Becoming a nurse requires completing an approved nursing education program, passing a national licensing exam, and meeting your state’s background check and health screening requirements. The full process takes anywhere from one year for a practical nursing certificate to four years for a bachelor’s degree, depending on which level of nursing you pursue.
Choose Your Nursing Level
There are two main entry points into nursing, and the one you pick determines how long you’ll be in school, what you can do on the job, and how much you’ll earn.
Licensed Practical Nurse (LPN): LPN programs typically take about one year and are offered at community colleges, technical schools, and some hospitals. LPNs provide basic patient care and commonly work in long-term care facilities, home health, and clinics. They generally work under the supervision of a registered nurse, advanced practice nurse, or physician.
Registered Nurse (RN): You can become an RN through three routes. A hospital diploma program takes about two years. An Associate Degree in Nursing (ADN) takes two to three years. A Bachelor of Science in Nursing (BSN) takes at least four years and requires roughly 120 total credits. RNs have a broader scope of practice: they assess, monitor, and treat patients, supervise LPNs and nursing assistants, and serve as patient advocates. Many hospitals now prefer or require a BSN for hiring.
Prerequisite Courses and GPA Standards
Before you even start your nursing courses, most programs require a set of prerequisite classes. A typical list includes human anatomy with lab, physiology with lab, chemistry with lab, microbiology with lab, and a statistics course. Many programs also require introductory psychology, introductory sociology, and human nutrition.
GPA requirements vary widely, but competition is stiff. While some programs list a minimum cumulative GPA of 3.0, the average GPA of admitted students is often much higher. At California State University campuses, for example, the average admitted GPA ranges from 3.0 at some schools to 4.0 at others, with many programs landing between 3.5 and 3.9. Some programs require that science prerequisites specifically be completed within seven years, so older coursework may not count. If your grades aren’t competitive yet, retaking a prerequisite or two in the sciences can make a real difference in your application.
Health Screenings and Immunizations
Nursing students must meet a list of health requirements before starting clinical rotations, the hands-on portion of the program where you work directly with patients. These requirements protect both you and the patients you’ll care for.
You’ll need to show immunity (through vaccination records or blood tests called titers) for measles, mumps, rubella (two MMR vaccines), hepatitis B (completed series), and varicella (two vaccines). You’ll also need a tetanus booster within the last 10 years and a tuberculosis screening (skin test or blood test) within 12 months of your start date. A flu vaccine is required each season. Additional vaccines may be required depending on where you do your clinical rotations.
Beyond immunizations, expect a background check, fingerprinting, and a drug test, all typically due at least two weeks before your first term. You’ll also complete training in bloodborne pathogen safety and HIPAA, the federal patient privacy law.
Pass the NCLEX Licensing Exam
After graduating from an approved nursing program, you must pass the National Council Licensure Examination. LPNs take the NCLEX-PN, and RNs take the NCLEX-RN. You cannot practice nursing without passing this exam.
To sit for the NCLEX, you need to submit a license application to your state’s board of nursing along with proof that you graduated from an approved program. Application fees vary by state. In Massachusetts, for instance, the fee is $230. You’ll also need to provide your Social Security number as part of the application. The exam itself is computerized and adaptive, meaning it adjusts difficulty based on your answers, so the number of questions you receive varies from test to test.
Background Check Requirements
Every state board of nursing runs a criminal background check before issuing a license. Having a criminal record doesn’t automatically disqualify you, but certain offenses make licensure very unlikely. Sexual offenses of a predatory nature are grounds for denial. Violent felonies (murder, felonious assault, kidnapping), criminal mistreatment of children or vulnerable adults, and patterns of repeated offenses are all treated seriously.
Boards also look closely at honesty. If your personal statement doesn’t match what shows up on your background report, that inconsistency alone can trigger a deeper review. A history of substance use is flagged for additional screening as well. If you have a past offense, most boards consider how long ago it happened and whether you’ve demonstrated rehabilitation. Being upfront about your history in your application is always better than having the board discover a discrepancy.
State Licensure and the Nurse Compact
Nursing licenses are issued by individual states, which means your license is only valid where it was issued. However, 43 U.S. jurisdictions currently participate in the Nurse Licensure Compact (NLC), which allows nurses who hold a compact license in their home state to practice in any other compact state without applying for a separate license. If you move to a new compact state, you have 60 days to apply for licensure in your new state of residence.
If you live in a non-compact state, or if you want to practice in one, you’ll need to apply for a separate license in that state. Each state sets its own fees, paperwork, and processing timelines.
Keeping Your License Current
Once you’re licensed, you’ll need to renew it periodically and complete continuing education. In California, for example, RNs must complete 30 contact hours of continuing education each renewal cycle. These courses must come from a provider recognized by the state board. New graduates in California get an exemption from continuing education requirements during their first two years of licensure, with the exception of a required course on implicit bias.
Other states set their own hour requirements and may mandate specific topics like pain management, substance abuse, or infection control. Check your state board’s website for exact renewal requirements, since they differ significantly.
Requirements for International Nurses
If you completed your nursing education outside the United States, you’ll need to go through a credential evaluation before you can apply for licensure. The Commission on Graduates of Foreign Nursing Schools (CGFNS) handles this process. If you were licensed as a nurse in your home country, you’ll request a Professional Report with licensure verification. If you were educated abroad but never licensed, you’ll need an Academic Report instead.
English language proficiency testing is required if your nursing education was not conducted in English. Two exams are accepted: the TOEFL iBT, which requires a minimum overall score of 84 and at least 23 on the speaking section, or the IELTS, which requires an overall band score of 6.5 and a 7.0 on the spoken band. After clearing these hurdles, you’ll still need to pass the NCLEX and meet your state’s individual licensure requirements, just like any domestically educated nurse.