GUIDE
April 19, 2022
Smiling nurse working with older patient

Medically Reviewed by Kathleen Gaines MSN, RN, BA, CBC

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 more about how to become a registered nurse, and what the career is all about to decide if it’s the right career for you.

Part One What is a Registered Nurse?

Being a registered nurse means that you’ve earned a license to practice nursing in your state, but there’s so much more to this exciting career. A registered nurse administers hands-on patient care in a variety of settings including hospitals, medical offices, nursing homes, and other facilities.

They work with physicians and other members of the health care 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?

Registered Nurse Job Duties

As a registered nurse some of your duties and responsibilities may be, 

  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

>>Related: Top 10 Online RN to BSN Programs

Part Two Registered Nurse Salary

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 $75,330 per year as of May 2020, according to the Bureau of Labor Statistics (BLS.) The lowest 10 percent earned less than $53,410, and the highest 10 percent earned more than $116,230, though conditions vary by area.

Highest Paying States for Registered Nurses

  1. California - $120,560
  2. Hawaii - $104,830
  3. Massachusetts - $96,250
  4. Oregon - $96,230
  5. Alaska - $95,270

 BLS

Highest Paying Cities for Registered Nurses

  1. San Francisco-Oakland-Hayward, CA - $149,200
  2. San Jose-Sunnyvale-Santa Clara, CA - $146,870
  3. Vallejo-Fairfield, CA - $142,140
  4. Sacramento--Roseville--Arden-Arcade, CA - $134,350
  5. Salinas, CA - $132,160

 BLS

Highest Paying Nonmetropolitan Areas for Registered Nurses

  1. North Valley-Northern Mountains Region of California nonmetropolitan area - $103,890
  2. Alaska nonmetropolitan area - $102,390
  3. Eastern Sierra-Mother Lode Region of California nonmetropolitan area - $101,000
  4. Hawaii / Kauai nonmetropolitan area - $97,950
  5. North Coast Region of California nonmetropolitan area - $92,760

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 at an elite big city research hospital in a special unit 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.

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Part Three How to Become a Registered Nurse

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 bachelor of science in nursing program, since some employers prefer candidates with the 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 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, a nurse only must take the NCLEX once in a lifetime — once you pass the NCLEX, your test result can be used 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.

Part Four Top 10 Registered Nurse Programs

There are numerous registered nursing programs and our panel of nurses ranked them based on factors mentioned in the methodology. Because individual nursing pathways and careers take various forms, the top 10 registered nurse programs are ranked in no particular order. 

Methodology

This list is based on a number of factors including:

  • Reputation
  • NCLEX pass rate
  • Tuition
  • Acceptance rate, when available
  • Only ACEN or CCNE accredited schools are eligible

Nurse Panel

Our selection panel is made up of 3 Registered Nurses with years of experience and multiple degrees:

  • Tracy Everhart, MSN, RN, CNS
  • Tyler Faust, MSN, RN
  • Kathleen Gaines, MSN, RN, BA, CBC

1. Villanova University

Annual Tuition: $57,460

Online: Yes

Program Length: 4 years

A private, Catholic school located in Villanova, Pennsylvania, Villanova University is often considered one of the best private schools in the nation. Similarly, the BSN ranks among the best, providing learners with plenty of high-quality clinical experience. Undergraduate nursing students also actively participate in research, which is great exposure for those planning on continuing their education, and students can choose to minor in global public health. Villanova even organizes summer study abroad programs specifically for nurses. Overall, Villanova provides perhaps the most well-rounded BSN of any school. 

2. Emory University

Annual Tuition: $53,868

Online: Yes

Program Length: 4 years

Emory University, a leader in nursing and healthcare education, provides BSN students with three paths to a degree: a high-school BSN entry, an Emory second-year entry, and a transfer BSN. The first two options see students complete all their courses at Emory's campus in Atlanta, Georgia, completed over four years. The university also uses a cohort system, so you'll be grouped with the same nursing students throughout the program. Outcomes for the program are excellent, and 61% of BSN students secure a job before graduating. 

3. University of Maryland

Annual In-State Tuition: $10,779 Annual Out-of-State Tuition: $36,891

Online: No

Program Length: 4 years

Located in Baltimore, the University of Maryland is among the best public schools for higher education in the region. Before beginning the BSN program, students must first complete two years of prerequisite courses, all of which are available at the University of MD. The nursing program takes two years to complete, making the degree a four-year process. Graduates enjoy a 90.33% NCLEX pass rate, higher than the state's average. Anyone living in Maryland can also take advantage of the low in-state tuition rates. 

4. University of Michigan

Annual In-State Tuition: $15,948 Annual Out-of-State Tuition: $52,266

Online: No

Program Length: 4 years

Aside from experiencing four years in the college town of Ann Arbor, Michigan, University of Michigan students can also earn one of the best BSN degrees. The nursing program has evolved over the past 127 years, and graduates can take advantage of networking with over 13,000 nursing school graduates. While studying, nurses can select a minor in health in a global context, and UM sets up global nursing experiences for students. 

5. Georgetown University

Annual Tuition: $57,928

Online: No

Program Length: 4 years

Located in the nation's capital, Georgetown University embraces the Jesuit tradition of educating the whole person. This holistic approach applies to the direct-entry BSN where students begin their clinical experience during the freshman year. By the end of the four-year degree, students will have earned over 850 hours of clinical experience in facilities across Washington, D.C., Maryland, and Virginia. Those who want to get global experience can choose to study abroad in Dublin, Ireland, or Sydney, Australia. Recent graduates enjoyed a 100% NCLEX pass rate, and Georgetown graduates regularly post a 95% pass rate or higher. 

6. Duke University

Annual Tuition: $57,633

Online: No

Program Length: 16 months

Regarded as one of the top universities in the nation for healthcare, Duke University doesn't offer a traditional BSN. However, the famous research institution does have an accelerated BSN for aspiring nurses who already have a bachelor's degree. This 16-month program sees students complete 58 credits and almost 800 hours of clinical experience at sites within the extensive Duke University Health System, as well as other locations in the Raleigh-Durham area in North Carolina. The program even lets graduates transfer nine credits into the renowned MSN degree. 

7. University of Washington

Annual In-State Tuition: $11,745 Annual Out-of-State Tuition: $39,114

Online: No

Program Length: 4 years

The Seattle-based University of Washington regularly sees students succeed with over 98% of all BSN students graduating each year. The traditional BSN takes two years to complete, though students must first complete two years of prerequisite courses. While studying, nursing students gain extensive clinical experience, earning over 1,000 hours of experience at over 700 sites, including the renowned Seattle Children's Hospital. Washington residents also get access to incredibly low in-state tuition rates. 

8. University of California Los Angeles

Annual In-State Tuition: $13,249 Annual Out-of-State Tuition: $43,003

Online: No

Program Length: 4 years

Ranked among the best public schools in the West, the University of California Los Angeles hosts some of the top programs in the nation, including its BSN. While UCLA's BSN program prepares nurses to continue their education and earn a masters' degree, graduates are more than ready to begin a career. In 2019, 97.73% of all NCLEX test-takers passed on their first try, better than most schools in California. Also, nursing students get to live in Southern California and enjoy near-perfect weather daily. 

9. University of Wisconsin

Annual In-State Tuition: $10,742 Annual Out-of-State Tuition: $38,630

Online: No

Program Length: 4 years

With options available for undergraduate, transfer, and second-degree seeking students, the University of Wisconsin at Madison has a BSN option for everyone. The BSN program begins with two years of prerequisite courses, followed by two years of intensive nursing courses. Aside from optional rural immersions, international experiences, and certificates, nursing students complete 124 credits and 720 clinical hours over a four-year period. Recent graduates enjoyed a 93% NCLEX pass rate, a high clip considering over 300 students are in the program. However, admissions are competitive with just 45% of applicants getting accepted. 

10. University of North Carolina Chapel Hill

Annual In-State Tuition: $8,980 Annual Out-of-State Tuition: $36,159

Online: No

Program Length: 4 years

Located in Chapel Hill, the University of North Carolina is considered a "Public Ivy" due to its incredible academics and world-renowned programs. Part of its success comes from its intensive programs -- BSN students begin clinical experience during their first semester at UNC. Graduates of the program end up in various roles, running from non-profit work to military nursing. In 2020, 99.37% of nursing students passed the NCLEX, an auspicious sign for anyone who gets into this highly competitive program. 

Part Five What Is It Like to Be an RN? 

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)

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Part Six Best and Worst Parts About Being a Registered 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. 

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

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

Part Seven What Are Registered Nursing Jobs Like?

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.

  • 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.

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).

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Part Eight Career Outlook for a Registered Nurse

One of the main reasons for becoming a registered nurse 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 2019. That number could grow to 3.44 million by 2028, according to projections (BLS). That’s an increase of 12 percent, faster than average for most occupations.

There were over 3 million registered nurses employed in the U.S. in 2020. That number could grow to 3.35 million by 2030, according to projections (BLS). That’s an increase of 9 percent, faster than average for most occupations. The BLS is projecting about 194,500 job openings for RNs each year, on average, between 2020 and 2030. 

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. 

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Part Nine Where Can I Learn More About Registered Nurse Careers?

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:

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

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

Becoming a registered nurse 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.

Part Ten Registered Nurse FAQs

  • 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 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.

Find Nursing Programs

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

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