Becoming a nurse starts with choosing a degree program, completing supervised clinical hours, and passing a national licensing exam called the NCLEX-RN. The entire process takes two to four years depending on the path you choose, and registered nurses earn a median salary of $93,600 per year. Here’s what each step looks like.
Choose Between a Two-Year and Four-Year Degree
Two main degree paths lead to becoming a registered nurse: an Associate Degree in Nursing (ADN) and a Bachelor of Science in Nursing (BSN). Both qualify you to sit for the licensing exam and work as an RN, but they differ in time, cost, and career flexibility.
An ADN is a two-year program typically offered at community colleges, with some accelerated versions finishing in 18 months. Tuition at a public school runs between $6,000 and $20,000. A BSN is a four-year undergraduate program at a college or university, with tuition ranging from $40,000 to over $200,000 depending on the school.
The trade-offs go beyond cost. Many employers prefer candidates with a BSN, and a bachelor’s degree is required if you ever want to enter a graduate nursing program. BSN holders also tend to earn more: average salaries sit around $92,000 compared to $75,000 for ADN holders, based on mid-2023 data from Payscale. BSN graduates also pass the licensing exam at a slightly higher rate (82.3% on the first attempt versus 77.9% for ADN graduates).
If you already have a bachelor’s degree in another field and want to switch careers, accelerated BSN programs compress the nursing curriculum into about 15 months of full-time study. NYU’s program, for example, runs four consecutive semesters and requires you to complete science prerequisites beforehand. These programs are intense but offer one of the fastest routes into nursing for career changers.
Complete Your Prerequisites
Before you start a nursing program, you’ll need to finish a set of prerequisite courses. The exact list varies by school, but the core requirements are consistent across most programs. Expect to take:
- Sciences: Human Anatomy and Physiology I and II (with lab), Microbiology (with lab), Chemistry (with lab), and Human Nutrition
- Math: College Algebra or higher, plus Statistics
- Liberal arts: English Composition, Introduction to Psychology, Introduction to Sociology, and Developmental Psychology covering the full human lifespan
Some schools add philosophy, history, or government courses depending on their general education requirements. Most programs require a C or better in every prerequisite. If you’re applying to an accelerated program, your science courses typically can’t be more than ten years old. Many students complete prerequisites at a community college before transferring to a nursing program, which keeps costs down.
What Nursing School Looks Like
Nursing programs combine classroom learning with hands-on clinical rotations in hospitals, clinics, and other healthcare settings. The classroom portion covers pharmacology, pathophysiology, patient assessment, and nursing ethics. The clinical portion is where you practice skills on real patients under supervision.
The number of required clinical hours varies by state. California mandates a minimum of 500 direct patient care hours, with at least 30 hours dedicated to each nursing specialty area. Across the country, state boards set minimums ranging from 250 to over 1,000 hours. Your rotations will cycle through areas like medical-surgical nursing, pediatrics, obstetrics, mental health, and critical care, giving you broad exposure before you graduate.
Pass the NCLEX-RN
After graduating from an accredited program, you need to pass the NCLEX-RN to earn your nursing license. The process has several administrative steps that are worth knowing upfront so nothing catches you off guard.
First, you apply for licensure with your state’s board of nursing. Separately, you register with Pearson VUE (the testing company) and pay a $200 exam fee, which is nonrefundable. Use the exact name on your government-issued ID when registering. Your state board then confirms your eligibility in the Pearson VUE system, and you receive an Authorization to Test letter. You typically have about 90 days from that letter to schedule and take your exam, with no extensions available.
The NCLEX-RN is a computerized adaptive test, meaning the difficulty adjusts based on your answers. It covers safe patient care, clinical judgment, pharmacology, and health promotion. Most nursing programs build NCLEX preparation into the final semester, and many students also use dedicated review courses or practice question banks.
Understand Multi-State Licensing
Once you’re licensed, your ability to work across state lines depends on where you live. The Nurse Licensure Compact (NLC) allows nurses to hold one license and practice in any participating state. As of 2025, 43 jurisdictions have enacted the compact, including Texas, Florida, Georgia, Ohio, Pennsylvania, and most of the Southeast and Midwest.
If your home state participates, your single license covers you in all other compact states. This is especially useful for travel nursing or telehealth roles. If you live in a non-compact state like California or New York, you’ll need to apply for a separate license in each state where you want to practice.
Career Growth and Advanced Roles
Registered nursing is a starting point with a strong outlook. Employment is projected to grow 5% from 2024 to 2034, faster than average across all occupations. But many nurses eventually move into advanced practice roles that come with more autonomy and higher pay.
Advanced Practice Registered Nurses (APRNs) include nurse practitioners, nurse anesthetists, and nurse midwives. All of these roles require at least a master’s degree, though some nurses pursue a Doctor of Nursing Practice (DNP). You must hold an active RN license before entering any graduate program. Nurse anesthetists face an additional requirement: at least one year of experience working in a critical care setting before they can apply to an anesthesia program. After completing your graduate degree, you’ll take a national certification exam specific to your specialty and obtain a separate APRN license.
Even without pursuing an advanced degree, experienced RNs can specialize in areas like oncology, emergency medicine, or intensive care through certification programs. Charge nurse and nurse manager roles also open up with experience, moving you into leadership without necessarily going back to school.
Realistic Timeline From Start to Finish
If you’re starting from scratch with no prerequisites completed, here’s roughly what each path looks like:
- ADN route: One to two semesters of prerequisites, then two years of nursing school. Total: about three years.
- BSN route: Prerequisites are often built into the four-year curriculum, so you’re looking at four years total if you enter as a freshman.
- Accelerated BSN: Prerequisites may take six months to a year if you haven’t taken them, then 15 months in the program. Total: about two to two and a half years.
Add a few weeks after graduation for the NCLEX registration and testing process, and you can be working as a licensed RN shortly after completing any of these paths.