A registered nurse (RN) assesses patients, gives medication and treatment, and coordinates care with doctors and other staff. The job suits people who can accept shift work, weekends and strict rules. For the UK route through the NMC register, see how to become a registered nurse in the UK.

This guide covers the US path: the education, the exam, the state licence, and what employers ask for in open jobs.

What employers ask for

Almost every RN posting asks for an active RN licence. BLS (Basic Life Support) or CPR is the most common extra requirement. Software is rarely named; the main digital skill is charting in an EHR (electronic health records) system. Most postings give an hourly rate, and remote RN jobs are rare, because nursing work is done with patients.

Many titles name the schedule, for example "PRN", "Weekend" or "Full-Time". PRN means "as needed": you pick up shifts, often with a higher hourly rate and fewer benefits.

For a national pay reference, the BLS median for RNs was $46.90 per hour, or $97,550 per year, in May 2025 (checked October 2026).

Step-by-step: how to get in

All paths share the same structure. The BLS says you need to finish an approved nursing program, pass a national exam, and get a licence from your state.

1. Choose an education path. There are three: - Bachelor of Science in Nursing (BSN). A four-year degree. Some hospitals require it, and it opens more doors later (management, public health, advanced practice). - Associate degree in nursing (ADN or ASN). Offered mostly by community colleges. The BLS says ADN and ASN degrees also typically take 4 years, the same as a BSN. There is no national tuition figure for nursing programs. As a general reference, average yearly tuition and fees at public 2-year colleges were $4,000 in 2022–23 (all programs, not only nursing). - Diploma from a hospital program. These take 2 to 3 years. Few programs of this type remain.

Pick a program approved by the board of nursing in your state. Without that approval, you cannot sit the exam.

1. Finish the clinical hours. Every program includes supervised practice with real patients. This is where you learn to give medication, chart, and work a full shift. Treat each placement as a job interview, because many employers hire their students.

1. Get BLS (and CPR) certified. BLS or CPR is one of the most common requirements in RN postings. Most schools require it before clinicals, so you will likely have it before you graduate. The card has an expiry date, so check it and renew it before it runs out.

1. Register for the NCLEX-RN. The NCLEX is the national licensing exam. The registration fee is $200 (checked October 2026). From 1 February 2027, it rises to $350. NCSBN confirms that a registration completed before that date pays the current fee, whatever the exam date. If you test outside the US, an extra $150 scheduling fee applies (checked October 2026). You also apply to your state board for the licence, and the board charges its own fee.

1. Prepare for the Next Generation NCLEX. The current exam format started on 1 April 2023. It uses case studies to test clinical judgment, so practice questions that only test facts are not enough. Practise with full patient scenarios.

1. Get your state licence. After you pass, your state board of nursing issues the RN licence. Fees and times differ by state. For example, in California the examination application costs $300 for a California graduate and $350 for a graduate from another state (checked October 2026), and the board listed a processing time of 10 to 12 weeks for US-educated applicants in October 2026. Check whether your state belongs to the Nurse Licensure Compact (see below).

1. Apply for your first job. Use the words employers use: "new graduate", "PRN", "home health", "start of care". Home health and hospice agencies often hire RNs. These roles can be a fast first job, but you work alone in patients' homes, so ask about orientation and mentoring.

Entry level

What the job is. You care for a set number of patients with support from senior nurses. You give medication, record vital signs, update the EHR, teach patients and families, and report changes to the doctor.

What employers ask for. An active RN licence, BLS, and basic patient care skills.

What to learn next. Fast and accurate charting. Wound care. Safe medication administration. Time management across a full patient load.

Mid level

What changes. You take harder patients, train new staff, and may act as charge nurse on a shift. Many nurses move into a specialty at this stage.

What employers ask for. Experience in a specialty (for example infusion, home health or critical care), and often ACLS (Advanced Cardiac Life Support).

What to learn next. A specialty. The BLS lists specialty areas such as critical care, neonatal, nephrology, rehabilitation and public health. Specialty certification is usually voluntary, but some employers require it. Check each certifying body's own site for its rules and fees.

Senior level

What changes. You move into a named role, such as case manager, nurse manager, supervisor, director or charge nurse.

What employers ask for. The most common skills are still clinical: patient care, medication administration and BLS. Some postings also ask for compliance work.

What to learn next. Compliance and HIPAA (patient privacy law). If you started with an ADN, a bachelor's degree is often the next step for management roles.

US rules: licence, compact and foreign nurses

• The licence is issued by the state. There is no single federal nursing licence. You apply to the board of nursing in the state where you want to work. Fees and processing times differ by state; check the board's site.
• The Nurse Licensure Compact. The compact has 43 jurisdictions. If your primary home is in a compact state, you can hold one multistate licence and work in other compact states. If you move your home to another compact state, you must apply for a licence there within 60 days. If your state is not in the compact, you need a separate licence for each state.
• Nurses educated abroad take the same NCLEX. Testing outside the US adds a $150 scheduling fee (checked October 2026). The state board decides whether your education meets its rules, and you also need a US work permit or visa. Ask the board of your target state about its exact steps before you register.

Common mistakes

• Enrolling in a program that your state board has not approved. You cannot take the NCLEX without an approved program. Check the board's list first.
• Waiting until after 1 February 2027 to register for the NCLEX. The fee goes from $200 to $350. If you are close to graduating, check when your school and state allow you to register.
• Studying only fact questions. The Next Generation NCLEX tests clinical judgment through case studies.
• Letting BLS or CPR expire. It is one of the most common requirements in postings. An expired card can stop a hire.
• Ignoring the compact when you move. If you change your home state within the compact, the 60-day rule applies.
• Taking the first home health job without asking about orientation. Home health agencies hire many new RNs. It can be a good start, but you work alone. Ask how many supervised visits you get.
• Expecting remote work early. Remote RN postings are rare, and they usually need experience.

FAQ

Do I need a bachelor's degree to become an RN in the US? No. A BSN, an ADN or ASN, or a hospital diploma can all lead to the licence. You must finish an approved program and pass the NCLEX. Some hospitals require a BSN.

How much does the NCLEX cost? The registration fee is $200 (checked October 2026). It rises to $350 for registrations made from 1 February 2027. Your state board charges its own licence fee.

How much do registered nurses earn in the US? The BLS median was $97,550 a year, or $46.90 an hour, in May 2025 (checked October 2026). Most RN postings give an hourly rate.

Can I work as an RN in more than one state? Yes, if you live in a Nurse Licensure Compact state and hold a multistate licence. The compact has 43 jurisdictions. Otherwise you need a licence from each state.

Can a registered nurse work remotely? Rarely. Remote RN postings are rare, because most RN work is with patients.

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