How to Become a Registered Nurse (RN)

For anyone who wants a career in healthcare with a lucrative salary, job security, and a variety of career advancement paths, becoming a registered nurse (RN) is a great choice.

Find out whether registered nursing is right for you in this complete career guide. Read on to learn how to become a registered nurse, top programs, salary expectations, and more to see whether this healthcare profession suits you!

An RN is a healthcare professional who has completed a two or four-year accredited nursing program and passed the NCLEX-RN licensing exam. By definition, being a registered nurse simply means you've earned the license to practice in your state - but there's so much more to this exciting career!

A registered nurse administers hands-on patient care in various settings, including hospitals, medical offices, nursing homes, and other facilities. They work with physicians and other members of the healthcare team to provide the best course of treatment possible. They also help to educate patients and their families about health issues.

>> Related: What Does RN Mean?

What Does a Registered Nurse Do

Some of the most common registered nurse job duties include the following: 

1. Administer and monitor medications
2. Admit and discharge patients
3. Assist patients with ADLs, including feeding, dressing, and bathing
4. Coordinate with other healthcare providers
5. Develop and implement nursing care plans
6. Educate patient and family on disease process and diagnosis
7. Insert and manage IV catheters
8. Perform basic and advanced life support
9. Perform end-of-life care
10. Perform physical examinations
11. Perform vital signs and recognize abnormalities
12. Prepare patients for bedside procedures and surgeries
13. Provide emotional support to patients and families
14. Review and maintain medical records
15. Supervise and orient new nurses and nursing students

Most registered nurses make a healthy living from the day they begin working in the field because starting salaries are usually competitive. The median annual salary for registered nurses was $81,220 per year as of May 2022, according to the Bureau of Labor Statistics (BLS.) 

Highest Paying States for Registered Nurses

1. California - $133,340 annually | $64.10 per hour
2. Hawaii - $113,220 annually | $54.43 per hour
3. Oregon - $106,610 annually | $51.26 per hour
4. Massachusetts - $104,150 annually | $50.07 per hour
5. Alaska - $103,310 annually | $49.67 per hour

Source: BLS

Highest Paying Cities for Registered Nurses

1. San Francisco-Oakland-Hayward, CA - $164,760 annually | $79.21 per hour
2. San Jose-Sunnyvale-Santa Clara, CA - $160,020 annually | $76.94 per hour
3. Vallejo-Fairfield, CA - $158,340 annually | $76.12    per hour
4. Santa Rosa, CA - $151,150 annually | $72.67 per hour
5. Santa Cruz-Watsonville, CA - $149,750 annually | $72.00 per hour

Source: BLS

Highest Paying Nonmetropolitan Areas for Registered Nurses

1. Eastern Sierra-Mother Lode Region of California - $127,820 annually | $61.45 per hour
2. North Valley-Northern Mountains Region of California - $123,450 annually | $59.35 per hour
3. North Coast Region of California - $120,740 annually | $58.05 per hour
4. Hawaii / Kauai - $105,190 annually | $50.57 per hour
5. Alaska - $104,350 annually | $50.17 per hour

Source: BLS

Registered Nurse Salary Factors

A registered nurse’s salary depends on a number of factors, including their level of expertise and areas of specialization and education. For example, a nurse with a Bachelor of Science in Nursing (BSN) will make more than one with an Associate Degree in Nursing (ADN).

Other factors that affect salary include experience as a nurse, location, and the type of facility they work in. Therefore, a registered nurse working in a special unit at an elite big-city research hospital will likely earn more than an RN working in a nursing home in a small town. However, the cost of living in a large city is likely higher than in a small town.

>> Show Me Online Nursing Programs

Becoming a registered nurse requires dedication and time. There are six primary steps you need to take before you can begin working as a registered nurse.

Step One: Choose a Nursing Program

Decide which type of nursing degree you will pursue. There are two levels of basic nursing education:

1. Associate Degree in Nursing (2-year program)
2. Bachelor of Science in Nursing (4-year program)

If you choose an associate degree in nursing, you can be finished in two years or less. However, many people decide to complete a four-year BSN program since some employers prefer candidates with a higher degree. For people who already have a bachelor’s degree in another field, there are accelerated BSN programs of study to earn a bachelor’s of science in nursing as well.

Step Two: Verify that Your Program is Accredited

Surprisingly, not every RN nursing program in the United States is accredited. Most states will only allow nurses to become licensed if they have attended an accredited school. Although there are different educational paths to becoming an RN, it’s important to choose a program of study that is accredited. 

Step Three: Complete Clinical Training Requirements

During your schooling, you will complete a combination of classroom coursework and supervised clinic hours in a hospital or other healthcare facility. Your school will make sure you complete the minimum number of hours required. 

Step Four: Apply for Your State License

The first license you ever apply for is generally called licensure by “examination”. You will apply to a state board of nursing to take the National Certification Licensing Examination (NCLEX) to become licensed in that state. Check with your state’s board of nursing to find out your specific requirements, as not every state has exactly the same requirements.

Almost every state now requires you to complete a Federal criminal background check (with fingerprinting) as well as meet the requirements of graduating from an accredited school of nursing. Once you meet your state’s requirements, you will be allowed to take the NCLEX. You cannot sit for the exam until your state board of nursing declares that you are eligible.

Step Five: Take the NCLEX-RN

Once you are deemed eligible by the state board of nursing you are seeking a license from, you must sit for and pass the NCLEX in order to earn your RN license. Once you pass the NCLEX and meet all additional requirements, you will receive licensure in your state. Some nursing students take an NCLEX review course or use other study techniques prior to taking the test.

In most instances, once you pass the NCLEX, you can use your test result as proof of initial licensure for the rest of your time as an RN. All future attempts to receive licensure in a state other than the original state where you received licensure are called licensure by “endorsement”. This means you can use your NCLEX results from your initial licensure to get endorsed for RN practice in other states.

To help you choose the best route for becoming a nurse, we compiled a list of the top nursing programs based on numerous factors, including graduation rate, cost, credit hours, and more. Check out our article on the best nursing schools for the full list of programs, as well as details like admission dates, tuition, and program length.  

1. Duke University
2. Georgetown University
3. Johns Hopkins University
4. New York University
5. University of Pennsylvania

Becoming an RN means a lot of things to nurses. Five nurses shared their thoughts on nursing to Nurse.org.

“Becoming a nurse is one of the most challenging but rewarding professions. Every shift, I go to work ready for the tough calls and the hard conversations. I never know if the shift is going to be full of helping patients with their ADLs or coding a patient. That’s one of the things I love the most about nursing - the unknown.” -- Renee (Adult Med-Surg Nurse)

“I’ve wanted to be a nurse for as long as I can remember, and it was always enough. Until recently. I used to feel like I was making a real difference and saving lives. Lately, it feels like all I do is get parents ice and water or perform other “customer service” duties.” -- Megan (Pediatric Nurse)

“I wasn’t sure if I would like nursing when I started my clinical rotations; however, the passion I have now for nursing is undeniable. I know I am helping people and their families during some of their darkest hours and most difficult times.” -- Gina (Pediatric ICU Nurse)

“Helping others was always my calling. Nursing came easy to me. I enjoy coming to work every day. I get to work side by side with some of my closest friends and have always built great relationships with the patients and the rest of the medical team. I couldn’t imagine doing anything else.” -- Marie (Telemetry Nurse)

“Nursing is hard. We are consistently short-staffed, and the patient assignments have become increasingly heavier. It’s exhausting. I love my job, my coworkers (the ones that are left), and my patients, BUT something has to change. Everyone I know is leaving the profession, but I want to stay. I want to try, though.” -- Nicole (Neonatal ICU Nurse)

As with any profession, nursing has some really great things about it but also some low points. Unfortunately, the past several years during the pandemic have made the worst parts a little bit worse. 

Registered Nursing Pros

1. Helping others during the worst time in their lives
2. Increased earning potential and opportunities 
3. Flexible schedule
4. Variety of opportunities
5. Very high demand
6. Highly rewarding
7. Job security
8. Relationships with other healthcare professionals

Registered Nursing Cons

1. Demanding physical requirements
2. Long hours
3. Emotional burnout
4. Exposure to contagious diseases
5. Pressure to succeed
6. Work weekends and holidays
7. Contact with hazardous chemicals

It Depends On Where You Work

Every registered nursing job will be unique depending on where you’re working and what type of unit or setting you’re in. What RNs do will change drastically depending on the setting or industry.

• An ER nurse might have a more fast-paced day assisting with many emergency cases, while a hospice nurse will focus more on quality-of-life care for just a few patients in their final months.
• Registered nurses in hospitals sometimes work longer, non-traditional work shifts (evenings, nights, weekends), while school nurses or those in a physician’s office may have steadier hours.

Where can RNs Work?

Registered nurses can work in many industries. However, the BLS reports they primarily work in hospitals (59%), followed by ambulatory care services (18%) and nursing facilities (6%). Some also work in government, educational services, or more niche settings.

Nurse-to-Patient Ratios Matter

Registered nursing is physically and emotionally demanding work. There is no national standard when it comes to nurse-to-patient ratio, which is determined largely by the type of nursing.

• For instance, medical-surgical units typically staff one RN for every 4-6 patients during the day shift and one for every 6-10 patients during the night shift, according to the Academy of Medical-Surgical Nurses  ⁶ . 

What You Do Depends on Your Specialty

Many registered nurses choose to specialize in one or more areas of patient care, and specialization usually means an increase in compensation.

Some paths to career advancement require RNs to earn certifications or complete some type of continuing education; other promotions come with experience.

Common registered nurse specialties can be related to work setting or type of treatment (e.g. critical care nurse); disease, ailment, or condition (e.g. oncology nurse); organ or body system type (e.g. cardiac or orthopedic nurse); or population (e.g. pediatric or geriatric nurse).

>> Show Me Online Nursing Programs

One of the main reasons a registered nurse career appeals to many people — aside from the opportunity to care for others — is that it has excellent job security.

There were over 3 million registered nurses employed in the U.S. in 2022. That number may grow to 3.35 million by 2032, according to projections (BLS). That’s an increase of 6 percent, which is about as fast as all other occupations. The BLS also projects about 193,100 job openings for RNs each year, on average, between 2022 and 2032. 

A large portion of these nurses will be needed to replace the baby boomer generation that is reaching retirement age. The Health Resources and Services Administration predicts that more than one million RNs will retire from the workforce by 2030.

Another factor greatly impacting the need for nurses is the increase in the aging population. The U.S. Census Bureau predicts that by 2030, the number of Americans age 65 and over will be about 82 million. This group of individuals will need advanced medical care, especially for chronic conditions such as arthritis and Alzheimer’s disease. 

>> Show Me Online Nursing Programs

For anyone interested in becoming a registered nurse, it’s good to know that there are many professional associations and resources available. You can use these resources to learn more about the profession and find career support. In fact, no matter your nursing specialty, there is likely an association you can join.

Here are just a few professional associations to consider:

• American Nurses Association
• American Society of Registered Nurses
• Alpha Tau Delta, National Fraternity for Professional Nurses
• National League for Nursing
• Visiting Nurse Association of America
• Explore our comprehensive list of nursing associations

If you’d like to do some more research into registered nursing, here are a few journals to put on your reading list:

• RNjournal.com
• The American Journal of Nursing
• The Online Journal of Issues in Nursing
• The Journal of Nursing

Are you ready to get started on your nursing journey or take your RN career to the next level? Read up on the top registered nursing school programs:

• Top 10 Online RN to BSN Programs
• Top Cheap and Fast Online RN to BSN Programs
• Top Accelerated BSN (ABSN) Programs
• Top Online Nursing Programs for Non-Nurses

Starting your registered nurse career requires a lot of hard work and dedication, but as most working RNs will tell you, the career rewards and personal fulfillment are worth the effort.

• What does a registered nurse do?

  • A registered nurse administers medications, admits and discharges patients, performs physical examinations and vital signs, and educates patients and their families on the disease process and diagnosis. 

• What does it mean to be a registered nurse?

  • Being a registered nurse means that you’ve earned a license to practice nursing in your state. A registered nurse administers hands-on patient care in a variety of settings, including hospitals, medical offices, nursing homes, and other facilities.

• How many years does it take to become a registered nurse?

  • It can take anywhere from 2 to 4 years to become a nurse depending on the degree. An Associate degree can take as little as two years to complete, while a BSN typically takes four years to complete. 

• What is the highest rank nurse?

  • The highest degree a nurse can earn is either a Doctorate of Nursing Practice (DNP) or a Ph.D. 

• Is it hard to become a nurse?

  • Truthfully, yes. It is hard to be a nurse because there are a lot of medications, disease processes, and health conditions. It takes time and dedication to learn the material during nursing school. 

• What is the hardest class in nursing school?

  • Nursing school, in general, is difficult. Most nurses would say the hardest classes are pharmacology and pathophysiology.

 

^References:

^{The Henry J. Kaiser Family Foundation
Bureau of Labor Statistics
National Council of State Boards of Nursing
Nurse Journal
National Council of State Boards of Nursing
Academy of Medical-Surgical Nurses}

RN $70,000 - $90,000 Associate Bachelors Bedside