How to Become a Nurse at the RN Level and Beyond
Do you feel called to help care for ill and injured people and improve their overall well-being? With this in-depth guide, you'll learn how to become a nurse so that you can do exactly that. It outlines all the steps you need to follow in order to become a registered nurse (RN) and start enjoying the benefits of this challenging and meaningful profession.
More detailed information is provided below, but the requirements to become a registered nurse include completing a state-approved training program, passing the national licensing exam, and getting a license from your state board of nursing. It takes anywhere from two to four years to become a registered nurse, depending on the educational route you choose. (As you will see, there are plenty of options.)
Once you become an RN, a wide world of career opportunities opens up for you. In fact, more than 200,000 new jobs for RNs are expected to become available each year between 2016 and 2026.1 Plus, you can pursue specialties in dozens of areas, from critical care and neonatology to geriatrics and public health. You can also become a travel nurse and work a series of temporary assignments all around the country. Or you can get additional training to take on higher-level responsibilities as a nurse practitioner, nurse-midwife, or nurse anesthetist.
So keep reading to get all the details on what's involved in becoming a nurse!
- How to become a registered nurse
How to Become a Registered Nurse
Are you ready to learn how to make a difference in patients' lives? Here are eight steps that explain how to become an RN:
1. Get a real sense of the profession.
If you dream of becoming a nurse, you'd be wise to do whatever you can to get a fuller picture of what the profession entails. Plus, any healthcare experience you can get will look good on your nursing school application. Even if you're still in high school, you can gain valuable insights and relevant experience by:
- Volunteering in a hospital or other medical setting—Nursing volunteers might greet visitors, answer phones, deliver meals and flowers, wipe down stretchers and wheelchairs, or offer companionship to patients. This is a great way to observe nurses up close and see if the career would be a good fit for you. Most places ask volunteers to commit to a certain number of hours each year. Some facilities will accept volunteers under the age of 18 provided they have parental consent along with recommendation letters from teachers or guidance counselors.
- Going to nursing camp—Several nursing schools and medical centers around the country offer specialized programs that are designed to give high school (or even middle school) students a better idea of what nurses do. Students get to spend a few days shadowing nurses on rounds and participating in interactive skills labs. You can learn how hospitals work and how patient care is delivered; you might even get training in first aid and CPR. Costs vary, but some programs are free.
- Becoming a certified nursing assistant (CNA)—Many aspiring nurses work as CNAs before or while pursuing their nursing degrees. That's because the barrier to entry is fairly low: You can complete a training program in one to three months, take the certification exam in your state, and be ready to work in nursing homes and assisted living facilities. Several states (including California, Ohio, Illinois, and Arizona) allow students as young as 16 to train as CNAs as long as they have parental consent.
If you've already graduated from high school, you can be a nurse without a degree by completing a diploma or certificate program that helps you become a licensed practical nurse (LPN) or a licensed vocational nurse (LVN). These programs are offered through community colleges and trade schools. They take about a year to complete. You must then pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN). Becoming an LPN or LVN can be a great stepping stone to becoming a registered nurse because, depending on the schools you attend, many of the credits from your training may be applied toward your RN coursework.
2. Choose an educational path.
What education is needed to become a registered nurse? The short answer is that you must complete a post-secondary program that prepares you to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). However, there are a variety of educational routes you can take. Hospitals, colleges, and vocational schools offer RN programs, so you have a few options.
Some hospital-based programs offer diplomas in nursing that take about three years to complete. Diploma programs qualify you to sit for the licensing exam and enter the field, but they are much less common than they once were. In fact, in many states, an associate degree in nursing (ADN) is the minimum education required to become a registered nurse, so make sure you check the requirements in your area. ADN programs are available at vocational schools and colleges and are generally about two years long.
Many nurses begin with a diploma or associate degree because doing so lets them become RNs and join the workforce sooner than if they went for a Bachelor of Science in Nursing (BSN) degree. If you earn an associate degree or diploma and later decide that you want to upgrade your education, you can complete an RN-to-BSN bridge program that enables you to get your bachelor's degree in one to two years. There are even RN-to-MSN bridge programs that allow nurses to earn their BSN and Master of Science in Nursing (MSN) degrees in a single program. As an added bonus, many employers offer tuition assistance programs that help cover the cost for working nurses to take additional training.
Of course, you can get a BSN without having an RN license by simply enrolling in a BSN program after high school. The advantage of a BSN degree is that it provides more in-depth training and allows you to pursue management positions or graduate-level training. (Keep in mind that you will need to get a graduate degree if you hope to move on to advanced roles like nurse practitioner or nurse educator.) Plus, many employers prefer to hire nurses with bachelor's-level training.
BSN programs do take more time to complete than ADN programs; most are four years long. However, if you already have a bachelor's degree in something other than nursing, you can take an accelerated program and get your BSN in about a year and a half.
3. Look for an approved program.
When checking out schools to become a registered nurse, it's important to choose a program that is approved by your state's board of nursing. Most boards provide a list of approved programs on their websites. You must graduate from a state-approved program in order to take the NCLEX.
Be aware that approval and accreditation are two different things. There's also a difference between program accreditation and school accreditation. A program that is accredited has met nationally established standards for nursing education. The two main national organizations that accredit nursing programs in the U.S. are:
- The Accreditation Commission for Education in Nursing (ACEN), which used to be known as the National League for Nursing Accreditation Commission (NLNAC), accredits nursing programs at all levels.
- The Commission on Collegiate Nursing Education (CCNE) only accredits programs at the bachelor's level and above.
Program accreditation is not required for state licensure; however, it's wise to double-check the specific rules in your area before committing to a training program. Some programs are approved by their state boards of nursing but are not accredited by a national body. Graduating from such programs still allows you to take the NCLEX and get your RN license.
However, some employers won't hire RNs who complete non-accredited programs. You might also find it difficult to transfer credits from a non-accredited program to another institution if you later decide to pursue additional training. That's because most bridge programs, as well as most graduate schools, require applicants to have a degree from an accredited program.
4. Meet entrance requirements.
Once you select a program, you have to qualify for admission. Requirements vary from school to school, but you will definitely need to have a high school diploma or GED and a solid transcript. Key subjects that are required to become a nurse include biology, chemistry, geometry, and algebra. You may have to complete prerequisite courses in microbiology, anatomy, or nutrition. Some programs also require a minimum score on SAT or ACT exams.
Most nursing programs require applicants to pass an entrance exam. Some common examples are:
- Test of Essential Academic Skills (TEAS)—This exam is designed to assess how prepared you are to handle the nursing school curriculum. As such, it tests your level of basic knowledge in subjects you covered in high school. It's comprised of 170 multiple-choice questions related to reading, science, language use, and math. Each section has its own time limit.
- HESI—Also known as the HESI A2 or Evolve Reach A2, this exam gets its name from the company that developed it: Health Education Systems Inc. It's a computer-based exam that assesses your grasp of science (mainly anatomy and physiology), math, vocabulary, grammar, and reading comprehension. It also includes a learning style component and a personality style component. Not all schools require candidates to take all the different sections.
- National League for Nursing Pre-Admission Exam for RN (NLN PAX-RN)—This is a timed test made up of multiple-choice questions in three main areas: science (such as biology, chemistry, and physics), math (including algebra, graphing, conversions, and word problems), and verbal ability (focusing on vocabulary knowledge and reading comprehension). The NLN PAX also features a section on first aid.
You may also need to go for an interview with a nursing school representative. You will likely be asked questions like why you want to become a nurse, what situations you have faced that challenged you, and why you have chosen to apply to that particular school. Be prepared with honest and self-reflective answers. Try to give specific examples.
In addition, before you can complete the clinical practice portion of your training, you will likely have to:
- Pass a drug screen and background check
- Submit verification of measles, mumps, rubella, varicella, and hepatitis B immunity
- Provide proof of immunizations for tetanus, diphtheria, pertussis, and influenza
- Test negative for tuberculosis
- Submit to a physical exam by your healthcare provider
- Provide evidence of health insurance
- Be certified in CPR (keeping in mind that some programs only accept certification from specific CPR course providers, which makes it important to check with the educational institution you plan to attend)
5. Complete a post-secondary program.
Registered nursing programs provide training in areas like physiology, anatomy, chemistry, and psychology. They involve classroom learning as well as hands-on clinical practice. Some programs can be completed online, but you'll still need to fulfill the clinical requirements through healthcare facilities in your local area. Each state has different rules about how many clinical hours you need to complete in order to qualify for RN licensure.
The cost to become a registered nurse largely depends on the program you choose and the type of institution you attend. For the 2017-2018 school year, the average tuition at public two-year colleges (for in-district students) was $3,570, so the total cost for a two-year program would be $7,140. At public four-year colleges, the average tuition for in-state students was $9,970, which works out to $39,880 for four years.2 For RN programs at vocational schools, total tuition and fees can range from $30,000 to $50,000; however, they often allow students to begin their training more quickly and therefore start working sooner.3
So, as a general estimate, it costs between $7,000 and $50,000 to get a nursing degree (not including living expenses). Remember that you may be able to lower those costs with bursaries, scholarships, grants, and other forms of financial aid.
Other common expenses include the following. (These costs are estimates only; check with your nursing school to get more exact figures.)
- Books—$200 to $1,000 or more
- Scrubs and shoes—$150 to $250
- Entrance exam—$40 to $100
- Vaccinations and physical exam—varies depending on what you need and what your healthcare plan covers
- Drug screening and background check—$60 to $100
- CPR certification—$40 to $85
- NCLEX exam—$200
- State licensing—$35 to $300
6. Pass the NCLEX.
Once you've graduated from a state-approved nursing program, you need to sit for the NCLEX-RN exam. Passing the NCLEX is a requirement to become a registered nurse. To be eligible to take the exam, you must first apply for a nursing license from the board of nursing in your state. If the board decides you meet its criteria, it will send you an NCLEX Candidate Bulletin. You'll then register with the testing service, pay the fee, and wait for the service to send you an Authorization to Test (ATT). Once you have your ATT, you can arrange a time to take the exam.
The NCLEX focuses on care management, infection control, human development, disease prevention and detection, and pharmacological therapies, among other areas. It is a computer-adaptive test, which means the questions change based on each test taker's ability level. As you answer questions correctly, you are presented with more difficult questions. The test could be as short as 75 questions or as long as 265 questions, but the average length is 119 questions.4
The computer will keep giving you questions until its algorithm determines that you either have met or cannot meet the passing standard. The good news is that in 2017, 87 percent of U.S. candidates passed the NCLEX on their first try. Those with diplomas and bachelor's degrees had a 90-percent pass rate.4
There are plenty of resources available to help you prepare for the NCLEX. Consider taking free online practice exams, enrolling in test prep courses, or purchasing study guides (such as Saunders Comprehensive Review for the NCLEX-RN Examination by Linda Anne Silvestri).
7. Get a license from your state.
Before you can get a registered nursing job, you need to be licensed by your state. The board of nursing in each state sets its own qualifications for RN licensure, and some boards have additional requirements beyond passing the NCLEX.
For instance, most states require you to pass a criminal background check. When you apply for a nursing license, you will be asked to disclose any felonies or misdemeanors in your past, and you may have to give fingerprints. If you've been convicted of a sexual offense, you will have to undergo a psychological evaluation. A criminal history will not necessarily keep you from becoming an RN: The nursing board will review your application and decide whether you should be granted a license.
Once you receive your license, you are officially a registered nurse!
If you live in a state that participates in the Nurse Licensure Compact, your nursing license is valid in each of the other participating states. That means you can take advantage of a nursing shortage in another area without having to apply for a new license. If you live in a non-compact state, your license only permits you to work in that one state; to practice nursing in a different state, you must apply for a license by endorsement for that state.
Maintaining your license requires completing a certain amount of continuing education credits every two years. Check with your state board to learn specific requirements in your region.
8. Consider specialized certifications.
Getting certifications in different nursing specialties demonstrates your commitment to the profession and can make you more attractive to potential employers. Here is a sample of the dozens of specialties available to RNs who have a few years of work experience:
- Critical Care Registered Nurse (CCRN)
- Certified Addictions Registered Nurse (CARN)
- Certified Pediatric Nurse (CPN)
- Certified Rehabilitation Registered Nurse (CRRN)
- Certified Dialysis Nurse (CDN)
- Certified Medical-Surgical Registered Nurse (CMSRN)
- Certified Managed Care Nurse (CMCN)
- Legal Nurse Consultant Certified (LNCC)
How to Become a Travel Nurse
Travel nurses are RNs who complete short-term assignments in different locations around the country. Most posts are 13 weeks long, but contracts can vary. Staffing agencies maintain lists of travel nursing job opportunities; they also frequently cover nurses' housing costs and offer travel stipends along with a range of tax-free reimbursements. Note that travel nurses must still maintain a permanent home for tax purposes.
To get into this career, you must first become an RN, which means you have to go to school for two to four years to be a travel nurse. Once you pass the NCLEX and receive your nursing license (ideally in a Nurse Licensure Compact state so that your license will be recognized in many other states), you will need to get at least one year of hospital work experience in whichever specialty you choose: critical care, emergency medicine, case management, etc. Specialty certifications can be very useful. You may also need Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), or NIH stroke certification.
A travel nurse makes up to $48 per hour.5 You may also be eligible for bonuses. Keep in mind that pay rates vary by position, location, and specialty. How much you make per year will also depend on how many assignments you take on.
When applying to an agency, you will need to provide copies of your nursing license and certifications, and you will need to supply references. Once you have been accepted and your paperwork has been processed, it can take as little as a week to get a travel nursing job. Your recruiter will work with you to find assignments that suit your abilities and preferences.
How to Become a Nurse Practitioner
A nurse practitioner (NP) is an advanced practice registered nurse (APRN) who provides a higher level of care than an RN and can often practice independently; however, the specific scope of practice varies from state to state. Typically, NPs can assess a patient's physical condition, order tests, diagnose illness, and plan courses of treatment in their areas of specialty. They can also prescribe certain medications.
It takes about seven or eight years to become a nurse practitioner, depending on the educational path you follow. Requirements vary a bit between jurisdictions, but here are the basic steps:
1. Become a registered nurse.
Once you have your RN license, you will generally need to get at least a year of clinical work experience before you will be eligible for graduate school. It's a good idea to collect letters of reference from your supervisors.
2. Earn a graduate degree from an accredited program.
A Master of Science in Nursing (MSN) degree is a requirement to be a nurse practitioner, but some nurses opt to get a Doctor of Nursing Practice (DNP) degree. Be sure to choose a program that is accredited by the CCNE or ACEN. When you enroll in an MSN program, you will select a specialty to focus on, such as acute care, psychiatric nursing, family care, pediatric nursing, or emergency care.
If you have a BSN, you can complete an MSN program in about two years. If you have an associate degree or diploma, you can complete an RN-to-MSN program in about four years. And if you have a bachelor's degree in a health-related field other than nursing, you can take a special program that allows you to earn your RN license and MSN degree together in about three years. So, in total, it takes six to seven years of school to be a nurse practitioner (plus a year of clinical experience after earning your initial RN license). That requires a serious financial commitment: It costs anywhere between $17,000 and $60,000 to go to school to be a nurse practitioner through an MSN program.
3. Get national certification.
In most cases, you need to pass a national certification exam related to your specialty in order to qualify for state licensure. Some organizations that certify nurse practitioners include:
- The American Academy of Nurse Practitioners
- The National Certification Corporation
- The American Nurses Credentialing Center
- The American Association of Critical-Care Nurses
- The Pediatric Nursing Certification Board
4. Become licensed in your state.
Most states require you to be licensed as an APRN in order to work as a nurse practitioner. Once you pass this final step, your efforts can really pay off: Nurse practitioners earn a median annual salary of $103,880.1
How to Become a Nurse-Midwife
Certified nurse-midwives are advanced practice registered nurses (APRNs) who specialize in women's reproductive and gynecologic health. They are primarily known for delivering babies, but they also conduct checkups, order tests, explain birth options, and teach women how to stay healthy and prevent disease throughout their lives.
Here's what you have to do to become a nurse-midwife:
1. Become an RN.
You must hold a valid RN license. It's best to complete a bachelor's degree in nursing, but you can get started with an associate degree and then take a bridge program to get your BSN. Once you are a fully licensed nurse, look for a position in obstetrics or gynecology. A graduate education is needed to be a nurse-midwife, and some midwifery graduate schools expect applicants to have at least a year of clinical experience with labor and delivery.
2. Complete a graduate program in midwifery.
You'll need to get at least a master's degree in nursing or specifically in nurse-midwifery. Make sure whatever program you choose is accredited by the Accreditation Commission for Midwifery Education (ACME). You must complete an ACME-accredited program in order to sit for the certification exam.
Midwifery coursework covers topics like health assessment, physiology, pharmacology, and prenatal and postpartum care. You'll also complete clinical rotations.
Most programs take two to three years to complete. That means, in total, it takes approximately six or seven years of school to be a midwife (four for a bachelor's degree and two to three for a master's). You should be aware that because the content of nurse-midwife programs and women's health nurse practitioner programs are so similar, students who graduate from a midwife program are often eligible to become certified as women's health nurse practitioners as well.
3. Pass the certification exam from the American Midwifery Certification Board.
The exam is administered by computer and consists of 175 multiple-choice questions related to pharmacology, physical examinations, and clinical decision making. You have four hours to complete it. If you don't pass, you can wait 30 days and then retake it. If you still don't pass, you are allowed two more tries, but you must wait 90 days between each attempt. Since 2015, more than 90 percent of candidates who've taken the exam have passed.6
You must recertify every five years, which requires either taking the exam again or completing a certain number of continuing education credits.
4. Obtain a state license.
Most states recognize certified nurse-midwives as APRNs and license them accordingly. You must supply evidence that you graduated from an accredited program and passed the certification exam. Once you have your state license, you have a fairly broad scope of practice. About half of all states allow nurse-midwives to practice on their own without being supervised by a doctor. Certified nurse-midwives make a median salary of $100,590 a year.1
How to Become a Nurse Anesthetist
Certified registered nurse anesthetists function much like anesthesiologists and often work independently. (You cannot become an anesthesiologist with a nursing degree, but as a nurse anesthetist, you will perform many of the same tasks.)
Nurse anesthetists are advanced practice registered nurses (APRNs) who focus on managing the pain of patients during childbirth, surgery, and other procedures. They study patient histories in order to make sure there are no allergies or conditions that might affect the safe administration of anesthesia. They also administer local anesthetics, epidurals, and spinal blocks, and they monitor patients' vital signs during operations. In addition, they care for patients who are recovering from anesthesia.
Here are the requirements to become a nurse anesthetist:
1. Get your RN license.
While there are many ways to become a registered nurse, aspiring nurse anesthetists must get a BSN. After you pass the NCLEX and become fully licensed, you will need to get at least one year of real-world clinical experience in an emergency room, coronary care environment, or intensive care setting. Becoming certified as a Critical Care Registered Nurse (CCRN) can be very beneficial.
2. Complete an accredited graduate program.
Currently, a master's degree is the minimum requirement to become a nurse anesthetist. (Beginning in 2025, a doctoral degree will be required.) Look for a program that is accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs. Once enrolled, you will take courses in pain management, physiology, advanced pharmacology, and the principles of anesthesia. You will also get hands-on practice during clinical rotations.
It takes two to three years to complete a master's program in nurse anesthesia. When you combine that with the four years for a bachelor's degree and one year of clinical experience, you'll notice it takes seven to eight years to become a nurse anesthetist.
3. Get certified by the National Board of Certification & Recertification of Nurse Anesthetists (NBCRNA).
The certification exam tests your knowledge in areas like anatomy, pathophysiology, pharmacology, airway management, anesthesia principles, and surgical procedures.7 Like the NCLEX, this exam is a computer-adaptive test. You will be given three hours to answer between 100 and 170 questions.
In 2017, 83 percent of candidates passed the exam on their first try.8 If you don't pass, you can retake the test up to three more times. Keep in mind that you must pass the certification exam within two years of completing your nurse anesthesia program.
The NBCRNA's Continued Professional Certification (CPC) Program requires that you check in with the board every two years and demonstrate full CPC compliance every four years.
4. Be licensed by your state.
The vast majority of states recognize and license nurse anesthetists as APRNs. Once you are licensed, you can start pursuing the rewarding opportunities in this field. Nurse anesthetists are some of the highest paid nursing professionals. According to the Bureau of Labor Statistics, you make a median salary of $165,120 as a nurse anesthetist.1
Get the Training You Need
You've just discovered how to become a nurse. Now you can start thinking about getting the education you need to achieve your career goals. So here's something that's definitely worth your while: Check out the registered nursing programs offered by vocational colleges and trade schools. Or put your zip code into the school finder below to get a list of training options close to where you live!
1 Bureau of Labor Statistics, U.S. Department of Labor, Employment Projections, website last visited on July 26, 2018.
2 The College Board, Trends in College Pricing 2017, website last visited on July 26, 2018.
3 U.S. Department of Education, College Affordability and Transparency Center, website last visited on July 26, 2018.
4 National Council of State Boards of Nursing, 2017 NCLEX Examination Statistics, website last visited on July 26, 2018.
5 TravelNursing.com, website last visited on July 26, 2018.
6 American Midwifery Certification Board 2017 Annual Report, website last visited on July 26, 2018.
7 National Board of Certification & Recertification for Nurse Anesthetists, NCE Handbook, website last visited on July 26, 2018.
8 National Board of Certification & Recertification for Nurse Anesthetists, Summary of NCE and SEE Performance and Clinical Experience, website last visited on July 26, 2018.