Nurses in the United States take the NCLEX, the National Council Licensure Examination, to earn their license to practice. There are two versions: the NCLEX-RN for registered nurses and the NCLEX-PN for licensed practical nurses (sometimes called licensed vocational nurses). Every state requires passing the appropriate NCLEX before you can work as a nurse.
NCLEX-RN vs. NCLEX-PN
Which version you take depends on your education level. Registered nurses typically complete either an associate degree (two years) or a bachelor’s degree (four years) in nursing before sitting for the NCLEX-RN. Licensed practical nurses complete a shorter program, often at a vocational school or career academy, and take the NCLEX-PN. Both exams are developed by the National Council of State Boards of Nursing (NCSBN) and serve the same basic purpose: confirming you have the minimum competency to provide safe patient care.
The NCLEX-RN is broadly considered the more challenging of the two, covering a wider scope of clinical decision-making and patient management. The NCLEX-PN focuses more on foundational nursing care under the supervision of a physician or registered nurse.
How the NCLEX Works
The NCLEX is a computerized adaptive test, meaning it adjusts to your performance in real time. If you answer a question correctly, the next question gets harder. If you answer incorrectly, the next one gets easier. The exam keeps going until the computer has enough information to determine whether you’re above or below the passing standard, or until you hit the maximum number of questions or the time limit.
A major update rolled out in 2023 called the Next Generation NCLEX (NGN). The biggest change is the addition of case studies that mirror real nursing scenarios. Roughly 22 to 33 percent of the exam now consists of these case studies. Each one presents a patient situation and includes six questions that walk through the clinical judgment process, from recognizing a problem to evaluating your nursing response. Every test taker sees three scored case studies (18 scored items total from case studies alone), alongside traditional standalone questions.
What the NCLEX-RN Covers
The NCLEX-RN is organized around four broad categories of patient needs, broken into eight subcategories. The heaviest areas are management of care (15 to 21 percent of the exam), medication-related questions (13 to 19 percent), and adapting care for complex physical conditions (11 to 17 percent). Safety and infection control makes up 10 to 16 percent.
The remaining categories cover reducing risk for complications (9 to 15 percent), basic comfort and care (6 to 12 percent), mental health and psychosocial support (6 to 12 percent), and health promotion and disease prevention (6 to 12 percent). In practice, this means the exam leans heavily toward clinical judgment in medical-surgical situations and safe medication administration, with a meaningful portion dedicated to leadership and delegation skills.
Steps From Graduation to License
Passing the NCLEX is the centerpiece, but it’s one step in a longer process. Here’s the typical sequence:
- Apply to your state board of nursing. You submit a state licensure application and register separately for the NCLEX through the testing service. Both must be completed before you’re cleared to test.
- Verify your education. Your nursing program’s dean or director sends a certificate of completion directly to the state board confirming you graduated.
- Complete a background check. Most states require criminal background screening. If you have any history to disclose, you’ll need to provide court documents and a personal statement.
- Receive your Authorization to Test (ATT). Once your state application and NCLEX registration are both processed, you’ll get an ATT email allowing you to schedule your exam at a testing center.
- Take and pass the NCLEX. Results typically come within 48 hours.
- Receive your license. If you pass and all other application requirements are met, your license is issued digitally. You can print it or order a physical copy.
Exams for International Nurses
If you were educated outside the United States, you still need to pass the NCLEX. But most states require an additional step first: completing the CGFNS Certification Program. This program has three parts. First, a review of your nursing education and registration credentials. Second, the CGFNS Qualifying Exam, which tests your nursing knowledge. Third, an English language proficiency exam.
Accepted English tests include the TOEFL, TOEIC, and the academic module of the IELTS. Minimum scores vary by test format. For the TOEFL iBT, you need at least an 83. For the IELTS academic module, the minimum is 6.5. For the TOEIC, it’s 725. Graduates of nursing programs in certain English-speaking countries may be exempt from the language requirement. Nurses who already hold a license in another U.S. state are also typically exempt from the CGFNS requirement.
Advanced Practice Certification Exams
Nurses who go on to earn a master’s or doctoral degree and become advanced practice registered nurses (APRNs) take an additional certification exam on top of their original NCLEX-RN. The specific exam depends on your specialty and which certifying body you choose.
Family nurse practitioners can certify through either the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC). Psychiatric mental health nurse practitioners have similar options from both organizations. For acute care nurse practitioners working with adult and elderly patients, the ANCC and the American Association of Critical-Care Nurses both offer certification paths. These exams are rigorous, specialty-specific tests that verify you can practice independently in your area of focus.
Specialty Certifications for Bedside Nurses
Beyond licensure and advanced practice, many nurses pursue voluntary specialty certifications to demonstrate expertise in a particular area. These aren’t required to practice, but they can strengthen your resume, increase your pay, and signal competence to employers.
Emergency nurses, for example, can earn the Certified Emergency Nurse (CEN) credential through the Board of Certification for Emergency Nursing. The same organization offers certifications for flight nurses (CFRN), transport nurses (CTRN), pediatric emergency nurses (CPEN), trauma nurses (TCRN), and burn nurses (CBRN). Similar specialty certifications exist across nearly every area of nursing, from critical care to oncology to perioperative care, each administered by its own professional board. These exams typically require a current RN license plus a set number of clinical hours in the specialty before you’re eligible to sit.