In the United States there are several levels of qualification which nurses can obtain as they progress through their careers. Licensed Vocational Nurses (in CA, TX) or Licensed Practical Nurses (all other states) are the lowest level of qualification for a licensed nurse. Nursing assistants may operate who are not qualified to this level, but they are by definition unlicensed. RNs, or Registered Nurses, form the next tier in the structure. Most of these will hold either a diploma or associate degree in nursing, and all will have many hours of clinical experience. They will also have had to pass the state board's examinations, or NCLEX-RN, before they are awarded the license as a registered nurse. For many RNs the next level will be to gain a Bachelor of Science in Nursing degree (BSN). RN to BSN college conversion courses, or bridging courses, are available both online and in traditional campus locations for those who wish to upgrade their qualification to a BSN.
The typical route into a registered nursing position in the United States is through a nursing program granting the degree of Associate of Science in Nursing (ASN). These courses are college based for two or three years, and there is always a heavy emphasis on practical clinical skills and knowledge.
The older style hospital based training, leading to a Diploma in Nursing, is now quite rare in the US. In the United States nurses do not become licensed to operate until they pass the examination of the state nursing board.
For RN level this exam is known as NCLEX-RN. Most college degrees provide their own tests to ensure that their graduates are ready for the state board exams.
A Bachelor of Science in Nursing (BSN) will be the next career step for many RNs. This can be taken as a four year course, but as RNs will already have large amounts of clinical experience, and will have covered a lot of the material already during their Associate degree (ASN), there are a fair number of fast-track or bridging programs which allow registered nurses to gain a BSN in two years.
The BSN prepares the nurse for a number of possible career moves away from the bedside. For example, the holders of BSN degrees will find themselves eligible for posts in management and training. Coursework in the BSN degree includes topics such as nursing science and leadership, and nursing informatics.
It is not always necessary to relocate to a community with a nursing school to gain a BSN, as there are a number of distance learning options. RN to BSN college bridging courses can be taken both online or at a college campus. Many nurses will find the online study to be a good way to upgrade their qualification to BSN, as they can continue to work their regular job while studying.
A BSN degree, via an RN to BSN college or online course, may be most appropriate for those who aim to become a nurse practitioner, or to enter teaching. Those who aim ultimately to earn a Master of Science in Nursing (MSN) have an additional choice, because they can take an RN to MSN course, bypassing the BSN qualification.