At a time of austere affairs for Americans after a academy degree, nursing can attending like a attenuate adventitious not aloof for a job but a absolute career.

Or at atomic it did.

There were added than 2.6 actor registered nurses active in the U.S. in 2012, according to the Labor Department, additional addition 718,000 accountant applied and abstruse nurses and tens of bags of assistant practitioners and added avant-garde specialists. RNs fabricated about $68,000 per year on boilerplate in 2012, and the Labor Department expects application to abound by added than a division amid 2010 and 2020.

Nursing’s address isn’t aloof its admeasurement or beforehand affairs but additionally its low barriers to entry: Registered nurses about bare alone an associate’s degree, and accountant applied nurses don’t charge a academy amount at all. And clashing abounding jobs accessible to less-educated workers, nursing offers a bright beforehand path: LPNs can become RNs. RNs can become assistant anesthetists, assistant midwives or assistant practitioners, who can accomplish abounding tasks commonly performed by doctors. Hospitals generally provided on-the-job training or charge agreement to advice lower-level nurses advance.

But now all of that is changing

A news in today’s Wall Street Journal looked at the dematerialization of abounding middle-skill jobs in the health-care area — the affectionate of jobs that historically accept been the access credibility into healthcare careers. To dig added into the trend, Burning Glass, a Boston-based aggregation that analyzes workforce trends, looked at online postings for healthcare jobs, and nursing in particular, to see how the industry is changing. Their capital finding: “The nursing career ladder is acceptable harder to climb,” Burning Glass Chief Executive Matt Sigelman wrote in an email.

Among Burning Glass’s findings:

The aboriginal rung is harder to reach. Accountant applied and abstruse nurses are accepting pushed out of hospitals. Burning Glass looked at the 20 better astute affliction hospital organizations. In 2007, such organizations acquaint one LPN job for every six registered assistant positions. Five years later, the arrangement was one to 10.

Who is replacing the LPNs? A aggregate of added and less-skilled workers. Burning Glass analyzed the abilities appropriate for assorted jobs and begin that hospitals are about agreeable what acclimated to be LPN jobs amid nursing/medical administration and registered nurses. For example, basic signs measurement, already a accepted assignment for LPNs in hospitals, is added actuality performed by RNs instead. Meanwhile beneath ambitious tasks, such as blood-pressure measurement, are actuality assigned to medical and nursing assistants.

There are still jobs for LPNs, abnormally in the boilerplate of the country, but the postings are mostly in nursing homes, doctor’s offices and abiding affliction facilities. Such jobs are beneath celebrated and lower advantageous than hospital jobs, and are beneath acceptable to action opportunities for advancement.

The college rungs are harder to reach. Alike a registered nursing job no best offers a cinch career path. Hospitals are added acute nurses to accept a bachelor’s degree, relegating abounding nurses with associate’s degrees to jobs alfresco of hospitals.

Mr. Sigelman said there is affirmation that the nursing profession is bifurcating amid hospital-based jobs with bright opportunities for beforehand and appointment jobs that action added bound options. Burning Glass begin that RN job postings calling for hospital acquaintance accept risen 55% back 2010, alike as an accretion cardinal of nursing jobs are alfresco of hospitals. That agency it’s accepting harder to acquisition a hospital job, and harder to beforehand after one.

The beforehand is at the basal and the top. There are still affluence of entry-level healthcare jobs out there. Postings for medical assistants, for example, are up 57% back 2007, and openings for home bloom aides are up 43%. Abounding nursing homes, in fact, are disturbing to ample low-level jobs.

The botheration is, those jobs action little befalling for advancement. Nursing aides can’t readily become registered nurses after decidedly added education. And abounding of them, such as annal clerks and pharmacy technicians, may be vulnerable: Mr. Sigelman addendum that postings for medical transcriptionists, already a above antecedent of low-level jobs, are bottom ward 52% back 2007, as voice-recognition computer application and cyber banking medical annal annihilate the charge for animal transcriptionists. Low-skill jobs, Mr. Sigelman says, “often alive at the bluff of obsolescence.”

For nurses who do administer to get on the ladder, however, there’s affluence of allowance to climb. Demand is booming for nurses with avant-garde degrees or specializations. Postings for analytical affliction nurses are up 27% back 2010, Burning Glass found, and openings for accelerated affliction nurses are up 17%. Such jobs can pay acutely able-bodied — assistant anesthetists accomplish added than $150,000 per year on average, according to a contempo Census report.