A registered nurse (RN) is a licensed healthcare professional who has graduated from an approved nursing program, passed a national licensing exam called the NCLEX-RN, and holds an active license from a state board of nursing. With roughly 3.4 million jobs in the United States as of 2024, registered nurses make up the single largest segment of the healthcare workforce.
RNs do far more than take vital signs. They assess patients, develop care plans, administer medications, coordinate treatment across providers, and educate patients and families about managing health conditions. The profession spans hospitals, clinics, schools, home health agencies, and government settings.
What Registered Nurses Actually Do
The core of an RN’s work revolves around a structured process: assessing a patient’s condition, identifying health problems, creating a care plan, carrying out interventions, and evaluating whether those interventions are working. This cycle repeats throughout a patient’s stay or course of treatment, and the RN is responsible for adjusting the plan when something isn’t improving.
On a typical day in a hospital, an RN might perform physical exams, review a patient’s medical history, administer medications and IV treatments, operate medical equipment, run or assist with diagnostic tests, and document observations about how a patient is responding. They also serve as the communication hub between doctors, specialists, therapists, and the patient’s family, making sure everyone is aligned on the care plan.
RNs also supervise licensed practical nurses (LPNs) and nursing assistants. While LPNs carry out specific tasks like wound care or medication administration under direction, it’s the RN who performs the initial comprehensive assessment, formulates the nursing diagnosis, builds the care plan, and decides when that plan needs to change. An LPN can collect data and suggest revisions, but the clinical judgment and decision-making authority rest with the RN.
How to Become a Registered Nurse
There are two main educational paths to becoming an RN. The first is an Associate Degree in Nursing (ADN), a two-year program typically offered at community colleges, with some accelerated versions finishing in 18 months. The second is a Bachelor of Science in Nursing (BSN), a four-year program at a college or university. Both qualify graduates to sit for the NCLEX-RN, and both produce licensed RNs.
The key difference is depth. ADN programs focus on core clinical skills needed for direct patient care. BSN programs cover the same clinical foundation but add coursework in public health, nursing ethics, pathophysiology, microbiology, and theoretical nursing concepts. Many hospitals now prefer or require a BSN, and nurses who start with an ADN frequently complete an RN-to-BSN bridge program while working.
The Licensing Exam
After completing a nursing program, graduates must pass the NCLEX-RN to practice. The process starts with submitting a licensure application to your state’s board of nursing, providing official transcripts and government-issued ID, and completing a criminal background check. Some states require additional steps like fingerprinting or proof of English proficiency for international graduates.
Once the state board approves your application and you register with the testing company (Pearson VUE), you receive an Authorization to Test by email. This authorization is typically valid for 90 days. If you don’t take the exam within that window, you’ll need to re-register. Each state sets its own specific rules, so requirements can vary.
Where RNs Work
Hospitals employ the majority of registered nurses, accounting for 59% of all RN positions. Ambulatory healthcare services, which includes doctors’ offices, outpatient care centers, and home health agencies, employ another 19%. Nursing and residential care facilities account for 6%, government roles for 5%, and educational institutions for 3%.
The setting shapes the work significantly. A hospital RN might manage post-surgical patients on a 12-hour shift, responding to rapidly changing conditions. A nurse in a primary care office handles routine assessments, chronic disease management, and patient education during business hours. Home health nurses travel to patients’ residences to provide wound care, medication management, and post-discharge follow-up. School nurses handle everything from managing chronic conditions like asthma and diabetes to responding to injuries during the school day.
How RNs Differ From LPNs
The distinction between an RN and a licensed practical nurse comes down to clinical judgment and autonomy. An RN independently assesses patients, interprets clinical data, formulates nursing diagnoses, and builds care plans. An LPN collects data and carries out nursing interventions, but does so under RN supervision and cannot independently interpret findings or develop the care plan.
RNs also hold delegation authority. They decide which tasks can be assigned to LPNs or nursing assistants based on the complexity of the patient’s condition. When a patient’s status changes unexpectedly, it’s the RN who evaluates the situation and modifies the approach. This broader scope of practice reflects the additional education and training required for RN licensure.
Specialization Options
After gaining experience, RNs can specialize through certification in dozens of clinical areas. The American Nurses Credentialing Center offers specialty certifications in fields like ambulatory care, psychiatric-mental health, and adult-gerontology care. Specialty certifications typically require a combination of clinical experience hours and passing a focused exam.
Common specialization paths include critical care, emergency nursing, labor and delivery, oncology, pediatrics, and operating room nursing. Each specialty involves working with a specific patient population or in a particular clinical environment, and certification signals advanced competency to employers.
Advancing Beyond the RN Role
RNs who want to expand their scope of practice can pursue advanced practice roles. Becoming a nurse practitioner (NP), for example, requires holding a BSN, completing a graduate-level master’s or doctoral nursing program focused on NP practice, and passing a national board certification exam. NPs can diagnose conditions, manage treatment plans, and prescribe medications, responsibilities that go well beyond the standard RN scope.
Other advanced practice paths include clinical nurse specialist, certified nurse midwife, and certified registered nurse anesthetist. Each requires graduate education built on the foundation of RN training and clinical experience. For nurses who start with an ADN, the typical progression is completing a BSN bridge program, gaining clinical experience, and then entering a graduate program.
Internationally Educated Nurses
Nurses educated outside the United States can pursue RN licensure, but the process involves additional steps. CGFNS International provides credential evaluation and verification services that confirm a foreign nursing education meets U.S. standards. International graduates also need to complete a VisaScreen assessment for immigration purposes and pass the NCLEX-RN just like domestically educated nurses. Some states require proof of English language proficiency as part of the licensure application.