Becoming a nurse in the United States requires completing an approved nursing education program and passing a national licensing exam called the NCLEX. Beyond that straightforward summary, though, the specific requirements vary depending on the type of nurse you want to be, the state where you plan to practice, and whether you pursue an associate degree or a bachelor’s degree. The path is more layered than most people expect, with prerequisites, clinical hours, background checks, and ongoing regulatory obligations all playing a role.
The Three Main Educational Pathways
There is no single route into nursing. Three types of programs qualify graduates to sit for the NCLEX-RN, the licensing exam for registered nurses. An Associate Degree in Nursing (ADN) typically takes two to three years at a community college. A Bachelor of Science in Nursing (BSN) takes four years at a university. And a handful of hospital-based diploma programs, descendants of the original training model, still exist, though they have become rare. All three pathways lead to the same licensing exam, and passing it earns you the same RN credential regardless of which program you attended.
For those aiming to become a licensed practical nurse or licensed vocational nurse (LPN/LVN), the educational track is shorter, usually about one year of study at a vocational school or community college, followed by a different version of the national exam (the NCLEX-PN). LPNs work under the supervision of RNs and physicians and have a narrower scope of practice. Most people asking about “becoming a nurse” are asking about the RN path, so that is the primary focus here, but much of what follows applies to LPN programs as well.
Prerequisite Courses
Before you ever touch a stethoscope in a clinical rotation, you need to complete a slate of prerequisite courses. These typically include anatomy and physiology, microbiology, chemistry, nutrition, statistics, and developmental psychology. BSN programs usually add general education requirements in the humanities and social sciences. An analysis of BSN program curricula found that the credit-hour demands of prerequisites and nursing coursework together leave little room for additional content areas, meaning most programs pack their requirements tightly and expect students to arrive with foundational science already completed.1PubMed Central. Leverage pre-requisite courses to teach bachelor of science in nursing students about social determinants of health
Prerequisite GPA matters. Nursing programs are competitive, and many use prerequisite grades as a primary filter for admission. A strong performance in anatomy and physiology is particularly weighted at many schools, because it signals readiness for the clinical sciences that follow. Some programs also require a minimum overall GPA, often around 2.75 to 3.0, just to apply.
Clinical Training and the Role of Simulation
Clinical hours are where students learn to care for actual patients under supervision, and they are a required part of every nursing program. But how many hours are required, and what counts as a clinical hour, varies more than you might assume. A review of state regulations found that only ten states specify a required number of clinical hours for prelicensure nursing education, and just twenty-six states include language that even defines what clinical experiences should look like.2PubMed. No Evidence to Support Number of Clinical Hours Necessary for Nursing Competency In practice, most programs require somewhere between 500 and 800 clinical hours for an RN degree, but the number is set by the school or its accrediting body rather than by a universal national standard.
One of the biggest shifts in nursing education over the past decade has been the growing acceptance of simulation as a substitute for some of those clinical hours. A landmark national study found that replacing up to half of traditional clinical hours with high-quality simulation produced comparable educational outcomes and graduates who were equally ready for practice.3Journal of Nursing Regulation. The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours With Simulation in Prelicensure Nursing Education That study accelerated regulatory change. Between 2014 and 2022, the number of state nursing boards permitting up to 50 percent simulation substitution for RN programs rose from one to twenty-three, and a similar expansion occurred for LPN/LVN programs.4Journal of Nursing Regulation. Simulation in Nursing Education: Advancements in Regulation, 2014–2022
This does not mean clinical experience with real patients is going away. Simulation supplements bedside learning; it does not fully replace it. But if you are entering a nursing program today, expect that a meaningful portion of your clinical education may take place in a simulation lab with high-fidelity mannequins and standardized scenarios rather than exclusively on hospital floors.
Passing the NCLEX
No matter which educational path you take, you cannot legally practice as a nurse until you pass the NCLEX, administered by the National Council of State Boards of Nursing (NCSBN). The NCLEX-RN for registered nurses and the NCLEX-PN for practical nurses are computerized adaptive tests, meaning the difficulty of each question adjusts based on how you answered the previous one. The exam tests clinical judgment, patient safety, and the ability to apply knowledge rather than just recall facts.
First-time pass rates for U.S.-educated candidates have historically hovered around 85 to 90 percent for the NCLEX-RN, though rates vary by program. If you do not pass, you can retake the exam after a waiting period (typically 45 days), but each state board sets its own rules on how many attempts are allowed and what additional steps may be required.
Background Checks and Legal Screening
Every state requires a criminal background check as part of the nursing licensure process. Most states use biometric (fingerprint-based) checks that search both state and federal databases. A criminal history does not automatically disqualify you, but it triggers a review process. The NCSBN has developed guidelines to help state boards assess whether a past conviction poses a genuine risk to patient safety or reflects something the applicant has moved past. The framework considers factors like the nature of the offense, how much time has passed, and whether the person has demonstrated rehabilitation.5Journal of Nursing Regulation. Guidelines for Assessing Candidates with Criminal Histories
If you have a criminal record and are considering nursing school, the best move is to contact the board of nursing in the state where you plan to practice before investing time and tuition. Many boards offer a pre-application review or declaratory order process that gives you a preliminary answer about whether your history is likely to be a barrier.
Physical and Technical Standards
Nursing programs typically publish a list of “essential abilities” or “technical standards” that applicants must meet, covering areas like mobility, manual dexterity, hearing, vision, and communication. These requirements are set by individual schools, not by state licensing boards. A study examining this gap found that no state boards of nursing mandated specific sensory or motor abilities for licensure, yet more than half of nursing programs surveyed had restrictive essential-abilities criteria, and some of those criteria conflicted with the Americans with Disabilities Act.6Nursing Education Perspectives. Barriers to Nursing School Admissions for Students With Physical or Sensory Disabilities
This mismatch means that a person with a disability could be turned away from a nursing program despite being legally eligible for a nursing license in the same state. If you have a physical or sensory disability and want to pursue nursing, it is worth looking at multiple programs, since their standards differ widely and some are more accommodating than others. Reasonable accommodations under the ADA may apply, and advocacy organizations exist to help students navigate the process.
ADN Versus BSN and Why It Matters for Patients
The question of whether nurses need a bachelor’s degree or whether an associate degree is sufficient has been debated for decades. Both lead to the same RN license, and ADN graduates can and do have excellent careers. But a growing body of research has tipped the conversation in the BSN’s favor, particularly in hospital settings.
A widely cited study published in JAMA found that each 10 percent increase in the proportion of nurses with at least a bachelor’s degree was associated with roughly a 5 percent decrease in the odds of patients dying within 30 days of admission. Hospitals where 60 percent of nurses held BSNs had about 19 percent lower odds of surgical patient mortality than hospitals where only 20 percent did, after controlling for patient severity and hospital characteristics.7JAMA. Educational Levels of Hospital Nurses and Surgical Patient Mortality That finding has been reinforced by subsequent research. A longitudinal study tracking changes from 2006 to 2016 found that hospitals that increased their share of BSN nurses over time saw reduced odds of patient mortality, shorter hospital stays, and lower readmission rates.8PubMed Central. Changes in proportion of bachelor’s nurses associated with improvements in patient outcomes Another analysis estimated that the difference between a hospital with 30 percent BSN nurses and one with 80 percent BSN nurses translated to roughly 25 percent lower odds of 30-day surgical mortality.9PubMed Central. Variations in nursing baccalaureate education and 30-day inpatient surgical mortality
None of this means ADN nurses provide poor care. The research reflects system-level patterns across hundreds of hospitals, not individual competence. But it explains why many hospitals now prefer or require BSN-prepared nurses, and why the American Association of Colleges of Nursing and others have pushed for the BSN to become the standard entry-level degree. If you start with an ADN, you should know that RN-to-BSN bridge programs are widely available online and can usually be completed in one to two years while you work.
State Licensure and the Nurse Licensure Compact
Nursing licenses are issued by individual states, which means the specific requirements for licensure (continuing education, renewal intervals, scope of practice) differ depending on where you live and work. If you move to a new state, you generally need to apply for a license there, which can involve additional paperwork, fees, and waiting periods.
The Nurse Licensure Compact (NLC) was created to ease this burden. Under the compact, a nurse who holds a multistate license in one member state can practice in any other member state without obtaining a separate license. The catch is that you must follow the practice laws of whatever state you are physically working in, not the rules of your home state.10The Journal for Nurse Practitioners. The Multi-State Nursing Licensure Compact: Making Nurses Mobile As of recent years, around 40 states have joined the compact, though the exact count shifts as new states enact legislation. If you plan to travel nurse or live near a state border, the compact is worth understanding before you choose where to establish your primary license.
What Schools Look for Beyond Grades
Competitive nursing programs do not evaluate applicants on transcripts alone. A large scoping review of admission criteria found that schools assess a wide range of non-academic characteristics, including interpersonal communication skills, moral reasoning, and psychological resilience.11PubMed Central. A scoping review of admission criteria and selection methods in nursing education Some programs use structured interviews, personality assessments, or situational judgment tests as part of the admissions process. Others weight volunteer experience, healthcare work history, or personal statements.
The reasoning behind these non-academic screens is straightforward: nursing demands emotional labor, ethical decision-making, and the ability to communicate under pressure. A 4.0 GPA in biology does not guarantee any of those qualities. If you are applying to nursing school, investing time in healthcare volunteering, patient-facing work experience, or community service is not just resume padding. These experiences give you material for interviews and essays and give admissions committees evidence that you understand what the work actually involves.
Paying for Nursing School
The cost of nursing education ranges widely, from a few thousand dollars per year at a community college ADN program to $40,000 or more annually at a private university BSN program. Research into how students finance their education found that most rely on a combination of financial aid and personal savings. Parents, institutional scholarships, and government loans are also common funding sources, though fewer than 15 percent of students in the study took out private bank loans.12PubMed. Nursing students assess nursing education
Federal financial aid (FAFSA), state grants, hospital-sponsored tuition programs, and loan forgiveness programs like the Public Service Loan Forgiveness (PSLF) program are all worth investigating. Many hospitals offer tuition reimbursement in exchange for a work commitment after graduation. Given the evidence linking BSN education to better patient outcomes, some health systems are willing to invest in their workforce’s education, which can offset the higher cost of a four-year degree.
Becoming an Advanced Practice Nurse
If your goal is to work as a nurse practitioner (NP), nurse midwife, clinical nurse specialist, or nurse anesthetist, the educational requirements go well beyond the initial RN license. Advanced practice registered nurses (APRNs) must complete a graduate degree, either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). Quality standards for NP education are set by organizations including the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties, which together oversee a task force that evaluates NP programs nationally.13Journal of the American Association of Nurse Practitioners. Education standards, accreditation, certification, and regulation of nurse practitioner practice
After completing a graduate program, NPs must pass a national certification exam in their specialty. There are eight recognized NP specialties, each with its own certifying body. State boards of nursing then regulate NP practice, and scope-of-practice laws vary considerably: some states grant NPs full independent practice authority, while others require a collaborative agreement with a physician. The regulatory patchwork means that where you practice as an NP matters almost as much as the credential itself.
Postgraduate Residencies for New Nurses
The transition from student to working nurse is notoriously rough. New graduates frequently report feeling underprepared for the pace and responsibility of clinical practice, and first-year turnover among new nurses is high. In 2010, the Institute of Medicine recommended that nursing adopt residency programs similar to those in medicine. The number of postgraduate residencies for nurse practitioners has grown since then, particularly in community health settings, though these programs remain voluntary.14Academic Medicine. Postgraduate Nurse Practitioner Residency Programs: Supporting Transition to Practice
For new RNs, nurse residency programs (sometimes called transition-to-practice programs) are now offered by many large hospital systems and typically last 6 to 12 months. They include mentorship, structured learning sessions, and gradual increases in patient load. Completing a residency is not a licensing requirement, and whether residencies should become mandatory is still debated. Research supports the idea that they ease the transition, but data on whether they improve patient outcomes directly remain limited. If you are a new graduate choosing between job offers, a position that includes a formal residency or transition program is generally a safer bet for your first year.
How Nursing Regulation Evolved
Modern nursing requirements did not appear overnight. The profession’s regulatory framework developed in response to wars, demographic shifts, and evolving healthcare needs. Registration and licensure standards emerged gradually over the twentieth century, shaped by the formation of professional organizations for education, practice, and accreditation.15PubMed. Understanding Nursing Backwards: The Evolution of Nursing as a Profession A systematic review of nursing regulation history found that factors including economic pressures, migration patterns, and societal upheavals (wars, in particular) have repeatedly reshaped what it means to be qualified to nurse.16PubMed. Shaping nursing profession regulation through history – a systematic review
The first state nursing practice acts were enacted in the early 1900s, and the NCLEX in its modern form has only existed since the 1980s. Accreditation standards, clinical hour expectations, and the push toward the BSN as a minimum degree have all intensified over the past few decades. Understanding that these requirements are not static helps explain why the answer to “what do I need to become a nurse?” depends partly on when and where you ask the question. Standards have consistently trended upward, and if current advocacy efforts succeed, the BSN may eventually become the minimum requirement for entry-level RN practice in more states than it is today.