Becoming a registered nurse requires completing an accredited nursing program (two to four years), passing the NCLEX-RN licensing exam, and meeting your state’s background check and health clearance requirements. The path is straightforward but has several distinct steps, and the choices you make early on affect your salary, job options, and ability to advance later.
Two Main Degree Paths
You can enter nursing through two primary routes: an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). Both qualify you to sit for the licensing exam and work as a registered nurse, but they differ in time, cost, depth, 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. The curriculum covers nursing fundamentals, medical-surgical nursing, pediatric nursing, psychiatric nursing, and community health. It’s the faster, more affordable entry point.
A BSN is a four-year program at a university. It covers everything in an ADN plus deeper coursework in public health, nursing ethics, pathophysiology, and theoretical nursing concepts. It also includes more clinical experience. Many employers prefer or require a BSN, and it’s a hard prerequisite if you ever want to pursue graduate school or become a nurse practitioner. BSN holders pass the licensing exam at a higher rate (82.3% on the first attempt versus 77.9% for ADN holders) and earn more on average: roughly $92,000 per year compared to $75,000 for ADN-prepared nurses.
If you start with an ADN, you can later complete an RN-to-BSN bridge program while working. Many nurses take this route to get into the workforce sooner and upgrade their credentials over time.
Prerequisite Courses You’ll Need First
Before you’re admitted to a nursing program, you’ll need to complete a set of prerequisite courses. These are typically taken during your first year or two of college, or at a community college before transferring. The exact list varies by school, but most programs require a similar foundation.
On the science and math side, expect to take human anatomy and physiology (usually a two-semester sequence with labs), microbiology with a lab, chemistry, college algebra or higher math, statistics, and human nutrition. These courses are non-negotiable at virtually every accredited program and tend to be the most competitive prerequisites.
Liberal arts requirements round out the list: English composition (two semesters), introductory psychology, introductory sociology, human growth and development covering conception through end of life, and often a philosophy or ethics course. Some state universities also require government and history courses as part of their general education core. All told, you may need around 60 semester hours of prerequisite work before you even begin the nursing-specific portion of a BSN program.
Background Checks, Immunizations, and CPR
Nursing programs require health and legal clearances before you can start clinical rotations. These aren’t optional, and missing a single item can delay your enrollment.
- Background check: A national criminal background check is standard, costing $60 or more depending on how many states you’ve lived in. Results are typically valid for six months, so timing matters when you apply.
- Tuberculosis screening: Renewed yearly. The initial screening is a two-step skin test, with results read 48 to 72 hours after each placement. A positive result requires a chest X-ray and provider follow-up.
- Hepatitis B: You’ll need proof of immunity through a blood test showing surface antibodies. If you haven’t been vaccinated or your antibody levels are insufficient, you’ll need to complete the full vaccine series.
- MMR (measles, mumps, rubella): Proof of two vaccines or positive blood titers for all three diseases.
- Influenza: An annual flu vaccine for the current season is required.
- CPR certification: You must hold an American Heart Association Basic Life Support card, which is valid for two years.
Drug screening is also commonly required. COVID-19 vaccination is not universally mandated at this point, though individual clinical sites can reinstate the requirement.
Passing the NCLEX-RN
After graduating from an accredited nursing program, you need to pass the NCLEX-RN to become a licensed registered nurse. The process starts by applying for licensure with the board of nursing in the state where you want to practice. Once the state board confirms your eligibility, you’ll receive authorization to schedule the exam.
The NCLEX-RN is a computerized adaptive test, meaning it adjusts the difficulty of questions based on your responses. It covers clinical judgment, patient safety, pharmacology, and nursing procedures across multiple patient populations. Preparation typically involves dedicated study over several weeks using review courses or practice exams. Most nursing programs build NCLEX preparation into the final semester.
State Licensing and the Nurse Licensure Compact
Your nursing license is issued by a specific state, and you need an active license in any state where you practice. Currently, 43 states and territories participate in the Nurse Licensure Compact, which allows nurses who live in a compact state to hold a single multistate license and practice across all participating states without applying separately in each one. If you move to a new compact state, you have 60 days to apply for licensure in your new home state.
If you live in a non-compact state or want to work in one, you’ll need to apply for a separate license in that state, which typically involves an additional application fee and verification of your credentials.
Physical Demands of the Job
Nursing is physically intense work, and it’s worth understanding this before you commit to the career. A typical 12-hour hospital shift involves standing and walking for up to 11 of those hours, often on uneven surfaces and ramps. You’ll push beds and equipment requiring up to 80 to 100 pounds of force, lift and carry items up to 25 pounds, and assist with transferring patients who weigh well over 100 pounds (with help from other staff and transfer aids).
The job also requires overhead reaching up to about 81 inches, sustained bending and stooping, and holding awkward positions for five minutes or more while performing patient care. You’ll spend at least a couple of hours per shift at a computer documenting care. Physical stamina, a healthy back, and the ability to stay on your feet for long stretches are genuine job requirements, not just nice-to-haves.
Keeping Your License Active
Once licensed, you’ll need to complete continuing education to renew. Requirements vary by state. California, for example, requires 30 contact hours of continuing education per renewal cycle, taken through a board-recognized provider. New nurses are typically exempt from continuing education during their first two years after initial licensure. Renewal also involves a fee and, in many states, proof that you’ve practiced a minimum number of hours.
Advancing Beyond the RN
If you want to move into advanced practice, the path starts with a BSN and an active RN license. From there, you can pursue a Master of Science in Nursing or a doctoral nursing program in a specialty area. Nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, and clinical nurse specialists all fall under the advanced practice umbrella.
Becoming a nurse practitioner, for example, requires completing a graduate program focused on a specific patient population (such as family practice, pediatrics, or psychiatric care), then passing a national board certification exam matched to that specialty. These exams test both general advanced practice knowledge and population-specific competencies. Advanced practice roles come with significantly higher earning potential, greater autonomy, and prescribing authority in most states.
Job Outlook and Pay
The median annual wage for registered nurses was $93,600 as of May 2024. Employment is projected to grow 5% from 2024 to 2034, which is faster than the average for all occupations. Demand is driven by an aging population, a wave of nurses nearing retirement, and expanding roles for nurses in primary care and outpatient settings. Specialties like critical care, emergency, and nurse anesthesia tend to command higher salaries, as do positions in metropolitan areas and states with higher costs of living.