An RN, or registered nurse, is a licensed healthcare professional who has graduated from an approved nursing program and passed a national licensing exam called the NCLEX-RN. RNs are the largest group of healthcare workers in the United States, with about 59% working in hospitals and the rest spread across clinics, home health agencies, schools, and government settings. Their core role is to assess patients, develop care plans, administer treatments, and coordinate with doctors and other providers to manage patient health.
What RNs Actually Do
The daily work of an RN revolves around a five-step clinical framework: assessment, diagnosis, planning, implementation, and evaluation. In practical terms, this means an RN starts by collecting information about a patient, both through conversation (symptoms, pain levels, medical history) and measurable data like vital signs, weight, and fluid intake. From that information, the RN identifies the patient’s nursing needs and builds a personalized care plan with specific goals.
From there, the RN carries out or coordinates the interventions outlined in the plan. That can include administering medications ordered by a physician, applying monitoring equipment, managing wound care, educating patients about their conditions, and adjusting care as the patient’s status changes. After each intervention, the RN evaluates whether the patient is improving and modifies the plan if needed. This cycle repeats throughout every shift.
RNs also serve as a bridge between patients and physicians. They relay critical changes in a patient’s condition, clarify treatment orders, and advocate for patients when something doesn’t seem right. In a hospital setting, shift handoffs are a major part of the job, where outgoing nurses brief incoming nurses on every patient’s status, ongoing treatments, and anything to watch for.
How RNs Differ From LPNs
Licensed practical nurses (LPNs) work alongside RNs but have a narrower scope of practice. The key distinction is clinical judgment. RNs are responsible for interpreting assessment data, formulating nursing diagnoses, and developing care plans. LPNs help gather information for those assessments and carry out tasks within an existing care plan, but they don’t create or modify the plan themselves.
RNs can also delegate tasks to LPNs and nursing assistants, then supervise and evaluate the quality of that work. When it comes to medications, RNs administer them as ordered by physicians or nurse practitioners, verifying patient identity, correct dosage, and proper timing. LPNs can administer some medications in many states, but with more restrictions. If you think of patient care as a chain of decisions, the RN is the one making and adjusting those decisions at the bedside.
Education: ADN vs. BSN
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. Some accelerated ADN programs can be completed in 18 months. The curriculum covers prerequisites like anatomy, chemistry, and psychology, then moves into nursing-specific coursework: fundamentals, medical-surgical nursing, pediatrics, psychiatric nursing, and community health.
The second path is a Bachelor of Science in Nursing (BSN), a four-year program at a college or university. BSN programs cover the same clinical skills as ADN programs but add coursework in nursing theory, public health, ethics, and pathophysiology. Both degrees qualify you to sit for the same licensing exam, and both produce registered nurses with the same legal title. The difference shows up in career trajectory. Many hospitals now prefer or require BSN-prepared nurses during hiring, and a BSN is required for admission to any graduate nursing program, such as nurse practitioner or nurse educator tracks. BSN-prepared nurses also tend to earn higher salaries.
Licensing: The NCLEX-RN
Regardless of which degree you earn, you must pass the NCLEX-RN to practice as a registered nurse. Eligibility requires graduating from a nursing program accredited by one of the recognized accrediting bodies (such as the Accreditation Commission for Education in Nursing or the Commission on Collegiate Nursing Education) or from a state-approved program that has been issued an exam code by the National Council of State Boards of Nursing. Military nursing program graduates and international nursing graduates whose education is deemed equivalent also qualify.
The exam uses a computerized adaptive testing format, meaning the difficulty of each question adjusts based on how you answered previous ones. The test narrows in on your competency level in real time rather than giving every test-taker the same set of questions. Once licensed, RNs must maintain their license through their state board of nursing, which typically requires continuing education credits for renewal.
Where RNs Work
Hospitals employ the majority of registered nurses, accounting for 59% of RN positions. Another 19% work in ambulatory healthcare services, a category that includes physicians’ offices, outpatient care centers, and home healthcare agencies. Nursing and residential care facilities employ about 6%, government roles (outside of hospitals and education) account for 5%, and educational settings make up roughly 3%.
These numbers only capture broad categories. Within them, RNs work in emergency departments, operating rooms, intensive care units, labor and delivery wards, primary care clinics, schools, correctional facilities, insurance companies, and corporate wellness programs. The variety of settings is one reason nursing attracts people with very different interests. An RN who thrives on fast-paced critical decisions might gravitate toward emergency or ICU work, while someone drawn to long-term relationships with patients might prefer home health or primary care.
Specialization and Certification
After gaining experience, RNs can pursue specialty certifications that validate advanced knowledge in a specific area of practice. The American Nurses Credentialing Center offers certifications in fields including medical-surgical nursing, pediatric nursing, psychiatric-mental health nursing, cardiac-vascular nursing, pain management, ambulatory care, gerontology, and nursing informatics. Each certification requires meeting eligibility criteria (usually a combination of clinical hours and continuing education) and passing a specialty exam.
Specialty certifications aren’t legally required to work in a particular unit, but they signal expertise to employers and can open doors to higher-paying roles or leadership positions. Some RNs pursue advanced practice credentials like family nurse practitioner or psychiatric-mental health nurse practitioner, which require a graduate degree and grant a broader scope of practice, including the ability to prescribe medications in most states.
A Typical Hospital Shift
A hospital RN’s shift, usually 12 hours, begins with a handoff report from the outgoing nurse. This briefing covers each assigned patient’s current condition, active treatments, recent lab results, and anything that needs follow-up. From there, the RN makes rounds: checking vital signs, assessing pain levels, reviewing medication schedules, and physically examining patients for changes since the last assessment.
Throughout the day, the RN administers medications, updates care plans, documents everything in the electronic health record, communicates with physicians about changes in patient status, and coordinates with other departments for imaging, labs, or specialist consultations. Many hospitals hold interprofessional rounds where nurses, physicians, pharmacists, and therapists discuss each patient’s progress as a team. The RN also handles patient and family education, explaining diagnoses, medications, and discharge instructions in plain language. Before the shift ends, the cycle closes with another detailed handoff to the next nurse.