Nursing represents the largest healthcare profession in the U.S., with more than 3 million active licensed registered nurses (RNs) working in the country. These highly regarded professionals rose to the challenges brought on by the COVID-19 pandemic, and the nation took notice by rating nursing the most honest and ethical profession for the 20th year in a row, according to Gallup. "Nursing is an excellent profession to choose for a number of reasons," said Rebecca J. Graves, PhD, NP-C, Associate Professor and Director of Special Projects and Evaluation, College of Nursing at University of South Alabama, in Mobile, Alabama. "Most importantly, it is incredibly rewarding to be able to help others every time you go to work." Another reason to become a registered nurse is that RNs are in high demand. RN employment is expected to grow 9% from 2020 to 2030 or by 194,500 job openings annually, according to the U.S. Bureau of Labor Statistics (BLS). Follow these steps for how to become a registered nurse and start your journey toward a satisfying, meaningful career.
What Is a Registered Nurse?
A registered nurse is, "An individual who has graduated from a state-approved school of nursing, passed the NCLEX-RN examination, and is licensed by a state board of nursing to provide patient care," according to the National Council of State Boards of Nursing (NCSBN). Becoming a registered nurse means taking on the incredible responsibility of caring for the loved ones of others, helping them heal, and advocating on their behalf.
What Does a Registered Nurse Do?
In essence, RNs:
- Provide and coordinate patient care as part of a team of healthcare providers and clinicians
- Educate patients and the public about health conditions
- Provide advice and emotional support to patients and their families
These broad definitions, however, do not capture the vast array of a nurse's responsibilities and the talents they require. Their talents are why nurses are highly sought after for a variety of settings. To start, RNs can work for:
- Skilled nursing facilities
- Long-term care facilities
- Ambulatory and outpatient clinics
- Private practices
- Correctional facilities
- Home health agencies
- Telehealth providers
- Insurance companies
- Addiction centers
- Mental health facilities
The list goes on and on. "'Patient care' is a term that accompanies many actions and may be defined differently according to the setting in which the RN practices," said Graves, who cited the sequential nursing process from Nursing Process by Tammy J. Toney-Butler and Jennifer M. Thayer. "However, for an RN, patient care always includes the nursing process: assessment, diagnosis, planning, implementation, and evaluation." For the registered nurse, this process is part of every new patient encounter, situation, or challenge, said Graves. Tasks that are common in nursing practice include:
- Taking vital signs
- Administering medications, IV fluids, IV medications, and blood and blood products
- Performing cardio-pulmonary resuscitation
- Suctioning airways
- Helping patients with ambulation, nutrition, and toileting
- Observing patients and recording those observations
- Consulting with doctors and other healthcare professionals
- Assisting with diagnostic tests and helping to analyze results
As you can see, nursing is a field that requires hands-on skills and critical thinking -- and a knack for working as part of a larger team.
How Long Does It Take to Become an RN?
Becoming an RN can take anywhere from 18 months to four years, depending on whether you pursue an associate's degree in nursing before taking the NCLEX or go for your bachelor's degree in nursing. It also depends on whether you attend school part time or full time. Like all career paths, becoming an RN has a required educational component. Nursing education generally includes courses in anatomy, physiology, microbiology psychology, and social and behavioral sciences. Students applying to nursing school should make sure those schools meet quality standards with accreditation by one or more specific organizations. Accrediting organizations that set minimum standards for nursing programs include the Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE), and the Commission for Nursing Education and Accreditation (CNEA), according to The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (FoN) report. Students who want to become registered nurses have a few main degree options, which qualify graduates to take the NCLEX-RN. The most common and generally recommended degree option is the Bachelor of Science in nursing (BSN). About 65% of the RN workforce are prepared at the baccalaureate level or higher, according to the NCSBN. The BSN prepares nurses for the full scope of nursing responsibilities in the spectrum of healthcare settings, according to the FoN report. The report also states that the degree generally takes four years to complete and offers courses that traditional two-year or three-year nursing degrees might not offer, such as training in physical and social sciences, leadership, research, and public health. "Most registered nurses today enter practice with a baccalaureate degree offered by a four-year college or university or an associate's degree offered by a community college," according to the American Association of Colleges of Nursing (AACN) Nursing Fact Sheet. The BSN is also the degree typically required for entry into many master's degree programs in nursing. "While a bachelor's degree is typically required to earn an MSN, there are bridge programs when RNs who have earned an [associate's degree in nursing] ADN can complete an MSN," Graves said. The ADN also clears the path for nursing students to become RNs. It generally takes two years to complete and is offered at community colleges and hospitals. However, ADNs from some hospital-based programs, called diploma degrees, often require three years of education. The ADN does not cover the same broad number of topics covered by the BSN, but it does prepare nurses to practice within the legal scope of nursing in a variety of healthcare settings.
Regardless of the degree type, a nurse needs to be licensed to be recognized as an RN, and the nursing license would be issued by the state in which the nurse intends to work. "... the term 'registered' in registered nurse means that the person has passed a national licensure exam, called the NCLEX-RN...," Graves said. "One becomes qualified to take the NCLEX-RN by completing an approved program of study."
How Much Do RNs Make?
Nurse.com's 2020 Nurse Salary and Research Report, which includes responses from more than 7,400 RNs in the U.S., found the median salary for U.S. RNs to be $73,300. "An RN can make a good living in today's economy," Graves said. "Hourly wage differs according to the cost of living of the location, but it also depends on several other variables such as shift differential, shift leadership positions (e.g., charge nurse), and mandatory overtime." The Nurse.com salary report revealed that where a nurse works does affect average annual pay. While nurses in western states, including California, Alaska, Nevada, Oregon, and Washington make an average $88,156, nurses working in Texas, Oklahoma, Arkansas, and Louisiana make an average annual salary of $69,244. The type of employer also makes a difference in RN average salaries in the U.S. For example, the U.S. government pays RNs an average $84,490 a year, versus $76,840 at hospitals, $72,340 at ambulatory care centers, $68,450 at residential care facilities and $64,630 at educational facilities, according to BLS. Factoring benefits into what nurses make, most RNs (66%) responding to Nurse.com's 2020 survey reported receiving medical benefits and 64% received dental benefits. Other common benefits among RNs working in the U.S. include the 401(k), life insurance, and short- and long-term disability. But only one in five reported receiving bonuses. About 40% of RNs surveyed indicated that their employers offered tuition reimbursement, according to Nurse.com. Certification and advanced education can also boost nursing salaries. For example, according to Graves, RNs can earn certifications in their areas of practice after getting some experience and training. Some certifications include Trauma Certified Registered Nurse, Certified Pediatric Nurse, National Certified School Nurse, and others. "In some practice settings, these certifications may be encouraged by an increase in hourly wage/salary," Graves said. With additional education, such as a Master of Science in Nursing, an RN becomes eligible to take an Advanced Practice Registered Nurse certification to become a family nurse practitioner, neonatal nurse practitioner, adult-gerontological certified nurse specialist, certified nurse midwife, or certified registered nurse anesthetist, according to Graves. Becoming an advanced practice nurse increases nurses' annual compensation.