Becoming a nurse requires formal academic education, direct hands-on experience in clinical settings, and official state licensure. Each step is designed to build the knowledge and practical skills necessary to provide safe and effective patient care. This pathway ensures that every individual who earns the title of nurse has met a standardized set of requirements.
Foundational Nursing Education Paths
The journey into nursing begins with a foundational education, and there are multiple paths a person can take. These programs are offered at various institutions, including technical schools, community colleges, and universities. Each educational route combines classroom-based theoretical instruction with supervised clinical practice.
Licensed Practical/Vocational Nurse (LPN/LVN)
The quickest entry point into the nursing profession is through a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) program. These diploma or certificate programs take about one to one and a half years to complete and are found at technical or community colleges. The curriculum focuses on skills for basic patient care, such as taking vital signs, administering certain medications, and collecting samples for testing. Graduates are prepared to work under the direct supervision of Registered Nurses (RNs) and physicians.
Associate Degree in Nursing (ADN)
A common route to becoming a Registered Nurse is by earning an Associate Degree in Nursing (ADN). These programs are offered at community colleges and take approximately two years to complete. The coursework in an ADN program is focused on the core clinical skills and fundamental knowledge required for RN practice. Students engage in a mix of classroom learning, simulation labs, and extensive clinical rotations in hospitals and other healthcare facilities.
Bachelor of Science in Nursing (BSN)
The Bachelor of Science in Nursing (BSN) is a four-year degree program offered at colleges and universities that also prepares graduates to become Registered Nurses. The BSN curriculum is broader, including the same core nursing skills as an ADN program but adding coursework in nursing research, public health, and leadership. This more extensive education can open doors to a wider range of career opportunities and is often preferred by employers in hospital settings.
The Nursing Licensure Process
Upon successfully graduating from an accredited nursing program, the next step is to obtain a license to practice. This process is managed by each state’s or territory’s Board of Nursing (BON). A graduate cannot legally work as a nurse until they have completed this step.
The central component of licensure is passing the National Council Licensure Examination (NCLEX). There are two versions of this exam: the NCLEX-PN for Licensed Practical/Vocational Nurses and the NCLEX-RN for Registered Nurses. The exam uses a computerized adaptive testing (CAT) format, meaning the difficulty of the questions adapts based on the candidate’s answers, to determine their competency for entry-level practice.
Before scheduling the exam, a candidate must first apply for licensure with their state’s Board of Nursing. The BON reviews the applicant’s educational background to confirm they graduated from an approved program and meet all other eligibility requirements, which may include a criminal background check. Once the BON deems a candidate eligible, they will receive an Authorization to Test (ATT) from the testing company, which allows them to schedule their NCLEX exam.
After successfully passing the NCLEX, the state Board of Nursing will issue the official nursing license. This license grants the individual the legal authority to practice as a nurse within that state.
Advanced and Specialized Nursing Training
For Registered Nurses seeking to advance their careers, graduate-level education offers pathways to highly specialized and autonomous roles. These advanced degrees are pursued after obtaining an RN license and gaining clinical experience. The most common advanced degrees are the Master of Science in Nursing (MSN) and the Doctor of Nursing Practice (DNP), which prepare nurses for roles as Advanced Practice Registered Nurses (APRNs).
An MSN degree takes one to two years to complete and allows nurses to specialize in a specific area. These programs build upon a BSN foundation with advanced coursework in topics like pathophysiology, pharmacology, and health assessment, along with extensive clinical hours. Common specializations lead to roles such as:
- Nurse Practitioner (NP), who provides primary or acute care to specific populations
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
The Doctor of Nursing Practice (DNP) is a terminal degree focused on clinical practice rather than academic research. A DNP program prepares nurses for leadership roles, focusing on evidence-based practice, quality improvement, and systems leadership. Nurses can enter a DNP program after earning an MSN, or through BSN-to-DNP programs, which equips them for executive positions and roles in healthcare policy.
Ongoing Training and Continuing Education
A nursing license is not a one-time achievement but a credential that must be actively maintained. To ensure that nurses remain competent and up-to-date with the latest advancements in medical science and patient care, state boards require the completion of continuing education for license renewal. This requirement reflects the profession’s commitment to lifelong learning.
Most states mandate that nurses complete a specific number of continuing education hours every renewal cycle, which is every two years. These hours, often referred to as Continuing Education Units (CEUs) or contact hours, can be earned through various approved activities. These may include attending workshops, taking academic courses, or completing online programs on relevant nursing topics.
Beyond mandatory continuing education for licensure, many nurses pursue voluntary specialty certifications. These certifications demonstrate a high level of expertise in a specific area of nursing, such as critical care, pediatrics, or oncology. Obtaining and maintaining these certifications requires passing a specialized exam and meeting specific practice hour requirements.