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. RNs form the backbone of patient care across hospitals, clinics, schools, and dozens of other settings, providing everything from bedside treatment to patient education to care coordination.
What an RN Actually Does
The day-to-day work of a registered nurse centers on a structured process: assessing patients, identifying health problems, creating care plans, carrying out treatments, and evaluating whether those treatments are working. This cycle of clinical decision-making is what separates an RN’s role from other nursing levels. Any task that requires nursing judgment, critical thinking, or clinical reasoning falls squarely within RN territory and cannot be handed off to less-credentialed staff.
In practical terms, that means RNs are the ones performing initial assessments when a patient is admitted, teaching patients how to manage conditions at home, developing and adjusting care plans, administering medications, interpreting lab results in context, and coordinating with physicians and specialists. RNs can also delegate certain tasks to licensed practical nurses (LPNs) or nursing assistants, but they remain responsible for supervising that work and handling anything that demands deeper clinical judgment.
Beyond direct patient care, registered nurses are expected to meet professional standards around ethics, patient advocacy, communication, collaboration, and leadership. These aren’t optional ideals. They’re formal performance standards set by the American Nurses Association that apply to every RN regardless of specialty or setting.
How to Become a Registered Nurse
There are two main educational paths to becoming an RN, and both lead to the same licensing exam.
- Associate Degree in Nursing (ADN): A two-year program (sometimes 18 months in accelerated formats) that covers nursing fundamentals, medical-surgical nursing, pediatrics, psychiatric nursing, and community health. Prerequisites include chemistry, anatomy, biology, and psychology.
- Bachelor of Science in Nursing (BSN): A four-year undergraduate degree that includes everything in an ADN plus broader coursework in public health, nursing ethics, pathophysiology, and theoretical nursing concepts. It also provides more extensive clinical experience.
Both degrees prepare you to sit for the NCLEX-RN, though BSN graduates pass on the first attempt at a slightly higher rate: 82.3% compared to 77.9% for ADN holders. The bigger difference shows up later in your career. A BSN is required for admission to any graduate nursing program, and it opens doors to leadership, research, and advanced practice roles. The salary gap is notable too, with BSN nurses earning an average of $92,000 compared to $75,000 for ADN nurses as of mid-2023.
The Licensing Process
After graduating from an approved nursing program, you apply for licensure through your state’s board of nursing. The process is straightforward but has several moving parts. You submit an online application, complete a fingerprint-based criminal background check, and register with Pearson VUE to schedule your NCLEX-RN exam. Registering with Pearson VUE immediately after submitting your board application helps avoid delays in receiving your Authorization to Test.
Each state has its own Nurse Practice Act, a law passed by that state’s legislature that defines exactly what RNs are permitted to do. This means your scope of practice can vary depending on where you work. If you move to a new state, you’ll need to apply for licensure by endorsement in that state and follow its specific regulations.
Where RNs Work
Hospitals remain the most common workplace for registered nurses, but the profession extends far beyond inpatient settings. RNs work in outpatient clinics, physician offices, home health agencies, schools, public health departments, insurance companies, nursing homes, surgical centers, and corporate wellness programs. Some work in non-traditional roles like legal nurse consulting, pharmaceutical sales, or health informatics. The setting shapes daily life significantly: a hospital RN working 12-hour shifts on a medical-surgical floor has a very different routine from an RN running a diabetes education clinic or coordinating care for homebound patients.
Salary and Job Outlook
The median annual pay for registered nurses was $93,600 in 2024, which works out to about $45.00 per hour. That’s the midpoint, meaning half of all RNs earn more and half earn less. Your actual salary depends on geography, education level, years of experience, and specialty. RNs in high-cost-of-living states and those working in specialized units like intensive care or operating rooms tend to earn at the higher end of the range.
Demand for registered nurses remains strong. An aging population, rising rates of chronic disease, and ongoing retirements within the nursing workforce all contribute to consistent job openings across the country.
Specializations and Career Growth
One of the defining features of nursing as a career is how many directions you can take it. After gaining experience in a general area, many RNs pursue board certification in a specialty. Options include critical care, emergency nursing, oncology, cardiac-vascular nursing, perioperative (surgical) nursing, obstetric and newborn care, medical-surgical nursing, stroke care, and endoscopy, among others. Each specialty certification requires passing an exam and, in most cases, documenting a certain number of clinical hours in that area.
With a BSN and further graduate education, RNs can advance into roles like nurse practitioner, nurse anesthetist, nurse midwife, or clinical nurse specialist. These advanced practice roles come with significantly expanded scope of practice, including the ability to diagnose conditions, prescribe medications, and manage patient care independently in many states. Other RNs move into management, education, informatics, or public health leadership without pursuing clinical advanced practice degrees.
RN vs. LPN: Key Differences
Licensed practical nurses (LPNs) complete shorter training programs, typically around one year, and work under the supervision of RNs or physicians. The core distinction is clinical autonomy. RNs perform initial patient assessments, create care plans, provide patient education, and make independent clinical judgments. These tasks cannot be delegated to an LPN because they require the deeper training and critical reasoning that RN education provides. LPNs handle important hands-on care like taking vital signs, assisting with hygiene, and administering certain medications, but the RN is responsible for the overall plan and for evaluating whether it’s working.