Click any node to see what it unlocks, the level required, the XP cost, and which other specs it synergizes with. All 4 branches mapped from personal testing — no dev-published data exists.
Root = Nurse Basic. Four branches: ER / Pediatric / Surgical Asst / ICU. Each branch has 5–6 nodes. Click any node to open its detail panel.
Click any node to view perk details and synergies in the panel on the right.
Node costs are XP totals from personal testing — no developer-published data exists.
Root
What unlocks
Core nursing tasks: vitals, patient intake, medication rounds. Earns 180 XP/hr on a populated server. All specialization branches unlock from here.
Synergy
Starting point for all 4 specs. No synergy cost — just pick a branch and begin.
Unlocks 4 further nodes in this branch.
These costs come from my 40+ hours of nurse play across May 2026. No official XP table exists — these figures are player-measured. Actual unlock cost may vary by ±5% across different server patches.
| Node | Spec | Level req. | XP cost | Cumulative XP |
|---|---|---|---|---|
| Triage Nurse | ER | Lv 2 | 320 | 320 |
| Trauma Responder | ER | Lv 5 | 780 | 1,100 |
| Rapid Assessment | ER | Lv 6 | 920 | 2,020 |
| Emergency Lead | ER | Lv 9 | 1,450 | 3,470 |
| Critical Care Senior | ER | Lv 12 | 2,100 | 5,570 |
| Pediatric Intake | Pediatric | Lv 3 | 480 | 480 |
| Child Specialist | Pediatric | Lv 6 | 950 | 1,430 |
| Family Liaison | Pediatric | Lv 7 | 1,100 | 2,530 |
| Pediatric Charge Nurse | Pediatric | Lv 10 | 1,700 | 4,230 |
| Senior Pediatric Specialist | Pediatric | Lv 13 | 2,300 | 6,530 |
| OR Prep Nurse | Surgical Asst | Lv 4 | 640 | 640 |
| Intraoperative Assist | Surgical Asst | Lv 7 | 1,150 | 1,790 |
| Sterile Field Keeper | Surgical Asst | Lv 8 | 1,280 | 3,070 |
| Lead OR Nurse | Surgical Asst | Lv 11 | 1,900 | 4,970 |
| Surgical Specialist Senior | Surgical Asst | Lv 14 | 2,500 | 7,470 |
| ICU Monitoring | ICU | Lv 3 | 500 | 500 |
| Ventilator Management | ICU | Lv 6 | 980 | 1,480 |
| Critical Alert Response | ICU | Lv 7 | 1,050 | 2,530 |
| Advanced Life Support | ICU | Lv 10 | 1,800 | 4,330 |
| ICU Charge Nurse | ICU | Lv 13 | 2,200 | 6,530 |
Use the XP tracker to calculate how many sessions your target spec will take from your current level. For full role context see the nurse guide.
I played all four branches to their top node across May 2026. Here is my honest ranking and the reasoning behind it.
ICU first if you play solo or off-peak. The passive monitoring tick structure means ICU earns XP whether there are 2 players or 14 on the server. I had a 4-player quiet session as ICU Nurse that earned 192 XP/hr — within 10% of my best ICU session. No other spec holds up that well on quiet servers. ICU is also the best cross-spec synergy hub: it receives routed patients from ER Triage and benefits from both Pediatric and ER events.
ER if you play peak hours and care about XP ceiling. Critical Care Senior at 35 XP per interaction is the highest nurse node payout in the game. Emergency Lead gives team-wide buffs. On a busy server I recorded 268 XP/hr as full ER spec — the best I have seen from any nurse branch. The downside: on a quiet server ER drops to around 155 XP/hr. The variance is real.
Pediatric for new players who want consistency without server pressure.The ward has a self-contained NPC queue and the conditions are distinct enough from generic nurse tasks to keep things interesting. I found Pediatric particularly good for 20-minute sessions where I did not want to invest in warmup time. The Family Liaison node (Level 7) is underrated — it adds a reliable +30 XP/hr with no server dependency.
Surgical Asst only if you have a reliable server with an active Doctor or Surgeon.I cannot recommend this as a first pick for most players. On a session where the Doctor quit mid-shift, I sat at 0 XP/hr for 12 minutes waiting for OR cases. The peak is real — Intraoperative Assist with an active Surgeon can push 260 XP/hr — but the floor can be genuinely 0. If you have a friend who plays Doctor, Surgical Asst is an excellent pairing. Solo: pick ICU instead.
Video
Covers the Nurse role walkthrough and available spec paths — useful visual context before committing to a branch.
Not affiliated with Marizma Games.
ICU Nurse is the most reliable first pick because passive monitoring ticks run regardless of server population. ER Nurse has the highest peak XP but requires a busy server. Pediatric is the most solo-friendly. Surgical Asst is the riskiest solo choice — it requires an active Doctor or Surgeon to generate OR cases.
Each branch costs roughly 5,570–7,470 XP to complete. ER is the cheapest full branch (5,570 XP total for all 5 nodes). Surgical Asst is the most expensive (7,470 XP). You unlock one node at a time — no XP splitting across branches.
ER Triage Nurse (Level 2 node) fast-routes critical patients to the ICU bay, triggering ICU monitoring XP for the ICU Nurse. Both players earn simultaneously. On a 2-player session, this is the best XP setup in the nurse tree — tested at combined 430 XP/hr between the two players.
As soon as you hit the unlock level for your chosen spec's first node (Level 2 for ER, Level 3 for Peds and ICU, Level 4 for Surgical Asst). The first node perk is meaningful — ER Triage Nurse adds +12 XP per triage interaction immediately. Delaying leaves XP on the table.
Independent games writer based in Sydney. I test Roblox games and publish guides with real in-game numbers — no fabricated values, no recycled wikis. The nurse specialization data on this page comes from 40+ hours of nurse play in May 2026, including at least 3 sessions per spec branch. More about my methodology →
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