Becoming a registered nurse (RN) requires a nursing degree, supervised clinical experience, and a passing score on the national licensing exam called the NCLEX-RN. The fastest route takes about two years through a community college, while a four-year bachelor’s degree opens more career options. Here’s what each step involves.
Two Degree Paths: ADN or BSN
You can qualify to sit for the licensing exam with either of two degrees. An Associate Degree in Nursing (ADN) is a two-year program typically offered at community colleges, with some accelerated tracks finishing in 18 months. A Bachelor of Science in Nursing (BSN) is a four-year program at a college or university that provides broader training and more extensive clinical experience than an ADN.
Both degrees make you eligible to become a licensed RN, and both lead to the same licensing exam. The practical difference shows up later in your career. Many hospitals now prefer or require a BSN for hiring, and management, research, and advanced practice roles almost always require one. If you start with an ADN, RN-to-BSN bridge programs let you complete the bachelor’s degree while working, often in 12 to 18 months.
Prerequisite Courses You’ll Need First
Before you enter a nursing program, you’ll need to complete a set of prerequisite courses. The exact list varies by school, but most programs require a similar core. Using the University of Minnesota’s requirements as a representative example, expect to complete:
- Anatomy and physiology: Usually a two-semester sequence covering body structure and function
- Microbiology: The study of bacteria, viruses, and other organisms relevant to infection and disease
- General biology: Covering cell structure, genetics, reproduction, and evolution (human biology courses often don’t count)
- General chemistry: A college-level course covering chemical reactions, acids and bases, and solutions
- Statistics: Probability, confidence intervals, correlations, and linear regression
- Nutrition: Essential nutrients, digestion, metabolism, and food safety
- Human growth and development: A lifespan course covering infancy through older adulthood, including death and dying
- College-level writing: Critical reading, academic arguments, and research-based papers
- Psychology: An introductory course in human behavior
Most programs require a minimum grade of C or C-minus in each prerequisite, and some schools won’t accept science courses older than ten years. If your biology or chemistry class is from a decade ago, you may need to retake it. Competitive programs often look for grades well above the minimum, so strong performance in these courses matters for admission.
Clinical Hours During Your Program
Nursing programs include supervised clinical rotations where you practice patient care in real healthcare settings. The number of required clinical hours varies by state and program. The Texas Board of Nursing, for instance, suggests a ratio of one hour of classroom instruction to three hours of related clinical practice, and its practical nursing track expects at least 840 clinical hours.
BSN programs generally require more total clinical hours than ADN programs, spread across a wider range of specialties. During clinicals, you’ll rotate through areas like medical-surgical nursing, pediatrics, maternity, mental health, and community health. These rotations don’t always have to take place in a hospital. Some states allow simulation labs and community-based settings to count toward a portion of the requirement.
Passing the NCLEX-RN
After graduating from an accredited nursing program, you need to pass the NCLEX-RN to earn your license. This is a computerized adaptive test, meaning the difficulty of each question adjusts based on how you’ve answered previous ones. The current version, called Next Generation NCLEX (NGN), includes case studies composed of six items each, designed to measure your clinical judgment rather than just factual recall. You’ll be presented with patient scenarios and asked to recognize problems, prioritize actions, and evaluate outcomes.
If you don’t pass on the first attempt, you can retake the exam after a waiting period. Each retake requires a new registration fee.
Licensing Fees and State Requirements
Licensing costs vary significantly by state. California’s fees give a sense of the range: $300 for in-state graduates applying for the first time, $350 for graduates from other states, and $750 for internationally educated nurses. The NCLEX-RN registration fee is paid separately on top of these state application costs. Renewal fees apply every two years (California charges $190 for timely renewal).
Each state’s Board of Nursing sets its own requirements for licensure, which may include background checks, fingerprinting, and continuing education for renewal. The good news is that 43 states and territories now participate in the Nurse Licensure Compact (NLC), which lets you hold a single multistate license. If you live in a compact state and meet the requirements, you can practice in any other compact state without applying for a separate license. Nurses who move from one compact state to another need to apply for licensure in their new home state within 60 days.
Skills and Physical Demands
The Bureau of Labor Statistics identifies several qualities that matter for day-to-day nursing work. Critical thinking tops the list: you’ll constantly assess changes in patients and decide when to escalate care. Strong communication skills are essential for explaining medication instructions to patients, coordinating with physicians and other team members, and accurately documenting care. Attention to detail keeps patients safe, since giving the wrong treatment or medication at the wrong time can have serious consequences.
The emotional side of the job is real. Nurses need resilience to cope with suffering, emergencies, and loss. Compassion and empathy aren’t just nice to have; they’re core to how you connect with patients during some of the hardest moments of their lives.
Physically, nursing is demanding. You’ll spend most of your shift on your feet, walking, bending, and stretching. Lifting and repositioning patients is a regular part of the job, and back injuries are a well-known occupational risk. Physical stamina isn’t optional. If you have concerns about mobility or strength, it’s worth understanding the specific demands of the unit or setting you’re interested in, since some specialties are more physically intensive than others.
Path for Internationally Educated Nurses
If you completed your nursing education outside the United States, additional steps apply. You’ll need to have your academic and professional credentials evaluated by CGFNS International, an organization approved by the Department of Homeland Security to verify foreign healthcare credentials. State Boards of Nursing require this evaluation to confirm that your training is comparable to U.S. nursing standards.
The general requirements include having graduated from an accredited nursing program in your home country, holding an active nursing license there, and having at least two years of practice as a registered nurse. You may also need to demonstrate English proficiency through a standardized exam, though exemptions exist depending on your country of origin. Before applying for a state license, many internationally educated nurses complete the CGFNS Certification Program, which bundles a credentials evaluation, a qualifying exam, and the English proficiency component into one process.
You’ll also need an immigrant visa (green card) or an H-1B visa to work in the U.S. as a nurse. Federal law requires foreign-educated nurses to complete a screening program before receiving an occupational visa, and CGFNS’ VisaScreen service satisfies that requirement. After clearing these hurdles, you still take the same NCLEX-RN exam and apply for state licensure like any domestically educated nurse.