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How to Become a Nurse in the USA

Nov 11, 2022

Comprehensive Guide to Becoming a Nurse in the US for International Students

Nursing is one of the most in-demand professions in the US. The expanding healthcare sector and a growing older population underline the need for highly skilled medical professionals.

The United States offers excellent career opportunities in nursing. Many of the best universities for nursing are present in the US. But the path to nursing can be confusing, especially for international students. With several courses available and many certifications to clear, becoming a licensed nurse in the US may seem challenging.

This article simplifies the essential steps that every student must take to start their nursing career.

Careers in nursing

Before diving into how one can become a nurse in the US, it is essential to understand the different professions within nursing. All nurse jobs can be classified as two: entry-level and advanced level. 

The list below is arranged from entry to advanced levels.

  • Certified Nurse Assistant
  • Licensed Practical Nurse/Licensed Vocational Nurse
  • Registered Nurse
  • Advanced Practice Registered Nurse

Students should consider their long-term goals for planning their careers. All professions in nursing can only be practiced after obtaining a state license. Advanced positions in nursing require students to have completed a master’s or doctoral program.

The requirements to acquire a state license for various nurse positions are summarized below.

  • Certified Nurse Assistant: Complete a 4-12 week training program and take the state competency exam
  • Licensed Practical Nurse: Complete a 12-18 month training program and take NCLEX-PN
  • Registered Nurse: Complete Associate’s Degree in Nursing or Bachelor of Science in Nursing and take NCLEX-RN
  • Nurse Practitioner: Complete Master of Science in Nursing, clear the NCLEX-RN, and take the exam conducted by the American Nurses Credentialing Center (ANCC) or American Association of Nurse Practitioners (AANP)
  • Certified Nurse Midwife: Complete Master of Science in Nursing, clear the NCLEX-RN, and take the American Midwifery Certification Board (AMCB)
  • Certified Registered Nurse Anesthetist: Complete Doctor of Nursing Practice (DNP), clear the NCLEX-RN, and take the exam by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)

Steps to becoming a nurse in the USA

International students can start their nursing careers through the following steps. These steps outline the path to becoming a Registered Nurse. Please note that the below steps are a general guide. Requirements to become a registered nurse in the US can vary for each state. 

Step 0: Deciding your career path

Before starting, it is important to consider whether a nursing career is the right fit. Assess whether you meet the eligibility criteria for nursing. Nursing requires students to have studied Mathematics, Chemistry, and Biology in high school.

Some students begin by enrolling in “Certified Nursing Assistant” courses after high school. A CNA course provides a good starting point. It is the most entry-level nursing profession. One can become a CNA after completing a 4-12 week accredited training course. CNAs perform essential care services, such as helping patients with bathing or eating, cleaning rooms, and other services.

CNA often gives students a fair idea of a nursing career and helps them decide if they should continue further.

A more advanced course of 12 to 18 months leads students to become Licensed Practical Nurses (LPN). LPNs perform many duties done by CNAs and some other more responsible tasks. LPNs usually supervise CNAs.

Step 1: Earn an undergraduate degree

Undergraduate degrees in Nursing are offered as an Associate degree in Nursing (ADN) and Bachelor’s of Science in Nursing (BSN). For most students, an ADN is a faster way to enter the nursing profession. One can receive their ADN degree after two years of study. ADN graduates are eligible for taking the NCLEX-RN. 

But a bachelor’s degree has its benefits. BSN graduates undergo four years of advanced theoretical and clinical training. A BSN prepares students for clinical and managerial roles. BSN graduates tend to earn higher than ADN graduates.

The choice of an undergraduate degree is dependent on the students’ time and money constraints. 

Step 2: Clear the NCLEX

To begin the process of licensure, students have to first determine their eligibility for the NCLEX test. The Nursing Regulatory Body (NRB) decides the eligibility for taking the test. Students should apply to the NRB of the state in which they want to practice.

The registration for the NCLEX is done via Pearson VUE. After applying to NRB, students must register with Pearson VUE and pay the required fees. The NCLEX fees can range from USD 200 to 350.

Once the NRB declares students eligible, they receive an Authorization To Test (ATT) email. The ATT is usually valid for 90 days or as specified by the NRB. Students should take the test within the expiry. 

Students should note that there are two categories of NCLEX: NCLEX-PN and NCLEX-RN.

NCLEX-PN is a test for aspiring practical nurses. This test helps become Licensed Practical Nurses/Licensed Vocational Nurses. NCLEX-RN is a test for upcoming registered nurses.

What is the format of NCLEX?

The NCLEX is a Computerized Adaptive Test (CAT). The format for no two persons is the same. Questions are churned based on your performance.

The grading of NCLEX is not like the usual entrance exams. The number of questions can range from 75 to 265. How many questions a student attempts depends on how early they reach the 95% confidence interval.

The students clear the test if they have answered enough questions correctly. The test fails those who do not reach the pass line with a 95% confidence interval. Testing may take up to six hours at the maximum. 

NCLEX-PN and NCLEX-RN test the candidates in the following categories:

  • Safety and Effective Care Environment
  • Health Promotion and Maintenance
  • Psychosocial Integrity
  • Physiological Integrity

How to prepare for the NCLEX?

Preparation for NCLEX begins by understanding the format. The NCBSN website for NCLEX provides students with two practice exams, each with 125 questions. These practice tests can help students familiarize themselves with the format.

Several online and classroom review courses are available. The choice of courses depends on reviews and affordability.

Step 3: Gain work experience

Nursing students can find employment through networking, university career centers, or job boards.

Nurses can work in a wide range of settings, such as

  • Hospitals
  • Clinics
  • Government agencies
  • Nursing homes and welfare organizations
  • Schools 

Step 4: Continue education and training

Entry-level nurses should look for ways to progress further in their careers. Getting a bachelor’s degree can open up several opportunities if you don’t have one already.

Registered nurses with a BSN earn approximately $13,000 more in their first-year salary than those with an ADN. 

Post-graduate nursing education, such as Master of Science in Nursing (MSN) or Doctor of Nurse Practice (DNP), is critical for advanced specializations. Nurses as APRNs need to have a master’s or a doctorate in nursing to be eligible for practice.

Salaries of nurses in the USA

Salaries by profession

Nurse Profession Average Annual Salary
Certified Nursing Assistant (CNA) $ 30,513
Licensed Practical Nurse (LNP) $ 47,597
Registered Nurse (RN) $ 68,237
Clinical Nurse Specialist (CNS) $ 93,736
Certified Nurse Midwife (CNM) $ 100,118
Nurse Practitioner (NP) $ 100,556
Certified Registered Nurse Anesthetist (CRNA) $ 165,581

Highest-paying states for Registered Nurses

State Average Annual Salary
California $ 124,000
Hawaii $ 106,530
Oregon $ 98,630
District of Columbia $ 98,540
Alaska $ 97,230
Massachusetts $ 96,630
Washington $ 95,350
New York $ 93,320
New Jersey $ 89,690
Nevada $ 88,800

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Yes, international students who meet the eligibility criteria for NCLEX can take the test. The NCLEX exam requires students to have completed an associate’s or bachelor’s degree in nursing.

Yes, CNAs must undergo a training program of 4-12 weeks. The training program will allow students to take a state competency exam and get a state license.

It takes approximately 2-4 years to become a Registered Nurse in the US. The fastest way to become an RN is through an Associate’s degree in Nursing, which takes two years to complete. But, a 4-year bachelor’s degree (BSN) can lead to better career prospects.

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