Nursing Career in the US: Complete Guide to Licensure, NCLEX, Salary & Career Paths

📊 US nursing career snapshot

Registered nursing remains one of the largest healthcare occupations in the United States. According to the U.S. Bureau of Labor Statistics (BLS), registered nurses had a median annual wage of $93,600 in May 2024, with 5% projected employment growth from 2024 to 2034 and about 189,100 openings per year on average. Advanced practice roles — nurse anesthetists, nurse midwives, and nurse practitioners — are projected to grow even faster, at 35% over the same period.

Most patient-facing nursing roles in the US require state board licensure. There is no single national nursing license — you must meet the requirements of the state where you practice, including approved education, the NCLEX where applicable, background checks, and ongoing renewal.

🩺 How to become a nurse in the US

The exact steps depend on whether you are starting from high school, changing careers, or already licensed abroad. For most US-trained RNs, the pathway looks like this:

1. Choose your license type — LPN/LVN (practical nursing), RN (associate or bachelor’s degree), or an advanced practice route after RN licensure.
2. Complete a state-approved nursing program — ADN, BSN, practical nursing diploma, or graduate program for APRNs. Program approval by your state board matters for NCLEX eligibility.
3. Apply to your state board of nursing — Submit transcripts, fingerprints, and any required coursework. The board determines whether you are eligible to test.
4. Register for the NCLEX — After board approval, register through Pearson VUE. You receive an Authorization to Test (ATT) before scheduling your exam date.
5. Pass NCLEX-RN or NCLEX-PN — Use structured prep such as the NurseOnShift NCLEX practice bank alongside your program’s review materials.
6. Receive your license and maintain it — Meet renewal cycles, continuing education, and any state-specific requirements. See our state-by-state CE requirement guide.
7. Start your first nursing role — Hospitals, clinics, home health, long-term care, and travel nursing are common entry points. Pair job search with specialty guides on the Nursing Careers hub.

Typical timelines: an ADN takes about two years; a BSN about four; LPN programs often run 12–18 months. Total cost varies widely by state, school type, and living expenses — community college ADN programs are often the lowest-cost RN route, while private BSN programs can cost substantially more than public community college or state university routes, especially before financial aid.

Next step: How to become a registered nurse — step-by-step ADN, BSN, NCLEX, and first-job guide.

🛤️ Choose your nursing path

US nursing careers branch into several license and education levels. The table below summarizes the most common pathways. For deeper comparisons, see our ADN vs BSN and RN vs LPN/LVN guides.

RN vs LPN/LVN vs APRN

Licensed Practical Nurses (LPNs) — called LVNs in Texas and California — provide basic bedside care under RN or physician direction. Registered Nurses (RNs) assess patients, develop care plans, administer treatments, and coordinate care across settings. Advanced Practice Registered Nurses (APRNs) include nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives; they hold graduate degrees and state-specific authority to diagnose, treat, and in many states prescribe medications.

ADN vs BSN vs MSN vs DNP

An ADN is the fastest common route to RN licensure. A BSN adds broader leadership, community health, and research coursework — increasingly preferred by acute-care employers. An MSN, DNP, or role-specific graduate degree is required for most APRN roles; nurse anesthesia entry-to-practice programs are now doctoral-level. Compare programs in the US nursing schools directory.

Next step: Compare ADN vs BSN or RN vs LPN/LVN to choose your entry path.

📜 Licensure & NCLEX

Most patient-facing nursing roles in the US require state board licensure, not registration. Pre-licensure students typically sit the NCLEX-RN or NCLEX-PN after completing a state-approved nursing program. Licensed nurses must meet renewal and continuing education rules that vary by state.

The National Council of State Boards of Nursing (NCSBN) notes that US nurses must be authorized by a board of nursing and that licensure requirements differ by jurisdiction. Key steps include:

• Board application — Apply to the state board where you seek your first license (or endorsement if already licensed elsewhere).
• NCLEX registration — After the board declares you eligible, register with Pearson VUE. NCLEX candidates receive an Authorization to Test (ATT) before scheduling.
• Exam day — NCLEX-RN and NCLEX-PN use computerized adaptive testing focused on clinical judgment and safe practice.
• License renewal — Many states require periodic renewal with continuing education, practice hours, or other state-specific requirements. Our state-by-state CE requirement guide tracks renewal hours, special topics, and board links.
• Nurse Licensure Compact (NLC) — Nurses in compact states can hold one multistate license valid in other compact jurisdictions (43 jurisdictions as of last review). Primary state of residence rules apply. See our NLC states guide.

For exam-specific prep, use NCLEX Practice and review NCLEX-RN vs NCLEX-PN if you are deciding between license types.

Next step: Check CE requirements by state or explore Nurse Licensure Compact states.

💰 Salary & best states for nurses

RN pay varies significantly by state, metro area, experience, specialty, and shift differentials. BLS publishes mean and median wages by state and metropolitan area. Recent BLS wage data places California, Hawaii, Oregon, Washington, Massachusetts, Alaska, New York, and the District of Columbia among the higher-paying RN markets, though rankings vary by year and cost of living.

When evaluating where to work, consider:

• Annual and hourly wages — Compare BLS Occupational Employment statistics for your target state.
• Job demand and openings — Growth projections and vacancy rates differ by region and care setting.
• Compact license status — Helpful for travel nurses and those planning to move between states.
• Cost of living and housing — A high salary in an expensive metro may net less than a moderate salary elsewhere.
• CE and renewal burden — Some states require more contact hours or topic-specific training at renewal.

For state-level breakdowns, see our dedicated guides: RN salary by state and best states for nurses. State-specific career pages — such as nursing careers in California, Texas, Florida, New York, and Georgia — will add board links, major employers, and local outlook data.

Next step: Compare RN salary by state or see best states for nurses.

🎓 Advanced practice & specialty roles

Graduate-level nursing opens doors to nurse practitioner, clinical nurse specialist, nurse anesthetist, and nurse midwife roles — each with distinct education, national certification, and state scope-of-practice rules. BLS projects strong demand for these roles through 2034.

🏫 Education pathways

Your degree path shapes licensure eligibility and long-term career options. ADN and BSN programs lead to RN licensure; MSN and DNP programs support advanced practice and leadership. Research state-approved and accredited programs before you apply, then pair your shortlist with exam prep and career planning tools.

Next step: Find nursing schools by state and start NCLEX practice while you study.

🌍 International nurses

Internationally educated nurses can work in the United States, but their pathway is different from US-trained nursing graduates. Instead of repeating every step here, NurseOnShift has a dedicated guide covering credential evaluation, English requirements, state board applications, NCLEX-RN, VisaScreen, employer sponsorship, and visa considerations.

If you trained outside the United States, start with the full international pathway guide below before choosing a state board or paying for credential evaluation.

🌐 US vs UK vs Canada: quick comparison

This is a quick overview only — rules change and vary by province, territory, and visa category. Verify details with official regulators and our country guides before you relocate.

Explore country-specific guides: Nursing Career in the UK, Work in Canada, and Work as a Nurse in the USA for the full international-to-US pathway.

🧰 NurseOnShift tools for your career

Use these resources alongside this guide for exam prep, licensure maintenance, and clinical reference.

❓ Frequently asked questions

📎 Official sources

Verify licensure and exam requirements with primary sources. NurseOnShift summarizes these for planning purposes — rules change and vary by state. For international nurse visas and credential screening, see the Work as a Nurse in the USA guide and its official sources.

• BLS — Registered Nurses Occupational Outlook
• BLS — Nurse Anesthetists, Midwives, and Nurse Practitioners
• NCSBN — Nursing Regulation
• NCLEX — Registration & Authorization to Test
• NURSECOMPACT — Nurse Licensure Compact
• NMC — Test of Competence
• Canadian Nurses Association — Regulatory Bodies

Salary and outlook figures on this page reflect the BLS Occupational Outlook Handbook data available at last review. For detailed state salary tables, use the most recent BLS OEWS state wage release. Last reviewed July 5, 2026.