Becoming a registered nurse, step by step

Most of the total time is spent in school. A nursing program typically runs 2 to 4 years and combines coursework, skills labs and clinical rotations in hospitals and clinics. Students commonly spend 30 to 40 or more hours per week on school. In one example BSN schedule, students attend classes three days a week and clinical shifts two days a week.

After graduation, candidates apply to their state board of nursing and register for the NCLEX-RN. The median initial license fee is $110. NCLEX registration and fingerprinting are paid separately. Many new nurses then enter a hospital residency program during their first months of work.

An ADN commonly takes about 2 years and is offered mainly by community colleges. A BSN commonly takes about 4 years at a college or university. Graduates of both programs take the same NCLEX-RN and receive the same state RN license. However, some employers prefer a BSN for certain positions. A BSN is also the usual starting point for graduate study toward advanced practice roles. 2,125 degree-granting institutions in the US and its territories offer RN programs. Those deciding between the two can compare the ADN and BSN routes in detail.

Every state requires the NCLEX-RN for an RN license. Candidates register with Pearson VUE for $200 and receive authorization to test once their state board approves the application. In addition, Kentucky and Texas require a jurisprudence exam on state nursing law. Candidates who fail the NCLEX-RN can retake it up to 8 times per year. Most candidates prepare with review courses and NCLEX-RN practice questions in the weeks before the test.

Many hospitals place new graduates in a nurse residency or transition program during their first months of work. These programs combine classroom sessions with supervised shifts alongside an experienced nurse, often called a preceptor. At the UCSF Center for Nursing Excellence & Innovation, the new-graduate program (NNRTP) runs 40 hours per week for 8 weeks. It then runs 36 to 40 hours per week for 6 more weeks.

Program length and structure vary by employer, so applicants can ask about them during job interviews. The transition from student to practicing nurse requires adjusting to patient loads, charting and unit routines. This adjustment generally eases as nurses gain experience. For this reason, many new graduates look for employers that offer a structured residency and a dedicated preceptor.

Licensed practical and vocational nurses (LPNs and LVNs) can enter LPN-to-RN bridge programs. These programs give credit for prior training and shorten the path to an ADN or BSN. Practical nursing programs commonly run about 12 months, so some people complete LPN training first and bridge to the RN later. Those comparing the two roles can review how LPN and RN work differs. Certified nursing assistants usually enter a standard ADN or BSN program, although their patient care experience can help with admission.

People who already hold a bachelor's degree in another field can apply to accelerated BSN programs. These programs build on prior coursework and finish faster than a traditional BSN, although the weekly workload is heavy. For every route, the first step is to confirm that the program is approved by the state board of nursing in the state where the student plans to work. After that, applicants can compare program length, prerequisites, tuition, and program options.