The licensed practical nurse holds a real nursing licence issued by a board of nursing, granted after a state-approved programme of roughly a year and a passing score on the practical nurse licensing examination. California and Texas call the same credential a licensed vocational nurse; the training, the examination, and the legal position are the same.
There were about 666,900 practical and vocational nurse jobs in 2025, with a median wage near $64,400. Employment is projected to grow about 3 percent through 2035, adding roughly 19,700 positions.
The boundary that actually defines the role
The practical nurse's scope is almost always explained as a list of tasks, and that is the wrong frame. The line between practical and registered nursing is drawn at assessment.
In most states the registered nurse performs the nursing assessment, reaches the nursing diagnosis, and builds the plan of care. The practical nurse collects data, contributes to the plan, and carries out care within it. Several practice acts say so explicitly by describing practical nursing as directed by a registered nurse, a physician, or a dentist. The distinction sounds academic until a patient deteriorates: gathering the observation is within the practical nurse's licence, and deciding what the changed picture means and what the plan should now be is not.
Delegation runs downhill from here as well. In many states a practical nurse may delegate to and supervise nursing assistants, which makes the tier a supervisory role in long-term care even though it is not an independent one. See scope of practice and the nursing process.
Why the scope changes at the state line
Which concrete procedures follow from the assessment principle varies more between states than almost anything else in nursing law. Intravenous push medications, blood product administration, central line care, initial patient assessment, and independent wound assessment are permitted in some states, permitted only after a board-recognized additional course, and flatly prohibited in others. Several states run a separate intravenous therapy certification that a practical nurse must hold before hanging any infusion at all.
The result is a predictable trap. A competent practical nurse relocates, is hired on the strength of years of experience, and continues doing what they always did — which is now outside scope. Practising beyond scope is a disciplinary matter regardless of skill or of what the employer asked for. Anyone moving should read the destination state's practice act and board advisory opinions rather than assume, and should check whether the state issues the licence through the nurse licensure compact, which covers practical nurses as well as registered nurses.
How the tier came about
Practical nursing predates its licence. The first American school for it opened in Brooklyn in 1892 under the Young Women's Christian Association, and federal vocational education money after the Smith-Hughes Act of 1917 funded more of them. For decades the graduates worked without any credential, in a labour market that also contained a great many people who simply called themselves practical nurses.
New York settled that in 1938 with the first state law requiring a licence for all nursing practice — and, controversially, licensing practical nurses alongside registered nurses, which created the two-level structure the country still uses. The controversy was not trivial: organized registered nursing had spent forty years arguing that nursing was a single profession, and the New York law made permanent a second tier that many in it wanted to see trained out of existence.
Wartime and post-war demand settled the question in practice. Hospitals hired practical nurses in very large numbers through the mid-twentieth century, and every state eventually licensed the role.
The move out of the hospital
From the 1980s onward acute care moved toward all-registered-nurse staffing, driven partly by rising patient acuity, partly by the evidence linking registered nurse hours to outcomes, and partly by Magnet-style expectations about skill mix. Practical nurses were displaced from medical-surgical floors in much of the country.
Where they went is visible in the employment data. Roughly 37 percent now work in nursing and residential care facilities, 16 percent in hospitals, 12 percent in home healthcare, and 11 percent in physicians' offices. Long-term care is the tier's centre of gravity, and in many nursing homes the practical nurse is the licensed nurse actually on the floor, passing medications and supervising assistants for a whole unit. See nurse staffing and patient outcomes and nursing home staffing requirements.
Bridging to registered nursing
Most practical nurses who want to move up do it through a bridge programme, usually an advanced-placement associate degree route that grants credit for practical nursing coursework and licensure. These programmes are common, and some employers pay for them.
The economics are straightforward: the median registered nurse wage is roughly half again the practical nurse median, and the range of settings open to the licence is far wider. The obstacle is the same one that limits every nursing pipeline — a shortage of clinical placements and faculty rather than a shortage of applicants. See the nurse faculty shortage and entry into practice and the BSN requirement.
Related
- Levels of nursing
- Nursing assistants
- Registered nurses
- Scope of practice
- The NCLEX
- Nurse licensure compact
Sources
- Occupational Outlook Handbook: Licensed Practical and Licensed Vocational Nurses — U.S. Bureau of Labor Statistics, 2025 data. Accessed September 9, 2026.
- Nursing Through Time: 1930–1959 — Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania, on the 1938 New York licensure law and the creation of two levels of nursing practice. Accessed September 9, 2026.
- National Guidelines for Nursing Delegation — National Council of State Boards of Nursing and American Nurses Association, 2019. Accessed September 9, 2026.
- Nurse Licensure Compact — National Council of State Boards of Nursing, on multistate licensure for registered and practical nurses. Accessed September 9, 2026.