There are quite a few steps involved in actually getting your nursing license and working as a nurse. Let’s answer an oh-so-common question: How hard it is to become a nurse?
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- Get into An Accredited Nursing School
- Nursing Prerequisite Courses
- The Nursing School Passing Requirement
- Nursing Coursework
- Clinical Experiences
- Graduating From Nursing School
- Getting an Authorization To Test (ATT) From a Regulatory Body
- Passing the NCLEX
- Congratulations, You're Now a Nurse!
- Resources For New Nursing Students
- More Resources for How Hard Is It to Become a Nurse
Get into An Accredited Nursing School
The first step to becoming a nurse is to get into nursing school. This can be quite challenging, as some programs are very competitive. There are various entrance exams that may be required.
(This article walks through all of the possible exams that may be required to get into nursing school and is very comprehensive!)
You may need to submit things like your GPA, TEAS exam, or another readiness exam, SAT score, etc. Each school has different requirements. More competitive schools have higher standards for entrance. But you can’t just get into any nursing school. It needs to be accredited.
What’s Nursing School Accreditation and Why Does it Matter?
The nursing school must be accredited to sit for your national board examination (NCLEX-RN). Just because a nursing school exists does not mean it’s accredited. Accreditation essentially means that there is a national standard for nursing schools, and regardless of if you went to one in Maine, Florida, or Oregon, if they’re accredited they’re all teaching a specific standard.
There are two accrediting bodies that can provide this:
- The Accreditation Commission for Education in Nursing (ACEN)
- The Commission on Collegiate Nursing Education (CCNE)
Accreditation is not permanent. It must be renewed. This is a very long and tedious process that nursing schools go through, but it is imperative because if they lose accreditation, then their graduating students cannot take their board examinations (unless your non-accredited program is approved at the state level). If a program is accredited, it’s approved. If not, there’s an entirely different process to go through to ensure you can sit for boards. Naturally, this isn’t ideal. When you’re paying thousands of dollars for an education and going into debt for it, you need a sure thing!
Nursing Prerequisite Courses
Before you can take your nursing courses, you have to pass various nursing prerequisites. You must get satisfactory grades in these courses (likely B and above) for them to count.
Common required courses include:
- Anatomy and Physiology
- Organic Chemistry
- Growth and Human Development
- Psychology – and likely a few more psych classes beyond 101
- English 101 – possibly 102 as well
If you take a normal course load and do not do any summer school or accelerated tracks, completing those courses typically takes two years.
Something people don’t tend to realize about nursing school in college is that you must complete these pre-nursing courses before starting your actual nursing courses. Only if you do well in these will you be permitted to move forward with the nursing classes.
This means you could be accepted into your college for the first two years as you complete prerequisites and then need to apply to the nursing program once you are finishing your sophomore year.
A Note About Additional Electives
While not technically prerequisite courses, as electives can be taken after you begin nursing courses, you may be required to take additional electives to graduate from your school. This could include courses in religion, public speaking, foreign language, etc. The specifics of requirements depend on the school you attend.
The Nursing School Passing Requirement
After you get into nursing school, the grading can be a bit different from a regular major. In many typical college courses and majors, you can get a C and still pass a course with 70%.
However, nursing programs often set their passing standard at 80%. Therefore, you could get a 79% in a course, fail, and have to retake the course. This adds to the pressure and complexity, but also does weed out students who would not be able to pass the NCLEX or safely care for patients upon graduation. Because nursing schools are training people to be registered nurses who are responsible for the lives of the patients under their watch, the school has a duty to ensure all graduates are competent.
Consider inquiring about the passing standard at prospective schools. It should be communicated to any prospective student, and also outlined on your first day of class.
Keep in mind, this would be for all nursing-specific courses, not electives.
Now that you’ve got all of those pesky pre-req’s out of the way, it’s time for the real deal! Nursing school coursework varies depending on your school but common required courses include:
- Medical Terminology
- Pathophysiology – anatomy and physiology cover normal functions, while patho discusses what happens when things go wrong
- Nursing Fundamentals – discusses assessments, types of nursing care, how health care is delivered in the US, ect.
- Mental and Behavioral Health
- Women’s Health – this would include labor and delivery, postpartum, etc.
- Child and Adolescent Health
- Medical-Surgical Nursing
- Community Nursing
- Population Health
- Health Assessments
- Health and Medical Ethics
- Leadership and Management
- Nursing Theory
These are just a few, but you can easily check out the exact required coursework on a nursing program’s website. For example, here is what is currently required to graduate from the University of Illinois Chicago’s nursing program.
Within these courses, you’ll likely have various quizzes, exams and assignments.
These are typically shorter exams that check your knowledge on specific medications, mechanism of action, dosage, use, contraindications, and more. These can be weekly, monthly, or another interval.
Med Math Quizzes
Giving medications requires math skills and dosage calculations. While computers take care of a lot for us, it’s important to be able to do this the old fashioned way if computers go down and to double check what the computer says. These are usually shorter exams, but may require a high pass rate. (In nursing school, I was required to get a 95% or above on all math exams to be able to pass.)
These exams are longer and encompass more information that the aforementioned quizzes. They tend to be quite difficult and require days of studying and prep to adequately prepare. These tend to coincide with larger sections of the course. Your school may use standardized computerized exams from companies like ATI throughout nursing school for these types of exams. Here’s a post on how to pass nursing school exams that you might find helpful! (Or you can listen below.)
Papers in nursing school can be pretty complex and require extensive citations and appropriate research. These papers also require APA citations, which is likely different from other courses and high school English courses.
Before nursing students can go into a clinical environment, they must have time in a simulation lab to be exposed to different procedures, equipment, and practices. Sim lab time requires competency check offs, where students study skills at home and then perform them in the lab for their professor to get the green light to go to clinicals.
Your nursing school coursework may also require you to write presentations, record videos, group projects, and more.
In addition to in-the-classroom learning, you’ll also need to go to clinical sites (like hospitals, nursing homes, community health centers, and more) to complete hours. These will coincide with your courses. For example, if you’re in a course on mental and behavioral health, you may have clinical hours at the local hospital’s inpatient psychiatric unit. If you’re in your women’s health course, you may have clinical hours on a labor and delivery unit.
The number of hours required differs based on your school. You may also have a senior project or capstone in which you’ll spend more hours in one location working on a specific project.
Often those are pass-fail aspects of your overall grade. You will go in, complete your clinical hours (which can be 4-12 hours in length), complete various paperwork and provide care to patients. You will have a clinical instructor who will be observing your time in clinicals who will ultimately decide if you pass or not.
Below is a video where I walk through what to expect at clinicals.
It can be a pretty intimidating environment, and it is a commitment because it’s not just going to class and doing assignments or maybe lab work. You’re physically going to a hospital and actually providing care to patients, which is an added responsibility. It’s not like regular college coursework where you have an exam every few weeks or at midterms and finals. You’re actually going to the hospital, working with patients regularly.
It can be a lot to juggle with other courses and deadlines, but it’s a necessary aspect of the nursing major. So, while your friends who are psych or communications majors have time to unwind and party, you might be filling that time studying for your next med quiz, writing your APA paper, or coming up with a care plan from clinicals yesterday.
Common clinical assignments:
- Patient prep – going to the hospital the night before to get information on the patient you will take care of the following day
- Patient summaries
- Care plans
- Case reports
- Papers based on clinical care
Successful completion of clinical would include both the assignments and the actual clinical time itself.
Graduating From Nursing School
To successfully graduate from nursing school, you must get an 80% or above in all of the aforementioned classes, pass all clinicals, and meet any other school-wide graduation requirements. For example, my college required students to complete 120 hours of volunteer work, write a 14-page paper, and give a presentation to professors about their experience – and they required it from everyone, regardless of their major.
In addition to this, your school may require you to get a certain grade on an NCLEX-readiness exam to successfully pass their program. Naturally, all of this depends on the requirements of your unique school.
But, time out friends! Just because you graduate does NOT mean you’re a registered nurse.
Getting an Authorization To Test (ATT) From a Regulatory Body
If you were to graduate nursing school, you would be a nurse. But, you would not be registered anywhere. To be considered an “RN” you must have a nursing license. Your nursing school does not provide this. A regulatory body, like your state board of nursing, does.
Whenever you want to sit for boards, you must be authorized to do so by a regulatory body. You’ll pay a fee and submit a bunch of information, including your transcripts. The regulatory body (state board of nursing) will then perform a background check on you and verify your transcripts to ensure it is safe to give you an official nursing license, which allows you to practice as a nurse and provide care to patients.
This step is a SAFETY measure to protect the community. We don’t want just anyone having a nursing license because nurses have access to medications and patients in very vulnerable positions. For example, if you passed nursing school but when they ran your background check found out you have been convicted of child endangerment – you’re not going to get a nursing license.
To be able to actually take that NCLEX, you must obtain this authorization to test, which is called the ATT.
Passing the NCLEX
Now, you’ve got your ATT and a state board of nursing says it’s legal to give you a nursing license, you’ve got to pass your board examination!
The NCLEX is a very intense long, complex and challenging exam you must pass to be an officially licensed registered nurse. To adequately prepare to take the NCLEX exam, you must be very intentional with your time and efforts. You also want to make sure you time it appropriately with graduation, and not wait too long, or test too quickly.
I highly, highly recommend purchasing some sort of NCLEX-review program. You can view my faves here.
(And, as of April 1, 2023, there is a massive update to the NCLEX. We go over it in detail in this blog post.)
Congratulations, You’re Now a Nurse!
So, to review, to become a nurse you must:
- Get a B or above in all nursing prerequisite courses
- Get into an accredited nursing program
- Get a B or above in all nursing courses (this includes med quizzes, exams, papers, simulation lab hours, and standardized tests)
- Pass all clinical experiences
- Complete any additional college-specific graduation requirements
- Pass a background check
- Pass the NCLEX
I hope that can answer for you whether or not becoming a nurse is hard or not. Getting through nursing school was one of the most challenging things I’ve ever done, but was very worthwhile.
One important thing to know about nursing school: It is challenging, but it is doable.
Resources For New Nursing Students
If you’re considering becoming a nurse and asking yourself if you can do it, I hope this post helped make sense of what’s expected of you to do so. Today, there are many resources to help nursing students throughout the difficult journey of nursing school.
My #1 recommendation is getting a Nursing.com subscription. They have tons of mini lectures that can help flesh out the more confusing concepts so that you can have much more effective study session, thus saving you time. Picmonic is also another great option that uses a research-driven methodology to increase retention and decrease study time. (Use promo code FRESHRN for 20% off!)
All the best to you in your decision making!
Getting ready for nursing school clinicals, but feeling unprepared?
Nursing Skills Refresh from FreshRN is a self-paced video course for both new and experienced nurses. Whether you’re preparing for your first clinical experience, or need to brush up on your nursing skills, this course is for you. Each lesson walks you through the basic tasks and concepts you will experience in the clinical setting. Once completed, you’ll feel comfortable in a hospital setting, understand the basics of what the bedside experience will feel like, and know insider tips and tricks that will make you feel confident and in control.
How Hard Is It to Become a Nurse?
Becoming a nurse is a very challenging but worthwhile journey. You will have to complete pre-requisite courses, get into a nursing school, pass all of your nursing coursework with 80% or above, get authorized by a state board of nursing, and pass your NCLEX examination to become a registered nurse. Please read the above post for the specific requirements.
Is Becoming a Nurse Worth It?
Nursing can be very rewarding, both emotionally and financially. It’s a challenging field, but it can also be very satisfying to help others. The financial compensation for nurses is reasonable, and the job market is healthy. Nurses are in high demand, and that trend will likely continue. The field is very versatile with many opportunities so if you find that you don’t enjoy one area of the field, you can always explore another one.
Further, nursing is one of those highly rewarding fields where you feel like you are actually making a difference in people’s lives. I know many people who went to college for a degree and while they made decent money, felt like they weren’t actually making an impact with all of the hours they were dedicating to work. So, they went back for a second degree – in nursing!
How Much Do Nurses Make?
The average nurse makes about $32 per hour nationally (as of report from May 2020). However, there is a lot of variation which depends quite a bit on where you live. For example, the competitive base salary of a registered nurse in California is an average of $51 per hour, while those in Texas earn an average of $28 per hour.
Some travel nursing agencies offer salaries well above the average, often starting at around $50 per hour, and that can go up to $150 per hour! (Please note, travel agencies typically require nurses to have a few years of experience first.)
How Long Does It Take To Become a Nurse?
Becoming a nurse, you can do it in as little as two years at a community college if you are full-time doing summer school and continuing school through breaks. With a two-year degree, you get an associate’s degree in nursing. You can also go the traditional route of the bachelor’s of science in nursing, which is a four-year degree and you will graduate with your Bachelor of Science in Nursing. There is also a third option of a direct-entry master’s program as well. I go through each of those options in this blog post.