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how to become a nurse in the us complete career guide

This complete guide details the essential steps to launch a nursing career in the US, from choosing the right education path and passing the NCLEX exam to securing your license and exploring various nursing specialties.

Updated October 10, 202622 min read7 sections

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How to Become a Nurse in the US: A Complete Career Guide

To become a registered nurse in the US, complete an approved nursing programme, meet the destination state board’s requirements, register for and pass the NCLEX-RN, and obtain your RN licence before practising independently. Initial licensure applications generally precede exam authorization; state-specific requirements govern the process.

Nursing is one of the few professions where the licence, not the degree, is what legally lets you work. The degree and the licence are two separate hurdles, and passing one says nothing about the other.

One warning up front, because it protects your money. Nursing licensure is regulated state by state in the US. Fees, background-check rules, exam eligibility and processing times all differ by state. Nothing in this article is legal advice, and nothing replaces your own board’s published requirements. Check with the specific board before you pay anyone a cent.

What you are signing up for, in three numbers

The Bureau of Labor Statistics Occupational Outlook Handbook, last modified 27 August 2026, reports 3,465,400 registered nurse jobs in 2025, with employment projected to rise 6% between 2025 and 2035 and about 180,800 openings per year on average.

Those 180,800 annual openings are the number most people quote as “shortage.” Read it carefully. BLS says many of those openings come from nurses leaving the profession rather than from new jobs being created, so the figure measures replacement demand as much as expansion.

The federal workforce forecaster paints a similar picture with a different method. HRSA’s National Center for Health Workforce Analysis, in its Nurse Workforce Projections, 2023-2038 brief published December 2025, projects a national shortage of 108,960 full-time-equivalent RNs in 2038, which works out to 3%. The same brief forecasts an 11% RN shortage in nonmetropolitan areas against 2% in metropolitan areas.

“In 2025, 86.7% of first-time U.S.-educated candidates passed the NCLEX-RN. Among first-time internationally educated candidates, the pass rate was 47.3%.” — National Council of State Boards of Nursing, 2025 NCLEX Examination Statistics, published 2026.

The nine-step path from high school to RN licence

Here is the pathway in the order you actually walk it.

  1. Meet the baseline for nursing school. Take the prerequisite coursework your target programmes require, typically anatomy and physiology, microbiology, English composition and sometimes a math or statistics course.
  2. Choose a route. Decide between an ADN, a BSN, a hospital diploma programme, or an accelerated second-degree BSN if you already hold a non-nursing bachelor’s degree.
  3. Choose a state-board-approved nursing programme. Confirm that the programme meets the licensing requirements of the state where you plan to practise. Also check whether it holds recognised nursing programme accreditation, such as ACEN or CCNE accreditation, since this may affect further education and employer preferences. Accreditation and state board approval serve different purposes.
  4. Finish the classroom and clinical blocks. Every route includes supervised clinical experience. BLS notes that all approved programmes include it.
  5. Apply to your state board of nursing. Submit your initial licensure application, educational verification, and any required background checks.
  6. Register for the NCLEX-RN through Pearson. Pay the examination registration fee and ensure your details match your licensing application and exam identification. Follow the official registration instructions.
  7. Receive your Authorization to Test (ATT). After the board confirms eligibility and Pearson registration is complete, you will receive your ATT by email.
  8. Schedule and pass the NCLEX-RN. Book an available appointment within your ATT validity period.
  9. Receive your RN licence. Your nursing board issues the licence after you meet all applicable examination and licensing requirements. If you are already licensed elsewhere, follow the endorsement process for the destination state.

The state board determines eligibility and issues the licence. NCSBN develops the examination, and Pearson handles registration, scheduling, and test delivery. The board must confirm candidate eligibility and Pearson registration must be complete before an ATT is issued.

ADN vs BSN vs accelerated BSN

This is the first real fork in the road, and people agonise over it more than the evidence requires.

  • ADN — Associate Degree in Nursing. A shorter, entry-level route into the RN licence.
  • BSN — Bachelor of Science in Nursing. The four-year route. BLS lists a bachelor’s degree as the typical entry-level education for RNs.
  • Accelerated second-degree BSN. Built for people who already hold a bachelor’s in another field.
Factor ADN BSN Accelerated BSN (second degree)
Time to degree Typically around two years of full-time study Typically four years, per BLS Shorter than a traditional BSN
First job eligibility Eligible for staff RN roles after satisfying licensing and employer requirements Same licensing and employer conditions apply Same licensing and employer conditions apply
Typical hiring preference Some employers, particularly hospitals, ask for a BSN Widest employer appeal Widest employer appeal
Exam eligibility Depends on programme approval and state board requirements Depends on programme approval and state board requirements Depends on programme approval and state board requirements
Best for Getting licensed fastest and cheapest Hospitals, leadership, teaching, research Career changers with a prior degree
Verified 2025 NCLEX-RN first-time pass rate 86.1% (89,549 candidates) 87.6% (100,258 candidates) Grouped under BSN

The pass rates come from NCSBN’s 2025 examination statistics. These are national examination outcomes, not an estimate of each student’s individual likelihood of passing. The roughly 1.5-percentage-point difference between ADN and BSN pass rates does not establish that either degree type causes better performance.

Nurses with an ADN, ASN or diploma can later bridge to a BSN through an RN-to-BSN programme, according to BLS. That route is the sensible answer for anyone worried about being locked into a two-year credential.

How long does it take to become an RN in the USA?

Roughly two to four years of school, plus exam time. A BSN takes four years at typical pace, an ADN roughly two, and a hospital diploma programme two to three years, per BLS.

The exam part is quicker than most applicants expect, but it is not instant:

  • You cannot schedule an appointment until your ATT arrives.
  • First-time candidates are offered an appointment 30 days after requesting a schedule.
  • Repeat candidates are offered one starting 45 days after their last attempt.
  • A registration stays open for 365 days while your board decides eligibility. If eligibility is not granted in that window, you forfeit the registration and the fee.

The total time to licensure depends on prerequisites, admission timing, programme length, clinical requirements, board processing, exam availability, and any retakes. Allow time beyond the degree itself, and use the school’s and state board’s current timelines to build a personal plan. Fixed estimates such as 2.5–3 years for ADN or 4.5–5 years for BSN are planning examples, not national averages established by BLS.

What does it cost to break down honestly?

We deliberately do not quote a single tuition figure. Public nursing tuition varies too much by state and programme for one number to help you. What you can verify precisely is the exam and licensing layer.

  1. Nursing school. Tuition, fees, lab and clinical costs, and required equipment. This is the dominant cost and the only one you cannot standardise. Use the NCES College Navigator to compare programmes near you.
  2. NCLEX registration fee. $200 USD through January 31, 2027; $350 from February 1, 2027 for candidates seeking US licensure, per the NCLEX fees page.
  3. Additional international scheduling fee. $150 USD plus value added tax where applicable, for candidates testing outside the US.
  4. State licence application fee. Set by each board of nursing, not by NCSBN. The NCLEX fee table simply directs candidates to contact their nursing regulatory body.
  5. Background check and fingerprinting. Required in many states, charged separately, priced by the vendor the state designates.

Internationally educated applicants should also budget for any required credential evaluation, English testing, immigration screening, and visa expenses. TruMerit lists a $485 base fee for its CES Professional Report, but the service required and total cost depend on the state and immigration route. Confirm the accepted service and current fees before paying.

Is the NCLEX hard to pass?

The NCLEX-RN is the standardised examination for initial RN licensure by examination in the US, and it is developed and administered by NCSBN, the National Council of State Boards of Nursing, through Pearson VUE.

Difficulty varies with preparation, curriculum alignment, language, prior attempts, and individual circumstances. National pass rates describe groups and should not be treated as personal predictions.

  • First-time, US-educated candidates: 86.7% passed in 2025.
  • First-time, internationally educated candidates: 47.3% passed in 2025.
  • Repeat, US-educated candidates: 52.7% passed in 2025.

All three figures come from NCSBN’s 2025 NCLEX Examination Statistics, published in 2026. Across all candidates and repeaters combined, 226,946 of 328,443 passed, a 69.1% rate.

Here is the part most people get wrong. The NCLEX does not have a fixed percentage of candidates who pass. The current passing standard is set at 0.00 logits for the NCLEX-RN and −0.18 logits for the NCLEX-PN, and NCSBN’s Board of Directors has upheld both through 31 March 2029. Every candidate is scored against that standard, not against a class curve.

What the exam will not tell you is anything. The number of items you receive does not indicate pass or fail. Each attempt is independent and the adaptive algorithm starts over from the beginning. Both points come straight from the NCLEX FAQs.

What does the NCLEX actually test?

The 2026 NCLEX-RN test plan organises content into four Client Needs categories, based on NCSBN’s 2024 practice analysis of roughly 24,000 newly licensed RNs. Test plans are revised every three years.

NCLEX-RN content area 2026 exam distribution
Management of Care 15–21%
Safety and Infection Prevention and Control 10–16%
Health Promotion and Maintenance 6–12%
Psychosocial Integrity 6–12%
Basic Care and Comfort 6–12%
Pharmacological and Parenteral Therapies 13–19%
Reduction of Risk Potential 9–15%
Physiological Adaptation 11–17%

These ranges are from the 2026 NCLEX-RN Test Plan, effective April 1, 2026 through March 31, 2029. Management of Care and Safety and Infection Prevention and Control are subcategories of Safe and Effective Care Environment; the four physiological areas are subcategories of Physiological Integrity.

Two structural facts matter for revision. The exam runs 85 to 150 items in five hours, and clinical judgment is measured separately through 18 case study items, three item sets, plus roughly 10% stand-alone items. Individual exams can vary about 3% per category. Full detail is in the 2026 RN Test Plan.

In 2025, the average first-time US-educated candidate answered 103 items and spent two hours and fourteen minutes of the five-hour allowance.

The NCLEX fee is about to go up

The NCLEX registration fee rises from $200 to $350 USD, effective 1 February 2027. The change was approved by NCSBN’s Delegate Assembly and announced in an NCSBN news release posted 21 August 2026, which called it the first adjustment since 2000 and attributed it to 25 years of inflation plus rising exam, data protection and cybersecurity costs.

Five details worth pinning down:

  • The registration date sets the fee. Your exam date does not.
  • The new fee applies to retakes as well.
  • International scheduling fees and change fees are unchanged.
  • The Canadian fee moves to 570 CAD.
  • There are no refunds, including for duplicate registrations, failure to appear, or failure to reschedule outside 24 business hours.

If you are registering soon, the practical advice is simple: get the registration submitted before 1 February 2027 if your timing allows it. That is the entire decision.

What is the Nurse Licensure Compact?

The Nurse Licensure Compact (NLC) allows eligible nurses whose primary state of residence is a participating compact state to obtain a multistate licence and practise in other states where compact privileges are active. As of October 2026, 43 jurisdictions have enacted the NLC, but implementation varies. Massachusetts and the US Virgin Islands have not completed implementation, while Guam has partial implementation. Enactment alone does not establish that all compact privileges are active.

Two rules cause most of the confusion:

  1. You need a primary state of residence. A multistate licence is issued by the state where you legally reside, evidenced by a driver’s licence, voter registration, federal tax return, military DD Form 2058, or a W-2.
  2. The 60-day rule applies when you move. If you relocate permanently to another compact state, you must apply for licensure in your new state within 60 days. You may start the application before you move.

Nursing is licensed where the patient is located, which is why telehealth and travel nursing both lean on the compact. Check whether your existing licence is single-state or multistate using NURSYS Quick Confirm at nursys.com.

Can I become a nurse in the US with a foreign degree?

Internationally educated nurses can pursue US licensure, but requirements differ by destination state. Check the board’s current eligibility and documentation rules before selecting a service or paying fees.

An internationally educated nurse (IEN) is a nurse educated outside the United States who seeks US licensure. The abbreviation IMG generally refers to an internationally trained medical graduate and should not be used for nurses. The outline below is informed by TruMerit’s guidance, with state board requirements controlling eligibility.

  1. Check your destination state’s nursing board requirements. Eligibility for internationally educated nurses varies by state and may depend on education, professional registration, clinical training, and English language proficiency. Two years of RN practice is not a universal US licensure requirement.
  2. Complete an accepted credential evaluation. Your state board may require a report from TruMerit or another approved agency. Confirm the accepted provider and required report before paying.
  3. Complete any additional qualifying requirements. Some boards require the TruMerit Certification Program, including its qualifying examination. This is not a universal requirement for every internationally educated nurse.
  4. Complete the board application and NCLEX registration process. Submit the initial licensure application and educational records as directed, register with Pearson, and receive the ATT after eligibility is confirmed. Then schedule and pass the NCLEX-RN. First-time internationally educated candidates had a 47.3% pass rate in 2025; that is a group outcome, not a personal prediction.
  5. Receive your state licence. The board issues it after all examination, background-check, and documentation requirements are met.
  6. Handle immigration and work authorization separately. Licensing does not itself grant permission to work in the US. Depending on the immigration route, credential screening and employer sponsorship may be required. Check the applicable USCIS health-care-worker requirements and the relevant visa rules; do not assume one visa category or screening service applies to every nurse.

Where the volume is, according to NCSBN’s 2025 first-time NCLEX-RN figures:

Country of education First-time NCLEX-RN candidates, 2025 Pass rate
Philippines 22,793 45.8%
India 4,866 33.3%
Kenya 4,096 58.2%
South Korea 2,485 58.4%
Nepal 2,407 52.4%
Ghana 2,236 54.7%
Nigeria 1,983 54.4%
Puerto Rico 1,709 41.0%
United Kingdom 240 46.7%
Canada 279 84.6%

One naming change to note if you have been reading older guides: CGFNS International now trades as TruMerit. The organisation announced the rebrand and rolled it out over the first half of 2025, and cgfns.org now redirects to trumerit.org. Old programme names survive in the new site, which is why you will still see CGFNS Certification Program and CGFNS Qualifying Exam referenced in official material.

How Much Do Registered Nurses Earn? (Latest 2025 Wage Data)

The national median annual wage for registered nurses was $97,550 in May 2025, or $46.90 an hour, per BLS. The O*NET national wage table, published by the Department of Labor, confirms the identical figures.

  • 10th percentile: $68,940
  • 25th percentile: $80,330
  • Median: $97,550
  • 75th percentile: $112,350
  • 90th percentile: $137,470

That spread is wider than most people expect. Location does more to your salary than the credential you chose.

State Median annual wage, May 2025 10th percentile 90th percentile
California $140,270 $101,260 $213,320
Hawaii $136,320 $82,500 $147,830
Oregon $129,010 $95,280 $155,010
Washington $124,200 $89,630 $161,910
New York $109,440 $79,760 $157,090
New Jersey $106,500 $83,060 $135,170
Minnesota $101,510 $79,960 $132,430
Illinois $95,990 $69,170 $118,190
Texas $95,970 $67,120 $127,950
Pennsylvania $96,430 $70,800 $117,900
North Carolina $84,350 $67,660 $110,220
Ohio $82,510 $66,980 $105,290
Missouri $81,780 $63,230 $104,390
Iowa $78,630 $63,840 $100,500
Mississippi $77,090 $60,610 $100,350
Alabama $77,080 $58,150 $98,910

Setting matters as much as state. BLS reports May 2025 medians by industry: government at $110,780, hospitals at $100,220, ambulatory healthcare at $91,230, nursing and residential care facilities at $84,300, and educational services at $78,620.

Advanced practice pays differently. BLS reports a median of $134,920 for nurse anesthetists, nurse midwives and nurse practitioners combined in May 2025.

  • CRNA — Certified Registered Nurse Anesthetist. A nurse anaesthetist who administers anaesthesia. Median pay $236,590 in May 2025.
  • NP — Nurse Practitioner. An advanced practice registered nurse who provides primary and specialty care and, in many states, prescribes. Median pay $132,300 in May 2025.
  • Certified Nurse Midwife. Median pay $134,040 in May 2025.

Employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 36% between 2025 and 2035. The occupation group employed approximately 399,000 people in 2025 and is projected to add 144,000 jobs by 2035. BLS separately projects approximately 32,200 job openings annually, including openings created by workers leaving their occupations or the labor force. The 144,000 figure is a ten-year net employment increase, not annual openings.

Advanced practice nursing education requirements depend on the specialty. Nurse practitioners and nurse midwives generally need an appropriate graduate degree, state licensure, and national certification. New entrants to nurse anesthesia practice must complete a doctoral-level nurse anesthesia programme. Existing CRNAs who qualified under earlier requirements do not necessarily need to earn a doctorate to continue practising. (AANA)

One caveat on the “become an NP for the money” logic. HRSA’s December 2025 projections put national NP supply at 766,260 against demand of 437,330 in 2038, or 175% adequacy. That is a distribution problem as much as a supply problem.

Is there really a nursing shortage?

HRSA’s model says yes, and says it is a geography problem as much as a headcount problem. Its December 2025 brief projects RN supply adequacy of 97% nationally in 2038, with wildly different state pictures: a 22% shortage in California against a 79% oversupply in Wyoming. The ten largest projected state RN shortages in 2038, from the same brief:

  • California, 22%, or 84,750 FTEs
  • North Carolina, 20%, or 25,710
  • Georgia, 20%, or 25,110
  • Michigan, 18%, or 20,290
  • Washington, 17%, or 15,020
  • Maryland, 16%, or 10,890
  • Oklahoma, 13%, or 5,900
  • South Carolina, 12%, or 7,250
  • Louisiana, 11%, or 5,680
  • Virginia, 8%, or 8,020

Nursing unions dispute parts of the shortage framing, and we think both things are true. There is a genuine shortage in specific markets and units, and there is also a well-documented retention problem that no graduation cohort fixes quickly.

Who is leaving the profession?

NCSBN’s National Nursing Workforce Survey, run every two years with the National Forum of State Nursing Workforce Centers, published its 2024 results in the Journal of Nursing Regulation. The survey covered about 800,000 nurses, and these figures describe the 2024 workforce.

  • The median age of RNs reached 50 in 2024, up from 46 in 2022.
  • BSN-prepared RNs rose from 39% in 2015 to 46% in 2024. MSN-prepared RNs went from 3% to 6%.
  • 40% of RNs and 41% of LPN/LVNs intended to leave the profession within five years, which NCSBN puts at roughly 1.6 million nurses.
  • More than 138,000 nurses left the workforce between 2022 and 2024.
  • Hospitals remained the primary employer for 53% of RNs, down 4.2 points from 2022.
  • Median pretax annual earnings reached $88,000 in 2024, up from $80,000 in 2022.
  • Male RNs were 10% of the workforce. White RNs were 77%, down from 80% in 2022, while Black RNs rose from 6% to 9%.

The BSN shift is the number we would watch. It tracks what employers ask for in job descriptions.

Which certifications show up in job ads?

These are voluntary, employer-preferred credentials issued by named bodies. Verify current eligibility, exam content and renewal cycles with the issuing organisation, because all of them change.

  • CCRN — Critical Care Registered Nurse, issued by the American Association of Critical-Care Nurses. Adult, pediatric and neonatal tracks.
  • CEN and specialty variants including TCRN, CFRN, CPEN, CBRN and CTRN — issued by the Board of Certification for Emergency Nursing.
  • TNCC — Trauma Nursing Core Course, delivered through the Emergency Nurses Association.
  • BLS, ACLS and PALS — American Heart Association courses.
  • NIHSS — the National Institutes of Health Stroke Scale certification, required by many stroke programmes.

Two honest warnings. First, no certification creates a licence. Second, a new graduate with a CCRN and no NCLEX has no advantage in the hiring market at all.

What changed for nursing in 2026?

Three things most career guides have not caught up with:

  1. Federal long-term care minimum staffing standards were repealed. CMS published an interim final rule, “Repeal of Minimum Staffing Standards for Long-Term Care Facilities,” at 90 FR 55687 on 3 December 2025, effective 2 February 2026. The rule notes that public law precludes HHS from implementing, administering or enforcing certain provisions of the prior staffing rule until 30 September 2034. The practical effect is on long-term care staffing specifically, not hospital staffing.
  2. The NCLEX registration fee changes on 1 February 2027, as detailed above.
  3. CGFNS International is now TruMerit, so older guides sending you to a dead-looking credentials site are out of date.

None of these change the core pathway. They do change cost, employer behaviour and which agencies you deal with.

Common questions, answered straight

Do I need a BSN to become an RN?

A bachelor’s degree is not the only RN entry route. Graduates of state-board-approved associate, baccalaureate, or diploma programmes may qualify for NCLEX-RN eligibility subject to the destination board’s requirements. Staff RN employment also requires the appropriate licence and compliance with employer requirements. Some hospitals prefer or require a BSN; an RN-to-BSN programme can support later progression.

Can I take the NCLEX before graduating?

Generally no. Your board of nursing sets eligibility, and NCLEX registration is built around a board sending your programme’s verification. You cannot schedule an appointment until you hold an ATT.

What happens if I fail the NCLEX?

You re-register and pay again. There is no refund of the registration fee for any reason, and the same fee applies to every attempt. Repeat candidates are offered an appointment starting 45 days after their last attempt. NCSBN also issues a Candidate Performance Report when you do not pass, which is the only detailed feedback the exam gives anyone.

How long are NCLEX registrations valid?

A registration stays open 365 days while you await board eligibility. Once eligible, you must test within the validity dates on your ATT email. Miss both windows and you re-register and pay again.

What is the difference between a multistate licence and a compact licence?

There isn’t one. The terms are used interchangeably for the NLC multistate licence, which is a single licence issued by your primary state of residence that authorises practice across all compact jurisdictions.

Do I need the compact to work in a hospital?

No, but it changes how easily you can move and how telehealth works. Nursing practice is authorised by state, so a non-compact destination always needs its own single-state licence.

The mistakes we would flag

  • Choosing a programme on price alone. Clinical placement capacity and NCLEX outcomes are what matter. Check your programme’s own first-time pass rate against the national 86.7% figure from NCSBN’s 2025 data.
  • Applying to a dozen schools and waiting. Nursing programme enrolment is capped and competitive, and waiting costs a year.
  • Ignoring the background check until week one. In many states it is the item that delays a licence you have already paid for.
  • Assuming the BSN is the only door in. The 2025 pass rate gap between ADN and BSN candidates was 1.5 points. Real, but not a career verdict.
  • Chasing a specialty before you have the licence. The NCLEX covers general entry-level practice. Specialty certifications come after.

Your next twelve months, in order

  1. Decide your route: ADN, BSN, or accelerated BSN if you already hold a degree.
  2. Shortlist state-board-approved programmes, check recognised accreditation, compare costs with NCES College Navigator, and review each programme’s reported first-time NCLEX pass rate.
  3. Apply. Get into the earliest seat you can.
  4. Meanwhile, pick your likely state and read that board’s application checklist top to bottom.
  5. When the board’s application requirements and your graduation timeline permit, apply for initial licensure and register with Pearson. Once the board confirms eligibility and Pearson registration is complete, wait for your ATT and schedule within its validity dates. The registration fee is $200 through January 31, 2027 and $350 from February 1, 2027; choose timing based on readiness and eligibility, not the fee alone.
  6. Use the 2026 RN Test Plan as your revision spine and the Client Needs percentages as your schedule.
  7. Pass the NCLEX and confirm that the board has issued your licence before practising independently. If eligible for a multistate licence, confirm your status and active compact privileges using NURSYS and the NLC map.

Sources

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