately 14% of LPNs work in outpatient physician and specialty offices. LPNs in this setting perform intake assessments (vital signs, chief complaint, medication reconciliation), prepare patients for examination, administer injections and immunizations, collect specimens, assist with minor procedures, manage prescription refill requests under physician protocol, provide patient education, and handle clinical documentation. The pace is typically faster and more varied than long-term care, with shorter patient interactions and a focus on clinical efficiency.
Home health LPNs provide skilled nursing visits to homebound patients under the direction of a registered nurse's plan of care. Common tasks include wound care, IV therapy, catheter management, medication teaching, and post-surgical monitoring. Home health LPNs work independently in the patient's home (without an RN physically present) but must coordinate all clinical decisions with the supervising RN. The role requires strong autonomy, time management, and clinical communication skills. Home health LPN positions often offer flexible scheduling and mileage reimbursement.
Hospital employment of LPNs has declined as many facilities prioritize all-RN nursing staff, particularly in acute care units. LPNs who work in hospitals are typically found in non-acute areas: post-partum, psychiatric units, rehabilitation, long-term acute care, and some medical-surgical units. Hospital LPNs often focus on medication administration, wound care, and patient monitoring under close RN supervision. LPN IV therapy privileges in hospitals vary by state and facility policy — many hospitals limit LPN IV authority to saline locks and flushes, with RNs managing complex infusion therapy.
According to the Bureau of Labor Statistics, the median annual wage for LPNs and LVNs in 2023 was $59,730 ($28.72/hr). Wages vary substantially by location, setting, and experience:
Employment of LPNs is projected to grow 5% from 2022–2032, roughly in line with the average for all occupations. Approximately 54,400 LPN job openings are projected per year over the decade, driven by the need to replace workers who retire or transfer to other occupations as well as growth in demand for elder care services.
The strongest job growth for LPNs is occurring in home health care services (projected 21% growth) and in outpatient care centers, reflecting broader healthcare delivery trends toward lower-cost community-based settings relative to inpatient hospital care.
One of the key advantages of the LPN pathway is the availability of bridge programs that credit LPN experience and education toward RN licensure. Rather than completing an RN program from scratch, LPNs can advance their nursing career more efficiently through dedicated LPN-to-RN bridges.
LPN to ADN (Associate Degree in Nursing) bridge: Most community colleges offering ADN programs have LPN-to-ADN tracks that allow LPNs to waive foundational nursing courses and complete the remaining coursework in as little as 12–18 months. Graduates take the NCLEX-RN upon completion.
LPN to BSN bridge: Available at many 4-year universities, these programs typically take 2–3 years and result in a bachelor's degree in nursing, which is preferred by employers for career advancement. Some programs offer the LPN-to-BSN online with in-person clinical requirements.
LPN to NP (Nurse Practitioner): While not a direct bridge, some master's and doctoral programs have provisions for experienced LPNs who have since completed their RN and have clinical experience. The pathway typically follows: LPN → RN (bridge) → BSN (bridge or completion program) → MSN/DNP NP program.
Many LPNs choose the advancement pathway after gaining 1–3 years of LPN experience, which both clarifies their specialty interest and strengthens their application to RN programs. The work experience also demonstrates clinical competency that can provide confidence in the transition to expanded nursing scope.