Becoming a registered nurse takes two to four years depending on the degree path you choose, and every path ends at the same gate: passing the NCLEX-RN licensing exam. The median annual wage for registered nurses was $93,600 in May 2024, and employment is projected to grow 5 percent through 2034, faster than the average for all occupations. Here’s what the process looks like from start to finish.
Choose Between a Two-Year and Four-Year Degree
There are two main educational routes to becoming an RN. The Associate Degree in Nursing (ADN) is a two-year program typically offered at community colleges, with some accelerated versions finishing in 18 months. The Bachelor of Science in Nursing (BSN) is a four-year program at a college or university. Both qualify you to sit for the NCLEX-RN, and both produce licensed registered nurses.
The difference is depth and career ceiling. ADN programs focus on core clinical skills: fundamentals of nursing, medical-surgical care, pediatrics, psychiatric nursing, and community health. BSN programs cover all of that plus coursework in nursing theory, public health, ethics, and pathophysiology. That broader foundation matters later. A BSN is required for admission to any graduate nursing program, and many hospitals now prefer or require it when hiring. BSN-prepared nurses also tend to earn higher salaries.
If speed and cost are your priorities, the ADN gets you working sooner and costs less upfront. Many nurses start with an ADN and later complete an RN-to-BSN bridge program online while working. If you already know you want to move into leadership, education, or advanced practice, starting with a BSN saves you from doubling back.
Complete Your Prerequisites
Before you can apply to a nursing program, you need to finish a set of prerequisite courses. The exact list varies by school, but the core sciences are consistent: human anatomy, human physiology, microbiology, general chemistry, and statistics. BSN programs typically add more general education requirements like psychology, developmental psychology, sociology, nutrition, English composition, and a course in cultural studies or the creative arts.
Grades matter more here than in many other fields. Most nursing schools require a C or higher in every prerequisite course and will not accept a C-minus. A minimum cumulative GPA of 3.0 is a common threshold, and competitive applicants often have a B or higher across the board. Nursing programs are selective, so strong prerequisite grades are one of the most important parts of your application.
Pass a Nursing Entrance Exam
Most nursing programs require either the TEAS or the HESI A2 as part of the admissions process. Your school decides which one.
The TEAS covers four subjects: reading, math, science, and English language usage. The HESI A2 tests math, reading, vocabulary, grammar, and anatomy and physiology, with some schools adding extra sections. Passing requirements vary by program. Some set minimum scores for each section, others evaluate your overall performance. Check your target school’s specific cutoffs before you register for the test, and give yourself a few weeks of focused study on the science and math sections, which tend to trip up the most applicants.
What Nursing School Looks Like
Nursing programs combine classroom learning with hands-on clinical rotations. In your first year, expect courses in fundamentals of nursing, pharmacology, and health assessment. You’ll practice skills like taking vital signs, administering injections, and inserting IVs on simulation mannequins before working with real patients.
Clinical rotations start early and intensify as you progress. You’ll rotate through different hospital units and community settings including medical-surgical floors, labor and delivery, pediatrics, psychiatric facilities, and intensive care. These rotations are where classroom knowledge becomes real, and they also help you figure out which specialty interests you. Programs typically require a certain number of clinical hours, and your schedule during rotations will feel more like a job than a class, often including early mornings, evenings, or weekends.
Most programs also require Basic Life Support (BLS) certification before you begin clinical rotations. This is a short course, usually completed in a single day, that teaches CPR and emergency response skills. You’ll need to keep this certification current throughout your career.
Pass the NCLEX-RN
After graduating, you need to pass the NCLEX-RN to earn your license. The process starts with an application to your state board of nursing. In most states, this is a two-part process: first you apply for exam approval and receive an Authorization to Test (ATT), then after passing the exam you complete a separate application for your actual license. Fingerprinting and a criminal background check are standard parts of the process.
The NCLEX-RN is a computerized adaptive test, meaning it adjusts its difficulty based on your answers. It covers safe and effective care, health promotion, psychosocial integrity, and physiological integrity. The minimum number of questions is 85, but you could answer up to 150 depending on how consistently you’re performing. Most candidates find out their results within 48 hours.
Study seriously for this exam. Your nursing program will prepare you, but most successful candidates also use a dedicated NCLEX review course or question bank in the weeks after graduation. The pass rate for first-time, U.S.-educated test takers is generally strong, but it’s not a formality.
Understand Your License and Where It Works
Your RN license is issued by the state where you apply, but it may work in more states than you think. Forty-three U.S. jurisdictions are now members of the Nurse Licensure Compact (NLC), which allows you to hold one multistate license and practice in person or via telehealth in any member state. The states that have not yet joined include California, New York, Illinois, Michigan, Minnesota, Oregon, Hawaii, Alaska, and Nevada, along with the District of Columbia and a few territories.
If you live in a compact state and obtain a multistate license, you can pick up travel nursing assignments, provide telehealth services across state lines, or respond to disaster relief without applying for separate licenses. If you live in a non-compact state, you’ll need to apply individually for a license in each state where you want to work.
Alternative Paths for Career Changers and LPNs
If you’re already a Licensed Practical Nurse, LPN-to-RN bridge programs let you build on your existing training rather than starting from scratch. These programs evaluate your clinical knowledge through proctored assessments in areas like nursing fundamentals and medication dosage calculations. If you score high enough, you can skip the first semester of foundational courses and move directly into advanced content. You’ll need to submit transcripts from your LPN program and meet the same admission standards as other applicants.
If you hold a bachelor’s degree in another field and want to switch to nursing, accelerated BSN programs compress the full nursing curriculum into 12 to 18 months. These programs are intense, often running year-round with no summer break, but they’re designed for people who have already completed general education coursework and just need the nursing-specific training. You’ll still need to complete science prerequisites before applying.
What Happens After You’re Licensed
New RNs typically start in a residency or orientation program at their first employer, lasting anywhere from a few weeks to several months depending on the unit. This transition period pairs you with an experienced nurse and gradually increases your patient load as your confidence and skills grow.
From there, the career branches widely. With experience and additional certifications, you can specialize in areas like critical care, oncology, emergency medicine, or neonatal care. With a BSN and a few years of clinical experience, you can apply to graduate programs to become a nurse practitioner, nurse anesthetist, nurse midwife, or clinical nurse specialist. Each of those roles requires a master’s or doctoral degree and its own certification, but the foundation is the same RN license you earn through the steps above.