Becoming a registered nurse requires completing an approved nursing education program, passing the national licensure exam known as the NCLEX-RN, and obtaining a license from the state board of nursing where you plan to practice. That three-step framework sounds simple, but the details at each stage involve real choices, costs, and potential stumbling blocks that shape the experience for every aspiring nurse differently.
Choosing an Education Pathway
There is no single degree that leads to RN licensure. In the United States, three main educational routes qualify you to sit for the NCLEX-RN. An Associate Degree in Nursing (ADN) typically takes two to three years at a community college. A Bachelor of Science in Nursing (BSN) is a four-year university degree. And for people who already hold a bachelor’s degree in another field, accelerated programs can compress the coursework into roughly 12 to 18 months. All three pathways lead to the same licensure exam and the same RN credential, though the depth of coursework and clinical hours differ.
The ADN route is often the fastest and least expensive way to become an RN, which makes it popular among career changers and students managing tight budgets. The BSN, meanwhile, includes more coursework in leadership, public health, and research. The American Nurses Association recommended the BSN as the minimum for professional practice as far back as 1965, and many hospitals now prefer or require it for new hires, but this is an employer preference rather than a legal requirement in most states.1PubMed. Factors Influencing Nurses’ Perceptions of the Baccalaureate Degree in Nursing as Minimum Requirement for Professional Practice Many ADN-prepared nurses later complete an RN-to-BSN bridge program while working, which typically takes one to two additional years online.
Prerequisites and Getting Into a Program
Before you start actual nursing courses, most programs require a set of prerequisite classes, usually in anatomy, physiology, microbiology, chemistry, and sometimes statistics or psychology. Your grades in these courses carry serious weight. A scoping review of nursing program admission criteria found that cumulative pre-nursing GPA was the single most commonly cited academic predictor of student success.2PubMed. Undergraduate nursing program admission criteria: A scoping review of the literature
Many programs also require a standardized entrance exam, most commonly the ATI TEAS (Test of Essential Academic Skills). This exam covers reading, math, science, and English language usage. Research on baccalaureate nursing students found that both cumulative GPA and TEAS composite scores predicted success in first-semester courses like health assessment and foundations of nursing.3PubMed. Preadmission predictors for first semester course success in a baccalaureate nursing program GPA and TEAS scores are widely used as cognitive admission criteria across both ADN and BSN programs.4PubMed. The Effect of ATI TEAS on Admission Into Prelicensure Nursing Programs
Competitive programs may also weigh healthcare experience, letters of recommendation, or interviews, but the academic metrics tend to drive the initial cut. If your prerequisite GPA falls below a program’s minimum threshold, typically somewhere around a 2.5 to 3.0, you may need to retake courses before you can apply.
Clinical Training and Simulation
Nursing is a hands-on profession, so every approved program includes clinical training alongside classroom instruction. Clinical rotations place students in hospitals, clinics, long-term care facilities, and community health settings where they practice skills like medication administration, wound care, and patient assessment under supervision. The exact number of clinical hours varies by state and program type, but most BSN programs require somewhere in the range of 500 to 800 hours.
One of the bigger shifts in nursing education over the past decade has been the growth of simulation-based learning. High-fidelity patient simulators and standardized patient scenarios allow students to practice critical skills in a controlled environment. Between 2014 and 2022, the number of U.S. jurisdictions with specific regulations about simulation in prelicensure RN programs doubled from 21 to 41. Even more striking, the number of nursing regulatory bodies that allowed up to half of clinical hours to be replaced with simulation jumped from just 1 to 23 during that same period.5Journal of Nursing Regulation. Simulation in Nursing Education: Advancements in Regulation, 2014–2022 This trend accelerated during the COVID-19 pandemic, when clinical site access was severely limited, and many of those regulatory changes have stuck.
Clinical assessments themselves are also evolving. Standardized testing formats like Objective Structured Clinical Examinations (OSCEs), where students rotate through stations performing specific tasks scored against a rubric, are increasingly used alongside traditional clinical evaluations. Nursing students have reported that OSCEs provide a more standardized and fairer measurement of clinical skills compared to traditional clinical exams, with less potential for personal biases to influence scores.6PubMed Central. Views and Satisfaction of Nursing Students Toward Objective Structured Clinical Examination and Traditional Clinical Examination: A Cross-Sectional Study
The NCLEX-RN Exam
After graduating from an approved nursing program, the next hurdle is the National Council Licensure Examination for Registered Nurses, known as the NCLEX-RN. This is a computerized adaptive test administered by the National Council of State Boards of Nursing (NCSBN). “Computerized adaptive” means the test adjusts its difficulty based on your answers: get a question right, and the next one gets harder; get one wrong, and it eases up. The exam continues until the algorithm is confident you are either above or below the passing standard, which means test length varies from person to person.
In 2023, the NCLEX-RN underwent a significant redesign with the introduction of the Next Generation NCLEX (NGN). The updated exam places heavier emphasis on clinical judgment, the reasoning process nurses use to make patient care decisions, rather than simple recall of facts.7ScienceDirect. Clinical Judgement and Next Generation NCLEX® – A Positive Direction for Nursing Education! New question types now include case studies that unfold over time, requiring test-takers to prioritize actions, recognize changes in patient condition, and evaluate outcomes. For students, this means preparation needs to go beyond memorizing content and practicing multiple-choice questions. Most nursing programs have restructured their curriculum and exams to reflect the NGN’s emphasis on clinical reasoning.
First-time pass rates on the NCLEX-RN fluctuate year to year and vary by program type. Historically, BSN graduates have had slightly higher pass rates than ADN graduates, but both pathways produce large numbers of successful test-takers. If you do not pass on the first attempt, you can retake the exam after a waiting period, typically 45 days, though the specific rules depend on your state.
State Licensure and Background Checks
Passing the NCLEX-RN does not automatically make you a registered nurse. You must apply separately to the board of nursing in the state where you want to practice. Each state board has its own application, fees, and timeline. Most require proof of your educational credentials, NCLEX-RN results, and a criminal background check.
The background check piece is worth understanding because it trips up some applicants. Most state boards now require biometric (fingerprint-based) criminal background checks at both the state and federal level, which provide the most comprehensive picture of an applicant’s criminal history.8Journal of Nursing Regulation. Guidelines for Assessing Candidates with Criminal Histories A criminal record does not automatically disqualify you from licensure, but it triggers a review process. Boards generally look at the nature and severity of the offense, how much time has passed, and any evidence of rehabilitation. Drug-related offenses, fraud, and crimes involving violence or vulnerable populations typically receive the closest scrutiny.
State applications also commonly include questions about physical and mental health fitness. An audit of RN licensure applications across 42 states found that only about a quarter fully adhered to recommended guidelines for how mental health questions should be framed, meaning some states still ask questions that mental health advocates consider overly broad or potentially discouraging to applicants who have sought treatment for conditions like depression or anxiety. The trend in nursing regulation is toward narrowing these questions to focus on current functional impairment rather than mere history of treatment, but the pace of change varies.
Working Across State Lines
If you hold an RN license in one state and want to practice in another, you traditionally need a separate license for each state. The enhanced Nurse Licensure Compact (NLC) offers an alternative: nurses who live in a compact member state and meet certain uniform requirements can hold a multistate license that allows them to practice in any other member state without applying for an additional license. As of recent years, the majority of U.S. states have joined the compact.
The NLC is promoted as a strategy to increase workforce flexibility and help address nursing shortages, particularly in rural and underserved areas. However, research is still catching up to the policy. One study noted that no prior research had assessed whether the compact actually helps licensed but non-practicing nurses return to the profession, suggesting that the compact’s real-world effects on workforce supply are still being measured.9Health Affairs Scholar. Effects of the enhanced nurse licensure compact on interstate mobility and nursing employment For individual nurses, the practical benefit is clear: if you live in a compact state and your job involves telehealth, travel nursing, or caring for patients across state lines, the multistate license saves time and fees.
Alternative Paths for Career Changers
People who already hold a bachelor’s degree in a non-nursing field have options beyond starting over with an ADN or traditional BSN. Accelerated BSN programs (often called ABSN programs) compress the nursing curriculum into 11 to 18 months of intensive full-time study. These programs are rigorous, frequently described by students as the academic equivalent of drinking from a fire hose, but they get career changers to the NCLEX-RN quickly.
Another option is the direct-entry Master of Science in Nursing (MSN) program. These programs accept applicants with a bachelor’s degree in another field and combine generalist nursing preparation with graduate-level coursework, typically over two to three years. Graduates earn an MSN and are eligible to sit for the NCLEX-RN. The number of these programs has been growing, and they are built on the premise that mature students with prior professional experience bring valuable skills to the nursing workforce.10PubMed. Accelerated Master’s Programs in Nursing for Non-Nurses: An Integrative Review of Students’ and Faculty’s Perceptions A review of these programs found that they produce generalist-prepared nurses who hold a graduate degree, which can open doors to leadership, education, or advanced practice roles sooner than the traditional ADN-to-BSN-to-MSN ladder would allow.11PubMed. Entry-Level Master’s Programs in Nursing: Review of Programmatic Features Some newer programs in this category are incorporating competency-based education models, where students progress by demonstrating mastery of skills rather than by accumulating seat time.12PubMed. Integrating innovation and competency-based education in the development of a new direct-entry master of science in nursing program
A common concern about these accelerated pathways is whether graduates are truly prepared for bedside nursing with so much less time in the clinical setting. The evidence is mixed but generally reassuring: accelerated-program graduates tend to pass the NCLEX-RN at comparable rates to traditional students and often report high levels of professional confidence. Where the challenge shows up is in the first year of practice, which brings us to what happens after licensure.
The First Year After Licensure
Getting your license is technically the finish line for the “becoming an RN” process, but the transition from student to practicing nurse is steep enough that an entire category of programs exists to smooth the landing. Nurse Residency Programs (NRPs) are structured post-hire experiences, typically lasting 6 to 12 months, that pair new graduates with mentors and provide ongoing education, skills development, and emotional support.
A systematic review found that NRPs show promise as an educational intervention to cultivate well-supported, competent, and confident new nurses, with evidence suggesting they improve retention during the first 12 months of employment.13PubMed Central. The effectiveness of nurse residency programs on new graduate nurses’ retention: Systematic review The retention effect can be substantial: one study comparing two hospitals found that the facility with an NRP had a three-year retention rate of 55%, compared to just 35% at a comparable facility without one.14PubMed. Nurturing Novice Nurses: Effect of a Nurse Residency Program on Nursing Retention Those numbers reflect a profession-wide problem: new nurse turnover is expensive for hospitals and stressful for nurses who feel unsupported in their first year. While NRPs are not a requirement for licensure, they are increasingly common at larger hospitals, and some hiring managers consider participation in one a strong signal of commitment to the profession.
What Causes People to Drop Out Along the Way
Not everyone who starts a nursing program finishes. Attrition in undergraduate nursing programs is a well-documented concern, and a scoping review identified four main categories of contributing factors: academic difficulty, gaps in institutional and social support, personal circumstances, and economic challenges.15PubMed Central. Examining Factors Associated with Attrition, Strategies for Retention Among Undergraduate Nursing Students, and Identified Research Gaps: A Scoping Review Academic struggles are the most straightforward: prerequisite science courses and early nursing classes like pathopharmacology are famously difficult, and students who arrive with weaker preparation often hit a wall. But the non-academic factors deserve attention too. Students who lack family support, work long hours to pay tuition, or face childcare challenges are at higher risk of leaving regardless of their academic ability.
Financial pressure runs through nearly all of these categories. Nursing education is expensive, and borrowing requirements shape who can pursue or complete a degree. Research on student debt in nursing has highlighted that when borrowing capacity is constrained, students may delay enrollment, turn to higher-interest private loans, or skip advanced education altogether. Policies that limit federal borrowing disproportionately affect nurses moving through associate-to-baccalaureate and graduate pathways, deepening existing inequities in the nursing workforce pipeline.16Health Affairs Scholar. The hidden costs of becoming a nurse: how student debt deepens inequities in the nursing workforce pipeline Community college ADN programs are significantly cheaper than university BSN programs, which is one reason the ADN pathway remains important even as the profession pushes toward higher educational standards.
Understanding Scope of Practice
Once you have your RN license, what you are legally allowed to do varies by state. Each state’s nurse practice act defines the scope of practice for registered nurses, including which tasks you can perform independently, which require a physician’s order, and which you can delegate to licensed practical nurses or unlicensed assistive personnel. In practice, scope of practice can feel blurry. Qualitative research with working nurses found that RNs frequently negotiate the boundaries of their role in real time, sometimes taking on tasks that could be delegated, other times stepping in to fill gaps left by other providers. A recurring theme was the tension between wanting to stay close to direct patient care and recognizing that delegation is sometimes the better use of an RN’s time and skills.17PubMed Central. Understanding nursing scope of practice: a qualitative study
For new nurses, this means your job description and day-to-day responsibilities depend heavily on where you work. An RN in a hospital intensive care unit performs very different tasks than an RN in a school health office or a public health department, even though they hold the same license. Specialty certifications, which are voluntary credentials offered by professional organizations in areas like critical care, pediatrics, or oncology, can expand your knowledge and career options but do not change your legal scope of practice.
How Nursing Licensure Got to Where It Is
State-level nursing licensure did not always exist. In the early twentieth century, virtually anyone could call themselves a nurse and work for hire, regardless of training. The push for mandatory licensure gained traction in the 1930s, with New York State’s 1938 Todd-Feld Act serving as a landmark. That law required licensing for both registered and practical nurses, addressing what were described as serious deficiencies in the nursing workforce during the economic pressures of the Depression.18PubMed Central. “All who nurse for hire”: nursing and the mixed legacy of legislative victories Other states gradually followed, and by the mid-twentieth century, mandatory licensure was the norm nationwide. The NCLEX-RN in its modern form dates to 1982, and the shift to computerized adaptive testing came in 1994. Each generation of regulatory change has been driven by the same core concern: protecting patients by ensuring that nurses meet a minimum standard of competence before they are allowed to practice independently.