Starting nursing school begins well before your first day of classes. Between choosing a degree path, completing prerequisites, passing an entrance exam, and clearing health requirements for clinical rotations, the process typically takes 12 to 18 months of preparation before you even start a program. Here’s what each step looks like and how to move through it efficiently.
Choose Your Degree Path
The first decision you’ll make is which type of nursing degree fits your situation. The two main entry-level options are the Associate Degree in Nursing (ADN) and the Bachelor of Science in Nursing (BSN). Both qualify you to take the licensing exam and work as a registered nurse, but they differ in time commitment, cost, and long-term career flexibility.
An ADN is a two-year program, typically offered at community colleges, with some accelerated versions finishing in 18 months. It’s a faster, less expensive route into the profession. A BSN is a four-year program at a university that includes broader training and more clinical experience. The career tradeoffs are real: BSN holders earn an average salary of $92,000 compared to $75,000 for ADN holders, and many hospitals now prefer or require a BSN. A BSN is also mandatory if you ever want to pursue a graduate nursing degree. Even first-attempt pass rates on the licensing exam tilt slightly in favor of BSN graduates, at 82.3% versus 77.9% for ADN graduates.
If you already hold a bachelor’s degree in another field, a third option exists. Accelerated BSN (ABSN) programs compress the nursing curriculum into 11 to 18 months, including prerequisites. These programs are intense (students are encouraged not to work during enrollment) and typically require a minimum 3.0 GPA from your previous degree.
Complete Your Prerequisites
Nearly every nursing program requires a set of science and general education courses before you can apply. The science prerequisites are the most important and often the most competitive part of your application. Expect to complete Anatomy and Physiology I and II plus Microbiology, all with a grade of C or better. Many programs require these courses to have been taken within the last five years, so older coursework may not count.
General education prerequisites commonly include English Composition, a literature course, a humanities or fine arts elective, a social or behavioral science course, and sometimes American History. Programs also frequently recommend Chemistry with a lab, General Psychology, college-level Algebra, Nutrition, and a Growth and Development course. Even when these are listed as “recommended,” completing them before you apply strengthens your application and lightens your course load once you’re in the program.
GPA matters more than you might expect. Competitive programs often set a minimum cumulative GPA of 3.0, with some requiring a 3.2 in your most recent degree. Science prerequisites sometimes carry their own GPA threshold, such as 2.67 or higher. If your GPA is borderline, retaking a science course or adding strong elective grades can make a difference.
Prepare for the Entrance Exam
Most nursing programs require either the TEAS or the HESI A2 exam as part of your application. The TEAS covers 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. BSN and ADN programs more commonly require the TEAS, though some use the HESI A2 instead. Check your target schools early so you study for the right test.
There’s no universal passing score. Each program sets its own cutoffs, and some evaluate your overall composite score while others require minimums in each section. Give yourself at least six to eight weeks of focused study time. Free and paid prep resources are widely available, and many students take the exam more than once to improve their scores (most testing companies allow retakes after a waiting period).
Build Your Application Timeline
Nursing school applications run on fixed cycles, and missing a deadline can mean waiting an entire year. Many programs use NursingCAS, a centralized application system where you submit transcripts, personal statements, a resume, and letters of recommendation all in one place. Your recommenders also upload their letters through this portal, so give them plenty of lead time.
Application timelines vary, but here’s a general sense of how the cycle works. Programs with a November deadline often release decisions by late January. Priority deadlines may yield decisions by late March. After you submit, expect four to six weeks before you hear whether you’ve been selected for an interview. Working backward from these dates, you should have your entrance exam scores, final transcripts, and recommendation letters ready at least two months before the application deadline. Starting your prerequisite courses 12 to 18 months before you plan to apply gives you a comfortable buffer.
Verify Program Accreditation
Before committing to any program, confirm it holds accreditation from one of two recognized bodies. The Commission on Collegiate Nursing Education (CCNE) accredits BSN, MSN, and doctoral programs. The Accreditation Commission for Education in Nursing (ACEN) covers the full range, from practical nursing certificates through doctoral degrees.
This isn’t a technicality. Accreditation is typically required for you to receive federal financial aid, and it often determines eligibility for scholarships and employer tuition reimbursement. Many hospitals prefer or require that their nurses graduated from an accredited program. If you ever want to transfer credits to a graduate program, accreditation is what makes that possible. You can verify a program’s status on the CCNE or ACEN websites before you apply.
Plan for the Cost
Nursing school costs vary dramatically depending on the type of program and whether you attend a public or private institution. An ADN at a public college runs roughly $24,000 to $40,000 total. At a private school, an ADN can cost $30,000 to $66,000. A four-year BSN ranges from about $90,000 to over $200,000, and once you factor in housing, transportation, and living expenses, the total can exceed $250,000 at some private universities.
Community college ADN programs offer the lowest upfront cost, and many nurses use this as a stepping stone, working as an RN while completing a BSN through an online RN-to-BSN bridge program later. Federal financial aid (FAFSA), state grants, hospital-sponsored scholarships, and employer tuition assistance programs can all reduce out-of-pocket costs significantly. Some hospitals offer loan forgiveness or tuition reimbursement in exchange for a work commitment after graduation.
Clear Health and Background Requirements
Before you can start clinical rotations (the hands-on patient care portion of nursing school), you’ll need to pass a series of health clearances. Programs require up-to-date immunizations, which typically include hepatitis B, MMR (measles, mumps, rubella), varicella, tetanus, and an annual flu shot. Healthcare facilities mandate influenza vaccination for anyone with potential patient exposure, though medical exemptions are available with a provider’s documentation.
You’ll also need a current tuberculosis screening, a physical exam, a drug screening, and a criminal background check. Some clinical sites run their own additional checks. These requirements protect patients and are non-negotiable for clinical placement. Start gathering your vaccination records and scheduling any needed boosters as soon as you’re accepted, because delays in health clearance can delay your start date.
From Graduation to Licensure
Finishing nursing school doesn’t make you a nurse yet. You need to pass the NCLEX-RN, the national licensing exam. The process works in a specific order: you apply for licensure with your state board of nursing, the board verifies your eligibility and enters you into the testing system, and then you receive an Authorization to Test (ATT) letter. You must complete testing within 365 days of your registration and payment.
The NCLEX-RN is a computerized adaptive test, meaning the difficulty adjusts based on your answers. The number of questions varies from person to person. Most new graduates take the exam within a few weeks of finishing their program, while the material is still fresh. Once you pass, your state board issues your RN license, and you can begin practicing. The job market is strong: registered nursing is projected to grow 5% through 2034, with roughly 189,100 openings per year nationwide.