Becoming a nurse in the United States requires completing an approved nursing program, passing a national licensing exam, and obtaining a state license. The full process takes two to four years depending on the degree path you choose, and the career pays well: registered nurses earned a median salary of $93,600 in 2024, with job growth projected at 5% through 2034.
Choose Between a Two-Year and Four-Year Degree
There are two main educational routes to becoming a registered nurse. An Associate Degree in Nursing (ADN) is a two-year program typically offered at community colleges, with some accelerated options finishing in 18 months. A Bachelor of Science in Nursing (BSN) is a four-year program at a college or university. Both degrees qualify you to sit for the licensing exam and work as an RN.
The ADN gets you working faster and costs less upfront. The BSN opens more doors. Many hospitals now prefer or require a bachelor’s degree, especially for leadership roles, specialty units, and positions at magnet-designated facilities. If you start with an ADN, bridge programs (called RN-to-BSN programs) let you complete your bachelor’s while working, often in 12 to 18 months online.
Complete Prerequisites Before You Apply
Nursing programs don’t accept students straight into clinical coursework. You’ll need to finish a set of prerequisite courses first, typically including anatomy, physiology, microbiology, chemistry, psychology, sociology, and a human growth and development course. Most programs also require general education credits in English composition, math, and sometimes statistics. At a community college, you can often knock out these prerequisites in two to three semesters.
Grades matter. Nursing programs are competitive, and most set minimum GPA requirements for prerequisite courses, commonly around 2.75 to 3.0. Many applicants carry GPAs well above the minimum. Your anatomy, physiology, and microbiology grades carry particular weight because they reflect your ability to handle the science-heavy nursing curriculum.
Pass an Entrance Exam
Most nursing programs require a standardized entrance exam as part of the application. The two most common are the TEAS (Test of Essential Academic Skills) and the HESI A2. The HESI A2 is a computerized exam with six sections: grammar, reading comprehension, vocabulary and general knowledge, biology, chemistry, and math. A typical minimum passing score is 75% on each section and a 75% composite. The TEAS covers similar subjects with slightly different formatting. Check your target school’s website to see which exam they accept, since some programs allow either one.
What Nursing School Looks Like
Once admitted, your coursework blends classroom learning with hands-on clinical rotations. You’ll study pharmacology, pathophysiology, health assessment, pediatric nursing, mental health nursing, and medical-surgical nursing, among other subjects. Clinical rotations place you in hospitals, clinics, long-term care facilities, and community health settings where you care for real patients under the supervision of an instructor.
States set minimum requirements for how many supervised clinical hours you complete. In Delaware, for example, RN programs must include at least 400 clinical hours of direct patient care. Many programs exceed these minimums. Expect to spend significant time in clinical settings during your final year, often working 12-hour shifts that mirror the schedule you’ll have as a practicing nurse.
Pass the NCLEX-RN
After graduating, you must pass the NCLEX-RN (National Council Licensure Examination for Registered Nurses) to earn your license. This is a computerized adaptive test, meaning the difficulty of questions adjusts based on your answers. The exam tests your clinical judgment across all the areas you studied: safe patient care, medication administration, infection control, and prioritization of care in different scenarios.
You’ll register for the exam through your state board of nursing and Pearson VUE, the testing company. Most graduates take the NCLEX within one to three months of finishing their program. First-time pass rates vary by school, and many programs publish theirs publicly, which is worth checking when you’re choosing where to apply.
Get Your State License
Nursing licenses are issued by individual states. You’ll apply through your state’s board of nursing, submit your transcripts, pass a background check, and provide your NCLEX results. Processing times vary but typically take a few weeks.
If you want flexibility to work in multiple states, look into the Nurse Licensure Compact (NLC). This agreement allows nurses to hold one multistate license and practice in any other NLC member state without getting a separate license. This is especially useful if you live near a state border, want to do travel nursing, or plan to provide telehealth services across state lines. Not every state participates, so verify your state’s membership before relying on this.
Your First Job: Nurse Residency Programs
Landing your first nursing job can feel overwhelming, and many hospitals address this through nurse residency programs designed specifically for new graduates. These structured programs pair you with a dedicated preceptor (an experienced nurse who mentors you one-on-one) and gradually increase your responsibilities over the course of the program. Research shows these programs should last at least 12 months for the best outcomes, as shorter programs are associated with lower retention rates among new nurses.
Residency programs are common in hospitals but not universal. If a facility doesn’t offer one, you’ll still receive orientation and training, but it tends to be shorter and less structured. When comparing job offers as a new grad, the quality of the onboarding support matters as much as the pay rate. A strong residency program can make the difference between thriving in your first year and burning out.
Path for International Nurses
If you were educated as a nurse outside the United States, the process has additional steps. U.S. law requires foreign-educated nurses to complete a screening program before receiving an occupational visa. CGFNS International, approved by the Department of Homeland Security, runs the VisaScreen program that satisfies this federal requirement.
To qualify, you generally need to show that you graduated from an accredited nursing program in your home country, hold a registered nurse license there, and have at least two years of practice experience. Depending on your country of origin, you may also need to demonstrate English language proficiency through a standardized exam. Beyond the federal screening, you can pursue the CGFNS Certification Program, which includes a credentials evaluation, a qualifying exam, and an English proficiency component. This certification, while not required by every state, strengthens your application and is mandatory in some states before you can sit for the NCLEX-RN.
After clearing these hurdles, the process converges with the domestic path: you take the NCLEX-RN, apply for a state license, and begin practicing. The timeline is longer due to visa processing and credential evaluation, often 6 to 18 months before you’re ready to start working.
Specializations and Advancement
Once you’re licensed and have some experience, nursing offers dozens of specialty paths. You can pursue certifications in areas like critical care, emergency nursing, oncology, labor and delivery, or pediatrics. These certifications typically require a set number of practice hours in the specialty and passing an additional exam.
For advanced practice roles, you’ll need a master’s or doctoral degree. Nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists all require graduate education and separate national certification. These roles come with greater autonomy, prescriptive authority in many states, and significantly higher salaries. A nurse practitioner, for instance, can diagnose conditions, order tests, and prescribe medications independently in more than half of U.S. states.