What it takes to become a nurse (Steps, nursing levels and requirements)

Steps to becoming a nurse

The first step to becoming a nurse is getting a solid education, whether you hope to be a licensed practical or vocational nurse (LPN/LVN), registered nurse (RN), or administrator. Every state and the District of Columbia require students to graduate from an accredited nursing program to become licensed.

1. Decide which type of nurse you want to be

Nursing can take you in many directions, from starting out as a certified nursing assistant (CNA) or staff nurse to working your way up to nurse administrator.

When choosing your career path, think about the type of work environment you prefer. For example, RNs can be found in hospitals, doctor’s offices and other medical settings, but certified nursing assistants often work in nursing homes. What type of setting will inspire you most?

You should also consider what role you want to play. If you want to support medical staff as part of a team, a CNA or LPN/LVN could suit you well. If you want to manage other nurses and assistants or oversee systems, a career as an RN or advanced practice nurse is likely a good fit.

Because there are so many facets to healthcare, nurses often specialize in certain areas, such as geriatrics or critical care. If you have a passion for a certain type of nursing, consider the type of education you’ll need to get there.

2. Earn your nursing degree

To become a registered nurse, obtaining a degree from an accredited institution is necessary. The specific degree and duration of the program will vary depending on your intended place of employment.

The career path you’re interested in pursuing will typically dictate the type of nursing degree you’ll need. Nursing programs include classroom instruction as well as clinical experience. Clinical training allows you to gain hands-on knowledge, ask questions in real-life scenarios and connect with nurses. The experience will also give you the chance to observe how a medical facility runs. Each degree will be a little different depending on the role it prepares you for.

These are the nursing positions you can qualify for with each type of degree:

• CNA diploma or certificate → Certified Nursing Assistant (CNA)
• LPN/LVN diploma or certificate → Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN)
• Associate Degree in Nursing (ADN) → Registered Nurse (RN)
• Bachelor of Science in Nursing (BSN) → Registered Nurse (RN)
• Master of Science in Nursing (MSN) → Nurse educator; Advanced Practice Registered Nurse (APRN)
• Doctor of Nursing Practice (DNP) → Advanced leadership and research roles

Before choosing a program, you should determine how nursing school will fit into your busy life. If your program is on campus, will you have time to get there and can you accommodate parking fees and permit costs? Many bachelor’s and master’s degrees in nursing may be hybrid programs, with some coursework earned online and clinical requirements completed in a medical setting in your community.

If you want to become an RN, an associate degree program takes less time to complete, allowing you to enter the workforce sooner. The downside? Employers may be more apt to hire a nurse with a bachelor’s degree because they have a more in-depth education. However, plenty of nurses with ADNs go on to earn higher degrees, often with the help of tuition reimbursement from their employer.

Before you choose a program, determine how nursing school will fit into your busy life.

Note: There is currently discussion and proposed legislation around requiring RNs to have completed a BSN in order to practice.

3. Pass the NCLEX and get state licensure

Once you complete your education, you’ll need to take an exam to demonstrate your knowledge and nursing skills. Nurses also need to be licensed to practice and exams are prerequisites to licensing.

4. Find a nursing job

With a nursing shortage that is projected to continue, you should have plenty of options for the types of jobs that are available to you. Your clinical experience may have given you a taste for the different environments and settings in which you can work, so you’ll have an idea of what kind of environment is right for you.

Nurses can find jobs in many healthcare settings, including:

• Hospitals
• Medical offices
• Nursing homes, assisted living and extended care facilities
• Home healthcare services
• Schools
• Churches
• Government offices
• Community centers
• Military bases
• Non-profit organizations and clinics
• Large corporations or companies

5. Keep up with continuing education

Nurses are required to complete continuing education courses, usually every two years. Depending on where you practice, these may be listed as contact hours or as continuing education units (CEUs). Every state has different laws that determine how many hours of continuing education you need and how often. Check with your state nursing board for requirements.

6. Maximize your potential through advanced training

With new technologies and treatments, the healthcare industry is constantly evolving. Working on the front lines of healthcare requires nurses to stay informed and educated to remain effective as their responsibilities change. Employers also need nurses who are willing to go the extra mile and apply themselves to specific medical and surgical fields and hone their advanced knowledge. Nurses who pursue their careers from the perspective of lifelong learners may set themselves up for new opportunities and roles. 

• Consider specializing: Specializing in a certain area of nursing can open the door to more career opportunities in a field that suits your interests and strengths.
• Get certified: If you decide to specialize, consider earning professional certification. This cements your commitment to the field and demonstrates your skills to employers.
• Earn an advanced degree: Earning a master’s degree may qualify you for a career as a nurse practitioner, clinical nurse specialist, certified nurse midwife or certified nurse anesthetist.

Levels of nursing

Several careers offer multiple opportunities for advancement and specialization in nursing. And, as more patients look for specialized approaches, nurses can fill this demand with more education which may lead to a higher salary.

What kind of nurse do you want to be?

The education you need to get where you want to go

Entry-Level nursing

Entry-level nursing offers several career paths. Bridge programs, such as LPN-to-RN and RN-to-BSN pathways, also often allow nurses to apply previous education and experience toward the degree they want to earn. Which one suits your goals?

Advanced Nursing

Advanced nursing programs require students to hold a bachelor’s degree before enrolling. Many students earn their BSN from one school and attend a different school for their MSN.

However, bridge programs allow students to earn the education of two degrees simultaneously from a single school. An RN-to-MSN curriculum is designed so that students who are already registered nurses can receive their undergraduate education first and then move on to MSN courses.

Salary source: U.S. Bureau of Labor Statistics Occupational Employment Statistics

Career changes within nursing

Nursing is infamously rewarding and challenging at the same time. After years of bedside care, some nurses look for a career switch within the field. Often, going back to school is the way to make a change.

• Specialize: Earning a master’s degree allows you to choose a specialty, such as midwifery. If an MSN isn’t what you’re looking for, you can enroll in a certificate program, which takes less time to complete. You can choose from a variety of specialty certificates.
• Teach: If you enjoy guiding new nurses in the workplace, you might be a good fit as a nurse educator. Colleges and universities hire nurses with a master’s or doctorate to teach nursing courses.
• Research: A Doctor of Nursing Philosophy (PhD) or Doctor of Nursing Science (DNSc) qualifies you to work in medical research. Your work could help make advances in the nursing profession.

Move to nursing from another career with an Accelerated BSN

Accelerated BSNs are designed for students who have already earned a bachelor’s degree in another field.

You want to become a nurse, but your background is in finance. No problem. Not all RNs start in nursing. Motivated by job dissatisfaction, salary or other reasons, some people change careers and head back to school to earn a bachelor’s in nursing. But what if you don’t have the time and money to invest in another four years of school? Enter the accelerated BSN.

Accelerated BSNs are designed for students who have already earned a bachelor’s degree in another field.

While you may have to complete certain science and math prerequisites, accelerated BSN students aren’t required to take general education courses again. Instead, the accelerated program (usually about 18 months) focuses solely on nursing skills. Students graduate with a BSN and should be prepared to take the NCLEX-RN.

What skills do I need to be a nurse?

Great nurses possess an array of skills that makes them successful. They must have the academic strengths to complete a rigorous education and the people skills to communicate with a diverse patient population. While everyone may excel in some areas more than others, it’s important to foster all of these skills if you want to be a top-tier nurse:

• Empathy
• Communication
• Critical-thinking and problem-solving
• Diligence and detail-oriented
• Teamwork and cooperation
• Professionalism
• Conflict resolution
• Adaptability/flexibility

Pros and cons of being a nurse

Nursing is one of those careers that inevitably produces high highs and low lows. To find out if a career in nursing is right for you, you should weigh the importance of various factors to determine if you have what it takes to withstand the challenges and reap the rewards.

Pros

• Meaningful impact: You get to help others heal, get well and return to their lives. You can witness a patient’s recovery journey, however short or long and see them go home with their families.
• Stable job: A consistent demand for nurses should make it easy to land a job nearly anywhere you go.
• Flexible schedule: Nurses tend to have a little more flexibility when it comes to when and how often they work, especially as they gain experience and seniority. They typically work longer shifts, but fewer days per week.
• Salary potential: The median annual salary for registered nurses is $86,070, almost $20,000 more than the annual mean wage across all occupations.

Cons

• Emotional toll: Day in and out, nurses witness great amounts of pain, suffering and death. This can be emotionally exhausting for many people and lead to burnout. Furthermore, treating people at their lowest point naturally means that patients can be upset, afraid and uncooperative.
• Workplace hazards: Working in any healthcare facility comes with its risks. Nurses are exposed to many germs and other contagions daily, which could be contracted, even with all the safety precautions medical professionals take.
• Physical demands: Nurses often have to work long hours, many of which are on their feet. This can be physically draining and cause foot and back problems. Maintaining your physical health is important to keep up with the job’s demands.
• Stressful environment: As any medical professional will tell you, medicine is not for the faint of heart. You have to keep calm under pressure and may have to make quick, life-or-death decisions.

Job outlook for nurses

According to the U.S. Bureau of Labor Statistics (BLS), as of 2021 there are 3,130,600 registered nurses in the United States. Yet there’s still room for more.

Registered nurses can begin their careers with an ADN or BSN. While both degrees qualify you for RN licensure and a wide range of positions in hospitals and other healthcare settings, a BSN provides a broader education and can position you for roles in nursing management.

The BLS predicts that the RN workforce will grow by 195,400 jobs by 2031. Since the BLS includes nurses who have ADNs, BSNs and MSNs in their reports on RNs, the expected opportunities extend across many roles. Opportunities will also expand as more than one million nurses reach retirement age over the next 10 to 15 years, according to the federal Health Resources and Services Administration.

Here’s a look at some factors that could impact the nursing job market in the foreseeable future.

Positive Factors	Negative Factors
More Jobs: Nursing shortages exist in some areas of the country.	Fewer Jobs: Nursing surpluses exist in some parts of the country.
Opportunities in a wide range of workplaces means more employment options across the length of a nursing career.	There are many steps to becoming a nurse. Nurses must meet education and clinical hour requirements, pass the NCLEX-RN and meet state-specific criteria to qualify for nursing jobs before they can pursue employment.
Baby boomers are living longer, creating a larger population of patients who need more complex care.	Nurses delay retirement as adults stay healthier longer and work past traditional retirement ages.
Specialized nursing is growing, allowing nurses to pursue areas of interest within their existing careers without losing the benefits of their work experience.	A limited number of clinical sites and a shortage of nurse educators means that admission to nursing schools in some areas is competitive and not everyone will get in, even if they qualify.

Where should you look for job growth?

The American Nurses Association (ANA) says there are opportunities for growth in community-based care, geriatrics, informatics and care coordination. Healthcare initiatives have also fueled growth in areas, including disease management, primary care, prevention and wellness.

How to find nursing jobs

Once you’ve graduated from school, you’ll want to find your first job as a nurse. Many nursing programs offer career counseling to help you identify potential employers, prepare your resume and ace the interview. It’s important to note that new nurses can face hurdles since employers often look for experienced staff.

Networking

In most careers, including nursing, you can improve your chances of getting the job you want by networking with established professionals in your field. Start by joining your local chapter of the ANA and attend chapter events. Connect with other nurses and, if there’s a job opening at their workplace, they might think of you first.

In most careers, including nursing, you can improve your chances of getting a job by making connections with established professionals in your field.

Specialized nursing associations, such as the Emergency Nurses Association or the National Association of School Nurses, also have local chapters. Another networking option: Join a registered nurse meetup in your area.

Find states with nursing needs

Research shows that some states will have nursing shortages in the coming years, while others will have surpluses. Moving to an area that needs nurses may potentially open doors to job opportunities.

The BLS projects 195,400 RN job openings through 2032, though the opportunities won’t be evenly distributed across the country. States with the highest number of employment during this period include California (307,060), Texas (219,330), Florida (183,130), New York (178,550) and Pennsylvania (146,640).

Military nursing jobs

The military is another avenue nurses can take as they build their career. Possible areas to consider in the military include critical care nursing, OBGYN nursing, family nurse practitioner and public health nursing.

As a military nurse on active duty, you may work overseas, on a ship, or on a base. You can also choose to enlist in the reserves. This allows you to continue working at home and only serve when you’re needed. Concerned about how you’ll pay off your nursing school loans? As a nurse in the military, you may qualify for loan repayment.

Become a healthcare volunteer

Volunteering is another networking opportunity. You’ll not only get experience working with patients, but you’ll also meet other healthcare professionals.

If you plan to choose a nursing specialty, look for volunteer opportunities in that area. While you won’t be paid for your time, treat the experience as you would a job. Making a good impression could mean a career connection in the future.

Make connections during clinicals

When it’s time for you to complete clinical rounds during school, you’ll likely be assigned to a hospital where you’ll shadow a nurse (preceptor). During this period, be an attentive learner with a positive attitude. Make connections with your preceptor and even their managers. If a position opens up, they may be more willing to recommend you for the job.

Once your clinical ends, stay in touch with your preceptors as they may be a good resource for job opportunities.

15 Growing Nursing Specialties

Technology, advocacy and education are just a few areas where nurses can excel. Here’s a look at 15 growing career paths.

1. Nursing informatics specialist

Nursing informatics gets more attention in today’s technology-obsessed world, but the discipline has been around for several decades. In the 1980s, nurse informatics specialists dreamed of big things:

“We envisioned such things as minimal time spent in documentation, working together with patients to document past history and care received, a lifetime healthcare record and the use of aggregated data to improve nursing practice.“

“Informatics, we believed, would free nurses and other healthcare professionals to spend more time with patients and minimize the pain of documentation.“

-Linda Thede, PhD, RN-BC.

While informatics has certainly changed the nursing landscape, experts say there is more work to be done. As electronic health records (EHRs) and mobile technology become the norm, nurse informatics is a field full of possibilities. Informatics nurses now also use data to learn how to improve workflows and deliver a higher quality of care.

2. Virtual nursing

Nurses have plenty of stories to share about patients treating a health problem based on information they find on the internet. As a virtual nurse, you can provide valid, accurate guidance and care for patients online via a video call or over the phone.

With the growth of telemedicine for diagnosing and treating patients, the job of a virtual nurse can extend past primary care. You can also be responsible for triaging online appointments, for example.

For patients who are unable to leave their homes, perhaps due to illness or other circumstances, a virtual nurse helps ensure continuity of care. Virtual nurses need at least an ADN or BSN and should be good communicators.

3. Nurse midwife

Nurse midwives go beyond delivering babies; they also work as primary care providers for women and newborns. Because of their versatility, more nurse midwives are needed. The BLS expects a 6.4% job growth through 2032, which is faster growth than the national average.

According to the National Library of Medicine, nurse midwives have been instrumental in improving primary health care services for women in inner-city and rural areas of the country. There’s even more good news: The National Institute of Medicine recommends that nurse midwives should have a larger role in providing women’s healthcare.

4. Travel nursing

Travel nursing was created to solve the nursing shortage and remains a popular option for adventurous types. While some nurses are placed in beautiful locales, you may also be sent to an emergency situation or disaster zone. During a strike, a travel nurse may be called to fill the role of a regular employee. RNs, NPs, LPNs and CNAs alike can work with an agency that matches them with a short-term assignment in another city or country. Flexibility and the ability to adapt to new surroundings easily are necessary to succeed in this role.

Travel nursing tends to offer higher-than-average pay and housing may be provided. To find travel nursing jobs, go online to look at agencies, such as TravelNursing.org, that match nurses with job opportunities.

Foreign nurses who would like to work in the U.S. also have opportunities, but they must meet certain criteria to be eligible.

5. Nurse educator

Share your experience and knowledge with aspiring nurses by educating them. According to the American Association of Colleges of Nursing (AACN), more than 80,407 qualified nursing school applicants were turned away in 2020 partly due to faculty shortages, including too few teaching candidates with master’s or doctoral degrees.

The demand for more nurse educators is likely to increase. The AACN states that a significant number of nurse educators will retire over the next decade, creating job vacancies at campuses across the country.

6. Home-care nurse

Hospital stays may have gotten shorter, but patients still need care once they’re discharged. This is why home-care nursing is experiencing a boost in employment. Another factor? Advances in technology allow patients to receive more elaborate treatments at home.

As a home-care nurse, you’ll have a variety of patients. You may treat older people, new moms, patients recovering from an accident and those with chronic illnesses. If you prefer to work outside a hospital and build relationships with a regular set of patients, a home-care nurse career could be a good fit.

7. Case management nurse

The number of older people in the U.S. is increasing and this has created more opportunities for case management nurses. For one thing, as people live longer, they’ll likely need expert advice and guidance for chronic illnesses over an extended period of time.

Case management nurses manage a patient’s care, monitor costs and resources and ensure patients and families are supported. At times, these nurses also serve as important decision-makers.

8. Geriatric nurse

The National Council on Aging estimates about 80% of older adults have a chronic condition. Combine this with the aging baby boomer population and it spells employment growth for geriatric nurses.

While many tasks of a staff RN will be the same for a geriatric nurse, you’ll also focus on treating conditions more prevalent in old age, such as cancer, Alzheimer’s disease and osteoporosis. Since some elderly patients may have trouble communicating their wishes, you’ll also serve as a patient advocate.

9. Critical care nurse

Good decision-making skills are crucial for a critical care nurse. Many work in hospital intensive care units (ICUs), treating patients suffering from burns, heart problems and other serious conditions.

As more hospitals expand their ICUs and nursing homes care for very sick patients, critical care nursing has become a growing specialty. Critical care nurses should be comfortable with advanced technology and working at a fast pace.

10. Neonatal/perinatal nurse

Neonatal and perinatal nurses work with women and their newborn babies, although in different ways. Perinatal nurses take care of women before, during and after birth.

Neonatal nurses care for infants up to 28 days old, usually as part of typical newborn care after childbirth.

Neonatal nurses also work in neonatal intensive care units (NICUs) with babies born prematurely or with serious medical complications.

Perinatal nurses, also called labor and delivery nurses, often serve as the patient’s advocate and guide during the birth experience in a hospital or birth center.

Both neonatal and perinatal nurses must be able to communicate effectively since educating patients and their families on prenatal and newborn care is part of their role.

11. Pediatric nurse

You’ll need a love of children from infants to teens and a lot of patience to succeed as a pediatric nurse.

In many cases, pediatric nurses have to examine and treat patients who don’t understand why they’re being prodded and poked, so you’ll have to gain patient cooperation and trust to accomplish tasks.

You’ll also need to be comfortable communicating with parents and other caregivers responsible for decision-making.

Pediatric nurses work in routine care, emergency services and treatment of diseases in a variety of medical settings from physicians’ offices and children’s hospitals to pediatric critical care facilities.

12. Psychiatric nurse

As a psychiatric nurse, you can help expand access to mental healthcare to patients who need it. A shortage of qualified mental health professionals means that only 44% of adults and less than 20% of children and adolescents who have diagnosable mental health problems get the help they need, according to the U.S. Department of Health and Human Services.

These nurses assist psychiatrists and physicians in interviewing and diagnosing patients.

The role requires a knowledge of mental health issues and the compassion and emotional maturity necessary to work the mentally ill.

Psych nurses work with individuals, families and groups in hospitals, substance abuse treatment centers, outpatient facilities, correctional facilities and schools.

13. Trauma/ER nurse

Trauma and ER nurses care for patients with acute injuries or illnesses. No two days in the life of a trauma or ER nurse are the same and many days are chaotic.

This specialty can be physically and emotionally intense. Nurses in trauma units, in particular, see patients with serious and life-threatening injuries and must often make split-second decisions. They must be prepared to perform a wide range of duties that can include triage, intubation and preparation for surgery.

14. OR nurse

OR nurses are also known as perioperative or surgical nurses. In this role, you’ll care for patients before, during and after surgery. The growing aging population has meant more surgical procedures.

Working as an OR nurse requires a commitment to teamwork, attention to detail and the ability to stay calm under pressure. There are OR positions in hospitals, although more surgeons are working in outpatient surgery centers.

15. Labor and delivery nurse

Labor and delivery nurses guide women through childbirth, coaching them through sometimes difficult contractions, administering medication, watching for any potential complications and helping new moms breastfeed their newborns for the first time.

It’s a nursing role that can be by turns intense, stressful and joyful. Every new mom’s delivery is different and that means labor and delivery nurses must be critical thinkers who can quickly switch from coaching a laboring mother to taking charge if a complication arises.

They must also be prepared for the times when there is a heartbreaking outcome and be able to accept loss.

Technology and nursing

Technology has led to new ways to diagnose and treat patients. Nurses today communicate with patients via email and consult with them during virtual appointments on desktop and mobile devices. OR nurses work with physicians who use robotic devices to perform surgeries.

To keep up with evolving technology, nurses will need to learn new skills throughout their career.

Up next: Artificial intelligence (AI)

Now, artificial intelligence (AI) is emerging as the next frontier of healthcare. Some healthcare systems use AI-supported virtual nursing assistants to direct patients to appropriate healthcare providers and help with time-consuming administrative tasks. The result: Managers can assign nurses to positions where direct human interaction is most critical.

Other advances that play a role in nursing

As you embark on a nursing career, you’ll need to be prepared for even more innovations in healthcare.

Genetics | Gene mutations can predict whether a patient is at risk of developing a disease. The use of genetics and genomes can also help identify whether a parent will pass along a mutation to their child. Since nurses often have the most communication with patients, it’s their job to gather as much information about family history, help patients make informed decisions about genetic/genomic tests, especially now that genetic tests are readily available to consumers and provide guidance and referrals to patients based on test results.

Biometrics | Proper healthcare can’t exist without confidentiality and security, which is why biometrics is so important in today’s fast-paced healthcare environment. Biometrics is a scientific method used to identify people through physical qualities such as fingerprints and voice. In healthcare, biometrics are used to accurately identify patients and providers, ensuring that care is provided to the right patients and that only authorized providers can access patient data. For nurses, this means easier sharing of patient records for more efficient and coordinated care. For patients, it means fewer medical errors and better outcomes.

Social Media | Using social media in nursing has benefits and drawbacks. It can provide networking opportunities and an easier way to communicate with fellow students and colleagues. A quick scan of Facebook and Pinterest will show you that nurses also use social media for support and levity.

There can be a risky side to social media, however. Nurses must be careful not to post disparaging remarks or information that violates a patient’s privacy. The American Nurses Association has established social networking principles that advise nurses to maintain the same standards of professionalism on social media as they do in any other situation. Nurses and nursing students are encouraged to use this resource to adhere to the do’s and don’ts of social media.