US Registered Nurse (BSN / RN & NCLEX-RN)
Master clinical nursing practice, pass the Next-Gen NCLEX-RN, and practice across compact states
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Where it leads
- Staff Registered Nurse (Med-Surg, Telemetry)
- ICU / Critical Care Nurse
- Emergency Department (ER) Nurse
- Travel Nurse (High-Compensation Contracts)
- Operating Room (OR) / Perioperative Nurse
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Bedside nursing involves intense physical stamina (12-hour shifts on your feet), bodily fluid exposure, combative patient encounters, and high nurse-to-patient staffing ratios in demanding hospital units.
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8 steps to your licence
Your route to practise: 8 steps in 4 stages. Tap a step to read it; log the date when you finish it.
Complete foundational science courses, pass entrance exams, and enroll in an accredited nursing program.
Master pharmacology, pathophysiology, and complete 700+ hands-on hospital clinical hours.
Master clinical judgment case studies, pass the adaptive Next-Gen NCLEX-RN, and obtain your RN license.
Transition smoothly into hospital practice, earn specialty certifications, and advance your nursing compensation.
More about this career
About the job, pay where you live, questions people ask, and where this career can take you next.
About the job
What you’d do
- Assess patients’ conditions and record their medical histories and symptoms
- Observe patients and record the observations
- Give patients medicines and treatments
- Set up or contribute to patients’ care plans with doctors and other professionals
- Operate and monitor medical equipment and help perform diagnostic tests
- Teach patients and families how to manage illness or injury at home
Where you’d work
- Hospitals (about 59% of US registered nurses)
- Ambulatory healthcare services (about 19%)
- Nursing and residential care facilities (about 6%)
- Government (about 5%)
- Educational services (about 3%)
Licence to practise
Registration is with State boards of nursing, with the NCLEX from the National Council of State Boards of Nursing (NCSBN)
- Check that you meet the requirements of the board of nursing where you plan to practise
- Apply to that nursing regulatory body for licensure
- Register for the NCLEX with Pearson VUE and schedule your exam
- Pass the NCLEX, a computerised adaptive licensure exam
Directions you can take
- Critical care
- Neonatal
- Cardiovascular
- Public health
- Addiction
- Rehabilitation
- Nephrology
- Genetics
Every step in full
The complete text of every step, to read or print. Work through them in the journey above.
Nursing Prerequisites & Nursing School Admission (TEAS/HESI) 2 steps
Complete Core Science Prerequisites
Complete Anatomy & Physiology I & II, Microbiology, Chemistry, Statistics, and Developmental Psychology with strong grades (each program sets its own GPA requirement).
Real-world task: Identify histological tissue samples under microscopy and trace the flow of blood through the cardiopulmonary vascular system.
Why it matters: Anatomy and physiology form the clinical foundation for understanding disease pathology and pharmacological mechanisms.
Checklist
- Complete Anatomy & Physiology I & II with wet lab dissection experience
- Complete General Microbiology with culturing and staining laboratory techniques
- Maintain prerequisite GPA >3.5 to secure admission in competitive state nursing programs
- Obtain CPR/BLS certification from the American Heart Association (AHA)
Conquer the TEAS / HESI Exam & Gain Admission to an ACEN/CCNE Program
Score competitively on the Test of Essential Academic Skills (TEAS) and enter a direct-entry BSN or community college ADN program.
Real-world task: Complete a timed 209-minute full-length TEAS practice test focusing on human anatomy questions and metric unit conversions.
Why it matters: Enrolling in an accredited program (CCNE or ACEN) is mandatory for NCLEX eligibility and Magnet hospital employment.
Checklist
- Study TEAS study guides covering Reading, Math, Science, and English Language
- Target a Composite TEAS score of 82%+ (Advanced/Exemplary tier)
- Submit applications to CCNE or ACEN accredited BSN / ADN programs
- Complete clinical compliance requirements (FBI background check, 10-panel drug screen, titers, immunization history)
Nursing Curriculum & Clinical Hospital Rotations 2 steps
Master Clinical Skills, Dosage Calculations & Pharmacology
Learn safe medication administration, intravenous (IV) insertion, sterile urinary catheterization, and 100% accuracy in dosage math.
Real-world task: Calculate an IV infusion rate (gtts/min and mL/hr) for a weight-based heparin drip protocol and verify with a peer double-check.
Why it matters: Medication errors are among the leading causes of preventable patient harm; hospitals require zero-tolerance mastery of dosage calculations.
Checklist
- Achieve 100% on dimensional analysis and pediatric/adult medication calculation exams
- Master major drug classes, therapeutic ranges, side effects, and antidote protocols (e.g. Naloxone, Protamine Sulfate, Vitamin K)
- Demonstrate competency in sterile dressing changes, tracheostomy suctioning, and NG tube placement in the simulation lab
- Document assessments using electronic charting simulation (EHR)
Complete Hospital Clinical Rotations Across Diverse Units
Rotate through Medical-Surgical, Pediatrics, Obstetrics/Maternity (Labor & Delivery), Psychiatry, and ICU/Telemetry units.
Real-world task: Deliver a structured SBAR (Situation, Background, Assessment, Recommendation) patient handoff report to an oncoming night shift nurse.
Why it matters: Senior preceptorship hours directly lead to new-graduate residency job offers in your specialty unit of choice.
Checklist
- Complete 600–800 hours of direct bedside clinical care under clinical nurse instructors
- Perform head-to-toe clinical assessments, medication passes, and morning handoff reports (SBAR format)
- Complete a senior capstone preceptorship working 1-on-1 with a staff RN in an emergency or critical care unit
- Graduate with an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN)
Conquer the Next-Generation NCLEX-RN & State Board Licensure 2 steps
Master Next-Generation NCLEX (NGN) Clinical Judgment Models
Prepare for the NCSBN Clinical Judgment Measurement Model (NCJMM) featuring unfolding case studies, matrix questions, and trend items.
Real-world task: Analyze an unfolding 6-question clinical case study tracking a worsening septic patient's vitals, lab values, and priority physician orders.
Why it matters: The Next-Gen NCLEX tests decision-making under clinical uncertainty rather than rote factual memorization.
Checklist
- Complete 2,000+ NGN-style questions on UWorld Nursing or Archer Review
- Master prioritization and delegation frameworks (ABC: Airway, Breathing, Circulation; Maslow's hierarchy; acute vs chronic)
- Achieve >70% High/Very High passing probability on consecutive self-assessment readiness tests
- Receive Authorization to Test (ATT) from your state board of nursing and Pearson VUE
Pass the NCLEX-RN & Secure Multi-State Compact License (eNLC)
Sit for the computerized adaptive test (CAT) at a Pearson VUE center and receive state board licensure.
Real-world task: Verify your active nursing license status and compact privilege endorsements on the national Nursys database.
Why it matters: Holding an enhanced Nursing Licensure Compact (eNLC) multi-state license enables immediate practice in 40+ states and lucrative travel nursing.
Checklist
- Complete the 85 to 150-question adaptive exam in under 5 hours
- Pass the exam above the passing standard logit score
- Register for your primary state of residence multi-state compact license (allowing practice in 40+ compact states)
- Receive your official Registered Nurse (RN) license verification through Nursys
New Graduate Nurse Residency, Specialty Certifications & Career Progression 2 steps
Complete a 1-Year Hospital Nurse Residency Program (NRP)
Enroll in an evidence-based Vizient/AACN Nurse Residency Program with dedicated preceptors to bridge from student to competent clinician.
Real-world task: Design a hospital unit protocol reducing catheter-associated urinary tract infections (CAUTI) using evidence-based bundle guidelines.
Why it matters: Hospitals with structured nurse residency programs reduce first-year new graduate turnover from 30% down to under 12%.
Checklist
- Complete 12–16 weeks of 1-on-1 precepted orientation before taking independent patient assignments
- Participate in monthly evidence-based practice (EBP) workshops and debriefing sessions
- Obtain advanced certifications: ACLS (Advanced Cardiac Life Support), PALS (Pediatric), or TNCC (Trauma Nurse Core Course)
- Complete an Evidence-Based Practice unit improvement capstone project
Specialty Board Certification & Advanced Career Pathways
Earn credentials like CCRN (Critical Care), CEN (Emergency), or enter high-paying travel nursing or graduate NP/CRNA school.
Real-world task: Evaluate a 13-week travel nurse assignment contract in California or New York, calculating tax-free housing stipends and hourly blended rates.
Why it matters: Specialty board certification (CCRN/CEN) validates expert clinical judgment and qualifies nurses for maximum clinical ladder pay differentials.
Checklist
- Accumulate 1,750 clinical specialty hours and pass the CCRN or CEN national board certification
- Transition into lucrative Travel Nursing ($2,000–$3,500/week) or local float pool contracts
- Earn a BSN/MSN if initially starting with an ADN to meet hospital Magnet facility standards
- Prepare applications for Doctor of Nursing Practice (DNP) or Nurse Anesthesia (CRNA) programs
Questions people ask about US Registered Nurse (BSN / RN & NCLEX-RN)
Clear answers regarding timelines, prerequisites, salaries, and study strategies.
What is the Next-Generation NCLEX (NGN) exam format and passing score?
The NCLEX-RN is computerized adaptive testing: it gives between 85 and 150 items and has a five-hour time limit, including breaks (NCSBN, NCLEX Candidate Bulletin, April 2026). The Next Generation NCLEX includes case studies and item types such as matrix, drag-and-drop and drop-down questions that test clinical judgment. The test ends when it is confident whether you have passed or failed, so the number of items varies.
What is the difference between an ADN and a BSN in the United States?
An ADN (Associate Degree in Nursing) takes 2 years at a community college, while a BSN (Bachelor of Science in Nursing) takes 4 years at a university. Both graduates take the identical NCLEX-RN exam and receive the same RN license. However, BSN graduates earn higher starting salaries, are preferred by Magnet hospitals, and qualify for leadership roles and nurse practitioner (NP/CRNA) graduate programs.
How much do Registered Nurses make in the US?
The US Bureau of Labor Statistics reports a median annual wage of $97,550 for registered nurses (May 2025), and projects employment to grow 6% from 2025 to 2035. Pay varies by state, setting and specialty: the BLS publishes wage data by state and metro area.
Can foreign-educated nurses get licensed and immigrate to the US?
Yes. Internationally educated nurses usually have their credentials evaluated (for example by CGFNS, now TruMerit), pass the NCLEX-RN, get a VisaScreen certificate and secure employer sponsorship, often through the EB-3 immigrant visa. VisaScreen’s English scores follow the US Health Resources and Services Administration: for registered nurses, for example, Academic IELTS 6.5 overall with 7 in speaking. Check the current scores with TruMerit before you book a test; nurses educated in English in certain countries are exempt.
What is the Enhanced Nurse Licensure Compact (eNLC)?
The Nurse Licensure Compact (NLC) lets a registered nurse with a multistate licence from their home state practise, in person or by telehealth, in the other compact states without a separate licence. 43 jurisdictions are part of the NLC (NCSBN, nursecompact.com); check the current map, because states keep joining.