How to Become a Registered Nurse
The American healthcare industry is expanding at a rapid pace, creating an immediate need for medical professionals. Registered nurses (RNs) are currently in high demand for many reasons, including the development of new technology, an aging population, and current nurses retiring.
When viewing all of these factors alongside the satisfaction that comes from helping people, the benefits of becoming a registered nurse have never been better. This guide delves into what it's like to be a registered nurse, outlines available educational paths, highlights skills needed to succeed, reviews current salaries, and provides an interview with a professional currently working in the field.
What Does a Registered Nurse Do?
According to the U.S. Bureau of Labor Statistics (BLS), more than 3 million registered nurses are employed in the United States, and approximately 60% work in hospitals. RNs may also find themselves in clinics, physicians
The increased educational and training requirements of a registered nurse compared to a licensed practical or vocational nurse is significant, but so is the bump in pay. According Payscale, a registered nurse makes about 40 percent more than a licensed practical or vocational nurse.
RN Salaries and Job Outlook
Salary Figures
Registered nurses' compensation reflects the high demand and advanced levels of training and education required. You may choose to become a nurse for reasons other than financial, but a national average median salary of $75,330 in 2020 does make registered nursing an attractive career if you're looking at the bottom line.
Geographical location and cost of living also affect nurses' income. Below is a list of five states with the highest average wage for registered nurses:
- California
- Hawaii
- Massachusetts
- Alaska
- Oregon
Registered Nurse Job Projections
The BLS expects tremendous job growth for registered nurses, with a 7% expansion expected between 2019 and 2029. Several reasons for this exist, including an aging population and wider healthcare availability through the Affordable Care Act.
Patients will increasingly need nurses to educate them on and care for their chronic health problems, such as:
- Arthritis
- Obesity
- Dementia
The BLS says that the increased demand for registered nurses will come from facilities other than hospitals, such as outpatient and long-term care centers.
As can be expected, the job growth is not necessarily even across the nation. The below table lists the top 10 states where growth is expected to be the highest from 2018 to 2028.
Steps to Becoming a Registered Nurse
Step 1 Complete an accredited registered nurse program
In order to become a registered nurse, students must graduate from an accredited program. Several options are available, including nursing diplomas, associate degrees or bachelor's degrees.An associate degree in nursing typically takes two years to complete, though accelerated programs can shorten this timeframe. A bachelor's degree in nursing takes about four years of full-time study, or two years for those in an associate-to-bachelor's RN program.
Another expedited option is to attend a school that offers a “second degree” program if you already hold a bachelor's degree in a field other than nursing. You may also decide to complete a four-year bachelor's program at the start of your education, allowing you to move into roles such as:
- Administration
- Nursing consulting
- Research
- Advanced nursing
- Teaching
Bachelor's degree programs require students to complete general education classes in addition to their nursing coursework. While many of the same topics taught at the associate level are covered in a bachelor's degree, a four-year program will provide a more in-depth set of knowledge and skills. As the field of nursing becomes more competitive, more employers are requiring newly appointed RNs to hold a bachelor's degree.
Common nursing coursework includes the following topics:
- Anatomy and Physiology
- Biochemistry
- Statistics
- Chemistry
- Health care law and ethics
- Health Care policy
- Microbiology
- Nutrition
- Patient care
- Psychology
- Nursing Research
- Introduction to Professional Nursing
Step 2: Take and pass the NCLEX-RN examinatio
Registered nursing programs should help prepare you to pass the NCLEX-RN examination. Upon graduation, you should register with the National Council of State Boards of Nursing to sign up for the exams. Candidates will receive an Authorization to Test notification when it is time to sign up for the examination.This computerized test has an average of 119 questions and must be completed within six hours. Those who do not pass must wait at least 45 days to retake the exam. The national average NCLEX-RN passage rate is around 70-75%.
Step 3: Obtain a state license
Every US state and territory, as well as the District of Columbia, requires employed registered nurses to have proper licensure. Mandates vary by state, so you should contact your state board of nursing to see if there are any additional steps, such as a background check.Step 4: Obtain employment as a registered nurse
Registered nurses are in high demand, so recent graduates from RN programs often have multiple options when it comes to deciding where they would like to work. Remember that much of what it takes to be a registered nurse or any other medical professional is learned with actual experience.Step 5: Pursue additional training or education
If a registered nurse decides to become an advanced practice registered nurse and specialize their knowledge, they will need a master's degree. After completing this education, you can apply for roles including:- Certified nurse specialist
- Nurse practitioner
- Nurse anesthetist
- Nurse midwife
If you want to go further, you might choose to enter a doctoral program. DNP or PhD programs are appealing to those aspiring to positions as scientific researchers or university professors in the nursing sciences. You may also undertake further certifications in areas such as critical care, acute care, or nursing management.
Understanding RN Programs
In order to become a registered nurse, you must obtain a degree or nursing diploma, with the most common avenues being associate or bachelor's programs.
A nursing diploma is less popular due to the fact that it still takes two years to complete but does not provide a degree upon completion. Additionally, many nursing organizations and associations are calling for the diploma to be phased out completely, encouraging aspiring nurses to opt for a bachelor's degree.
A master's degree in nursing is also available, and registered nurses who wish to specialize their knowledge or take the first step in receiving a doctorate level nursing degree usually obtain them.
Nursing Diploma
Nursing diplomas are hospital-based programs providing intensive hands-on training alongside nursing coursework. The program also requires co-requisite classes in areas such as anatomy, biology, and psychology at a traditional educational institution.
This experiential style of learning provides you with knowledge of basic nursing care. You will also receive a supplementary education in math and science topics. The chart below provides a snapshot of a typical nursing diploma curriculum.
Anatomy and Physiology
Basics of human systems will be covered, as well as identification of human body components. Areas include cell metabolism and the circulatory, nervous, and muscular systems.
Skills & Knowledge Gained
-
Basic understanding of human anatomy and how parts work together -
Familiarization with proper names and wording for bodily processes and parts -
Developed vocabulary of medical terminology
Psychology
Students will be introduced to the basic principles of the human mind and behavior. Topics include personality, motivation, learning, perception, and mental disorders
Skills & Knowledge Gained
-
Awareness of methodologies used to study and treat the human mind -
Understanding of human psychology -
Ability to effectively diagnose and treat patients
Theoretical Foundations in Nursing
Teaches fundamentals of the nursing profession by introducing students to theories forming the basis for patient assessment, laboratory testing, and medical safety.
Skills & Knowledge Gained
-
Ability to apply theoretical frameworks to clinical settings -
Development of basic medical care skills, including taking vital signs and providing assessments
Transition into Practice
Through clinical practice, students will demonstrate their nursing competencies, study nursing and medical literature, and explore future trends in the field.
Skills & Knowledge Gained
-
Refinement of nursing skills -
Awareness of nursing trends and issues and how to effectively handle them
Associate Degree in Nursing
While the curriculum of an associate degree in nursing shares similarities with vocational nursing and nursing diploma programs, the breadth and depth of material covered is significantly different.
General education requirements of an associate degree provide a more holistic educational experience, while advanced nursing classes and additional clinical experience equip graduates with a nuanced understanding of the field. The table below reviews common classes and highlights how topics covered translate to nursing practice.
Microbiology and Immunology
This course involves the study of microorganisms and how they affect human health.
Skills & Knowledge Gained
-
Understanding of how microorganisms work and how they affect humans -
Awareness of infection and immunity principles
Nursing Care of Patients with Complex Needs
Students learn about the nursing care process and how it is used to treat patients throughout their lives. Special emphasis is placed on increasingly complex medical issues seen in patients, such as obesity, heart disease and diabetes.
Skills & Knowledge Gained
-
Experience in clinical settings -
Ability to provide treatment with lessened supervision, especially for patients with complex issues
Nursing Management of Patient Care
Patient management techniques will be covered, preparing students to effectively serve patients with a wide range of medical issues while maintaining a high level of care.
Skills & Knowledge Gained
-
Development of patient advocacy skills -
Understanding of how to collaborate with other health professionals to provide holistic care
Professional Issues in Nursing
Students will be exposed to recurring and potential nursing issues, such as legal and ethical dilemmas, healthcare leadership conflicts, and healthcare policies.
Skills & Knowledge Gained
-
Students will be exposed to recurring and potential nursing issues, such as legal and ethical dilemmas, healthcare leadership conflicts, and healthcare policies. -
Development of leadership strategies -
Ability to resolve legal and ethical issues arising during care provision
Bachelor of Science in Nursing
A bachelor's degree in nursing builds on the associate degree curriculum by exposing you to an even wider range of nursing and healthcare-related concepts and theories. Emphasis is placed on research and related medical concepts, equipping you with a broader theoretical foundation.
If you already hold a non-nursing undergraduate degree, you can undertake an accelerated program to earn a bachelor's degree in nursing. Another popular option allows professionals already working in a nursing position to obtain their bachelor's degree in less time by taking into account existing experience and education.
Examples of classes often found in a bachelor's program are listed below.
Health Care of Women
Commonly encountered issues in women's health are addressed in this course, with added emphasis on reproductive concepts and pregnant patients.
Skills & Knowledge Gained
-
Familiarity with common female health issues, including pregnancy complications and menopause
Introduction to Nursing Research
Research related concepts and practice methods are covered. Topics such as scientific methods and statistical analysis will be explained.
Skills & Knowledge Gained
-
Development of critical analyzing skills for health research data -
Ability to identify specific methods used while conducting medical research
Public Health Nursing
This course focuses on the delivery of medical care to communities and to different populations. Public health and nursing theories will also be discussed.
Skills & Knowledge Gained
-
Awareness of best practices for studying population-based health issues -
Understanding of preventative care provisions
Chemistry and Physics for Nurse Anesthesia
The basic scientific principles for effective nurse anesthesia will be taught in this course. Chemistry and physics concepts forming the basis of anesthesiology will also be reviewed.
Skills & Knowledge Gained
-
Knowledge of physical laws of fluid, matter, gas, and electricity and how they apply to anesthetics -
Understanding of how anesthesia is administered to patients
The MSN Degree
A master's degree in nursing allows RNs to specialize in a particular area or take the first step in achieving a nursing degree at the doctoral level. While undergraduate degrees and programs prepare students to be registered nurses, master's level degrees emphasize a nursing specialty. Below is a brief list of skills students can expect to possess upon graduation.
Understanding of health care policy
During the course of their studies, students will develop a complex understanding of how and why medical care is provided in a certain way. They will know learn why specific medical techniques or treatments are used over others, with consideration given to prevailing societal, cultural, political, and business influences.
Use of specialized medical technology
A major reason many nurses choose to pursue a master's degree is to learn a specialization. The use of medical tools and techniques specific to that concentration will be taught at the graduate level. For example, a registered nurse specializing in pediatric care will develop a detailed understanding of incubators found in neonatal intensive care units.
Implementing advanced research methods
Many medical care technologies and methodologies originated from historical research and subsequent discoveries, and recent medical developments always revolve around research. Graduate level nurses learn about a spectrum of research methods with great depth, allowing them to effectively analyze data or design and undertake independent research projects.
Nursing management
Providing effective medical care is a team effort, and successful nurses understand how to balance providing excellent care to multiple patients while working with a variety of healthcare professionals. A master's degree in nursing offers guidance to help nurses provide more efficient care, move into leadership roles, and manage others.
Areas of Concentration for Registered Nurses
Most registered nurses choose to specialize in one particular area of healthcare, such as emergency care, geriatrics, informatics, or neonatal. The following table highlights numerous concentrations available to registered nurses.
| Critical Care | Midwifery | Research | Anesthesia | Informatics | |
|---|---|---|---|---|---|
| I want to work with the critically ill and patients who are at high risk for life-threatening conditions, diseases, and health problems. | |||||
| I want to work with pregnant women, those trying to get pregnant, or patients who have just given birth. | |||||
| I would like to help patients reduce or manage pain and keep them as comfortable as possible during their medical care. | |||||
| I like working with computers as much as I like working with people. I would also like to help run computer and information systems that monitor and manage patient care. | |||||
| I like numbers, statistics, and the development of new medical discoveries that help patients. |
Online RN Programs
Though the majority of RN classes were administered through traditional campus-based programs in the past, today, a large number of institutions offer online nursing degrees at undergraduate and postgraduate levels.
In most cases, you should expect online programs to be equally as rigorous and respected as those being taught at brick-and-mortar institutions. When researching potential online programs, look for a few specific components, including:
Reputation
What is the school's reputation, especially at local hospitals and medical facilities? Does the online degree have brand recognition on a regional or national level? Depending on future goals, the marketability of a nursing degree may be a serious factor to consider.
Quality of Faculty
The quality of a degree depends not only on the level of student commitment, but also the effectiveness of their professors. Teachers with terminal degrees in their specialty, recent clinical experience and a widely published oeuvre are much more likely to be dynamic and knowledgeable educators.
NCLEX-RN Licensure Prep
Before students can become active registered nurses, they must first pass the NCLEX-RN examination, so selecting a program that properly equips graduates is a crucial step. Does the school offer adequate preparation for students? Outside of logistical and financial considerations, a school's ability to groom students for successful licensure is the most important factor when selecting an RN program.
NCLEX-RN Passage Rates
Another crucial factor in selecting a program is its licensure passage rate. Most schools will list these statistics on their website, but they can also be accessed by calling the school's admissions department. The national average is around 70-75 percent; a school posting results lower than these figures should be carefully researched to understand the reason.
Components of a Successful Nursing Career
Skills
The most successful registered nurses possess a wide spectrum of clinical and administrative skills. Critical thinking is crucial, as nurses often work in emergency situations requiring snap decisions. Communication also plays a vital role when forming a proper diagnosis and conveying treatment plans to other medical staff. Attention to detail can mean the difference between life and death: forgetting to add a decimal point in the correct location on a patient's record could mean providing a very incorrect dosage of medicine.
Credentials
Aside from passing the NCLEX-RN examination, there are numerous other credentials or certifications available to registered nurses. The American Nurses Credentialing Center provides many certification programs, some of which are listed below:
- International Board Certified Lactation Consultant
- Acute Care Nurse Practitioner
- Gerontological Nursing
- Pediatric Nursing
- Ambulatory Care Nursing
- Neonatal Pediatric Transport
- Cardiac-Vascular Nursing
- Public Health Nursing, Advance
- Nurse Executive
Depending on the certification and the organization that offers it, most must be renewed after a certain period of time, usually every few years.
Tools and Technology
Registered nurses use a wide range of tools and technologies in the course of their work. A few of the most common types are reviewed below:
| Medical Instruments | Stethoscope, pulse oximeter, syringes and lancets, thermometer, defibrillator, forceps, hemostats, medical suction equipment, catheters, blood pressure monitor, and automated IV pumps |
| Medical software | IDX Systems database software, Misys Healthcare Systems medical software, Microsoft Word, Microsoft Excel, and Kronos Workforce Timekeeper, Drug reference guides |
| Protective gear | Disposable gloves, disposable protective masks, disposable gowns, hair covers, and shoe covers. |
Spotlight Career Interview
Mary A. Osborne, BA, BSN, RN, and award winning author of Alchemy's Daughter has provided the following insight into what it's like to be a registered nurse.
What led to your decision to become a registered nurse?
As a first-time college student I had no definite career path in mind, but I wanted a job that would allow me to make a positive difference in people's lives. With the thought of working as a health care professional in some capacity, I earned my first my first bachelor's degree in chemistry while also pursuing studies in creative writing. As my love for writing grew, I ultimately came to the conclusion that becoming an RN would lead to a solid career path while also allowing me the flexibility to pursue my artistic ambitions.
What was your educational path?
Two years after earning my BA in chemistry from Knox College, I enrolled at the Rush University College of Nursing. Because I had already completed a bachelor's degree at Knox, only two additional years of study were required to earn my bachelor's of science in nursing.
The program at the Rush has changed since I was a student, and now offers a “Direct Entry Masters” program. This program offers non-nurses with a bachelor's degree from an accredited school the opportunity to earn a master's degree in nursing and to sit for the NCLEX-RN examination in just two years. The advanced degree offers a clear advantage because employers are looking for nurses who can take on more responsibility in today's world of complex health care.
What were some of your favorite courses and why?
In nursing school I was fascinated by pharmacology classes. I loved learning the biochemistry or chemical pathways that make drugs work in the specific way that they do in the human body. I also enjoyed the skills lab, where we students practiced our newly learned nursing skills, such as taking blood pressure or listening to lung sounds, on one another or on mannequins, which were forgiving of our early mistakes.
What does your day-to-day work entail?
As a nurse care manager for an eldercare company, I help manage the complex medical care of older adults who wish to remain at home as well as those who are in assisted living or skilled nursing facilities. I conduct nursing assessments to determine the specific needs of our clients, develop professional plans of care, and communicate with physicians. I also supervise and instruct nursing assistants, who help our clients with their activities of daily living. As a per diem nurse care manager, I decide when I am available to work (and when I write my novels). Typically, I provide coverage during busy periods. Per diem nurse jobs are available in a variety of health care settings, such as hospitals, clinics, and rehab centers.
Do you have any advice for students interested in becoming a registered nurse?
Nursing is a rewarding profession that can provide life-long job satisfaction and job security. Nurses with bachelor's degrees have a wide variety of job opportunities, and master's prepared nurses have the ability to move directly into leadership roles after graduation.
Similar Healthcare Careers
By now, interested individuals know there are other health care professions related to registered nursing. However, what type of education is required? Is the growth rate expected to be better or worse than that of registered nurses? The table below will help answer those questions.
Licensed practical/
vocational nurse
$48,820
Education and Training:Post-secondary non-degree award
Nurse practitioner
$117,670
Education and Training:Master's degree
Nurse midwife
$117,670
Education and Training:Master's degree
Dental Hygienist
$77,090
Education and Training:Associate degree
Diagnostic medical
sonographer
$70,380
Education and Training:Associate degree
Physician assistant
$115,390
Education and Training:Master's degree
EMT/paramedic
$36,650
Education and Training:Post-secondary non-degree award
Marriage and family
therapists
$51,340
Education and Training:Master's degree
Physical therapist
$91,010
Education and Training:Doctorate
What Do Similar Careers Make?
There are other careers similar to registered nursing that may be of interest to those looking to work in the healthcare field. The chart below lists a few related occupations as well as their salaries.
Registered Nurse and Related Job Salaries
Related Careers at a Glance
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