A nurse with a graduate degree who can diagnose, order tests and prescribe. Six years of school, six figures, and one of the fastest growing jobs in the country.
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What you earn and what it costs to get there.
Typical
$132,300
Starting out
$101,340
Experienced or specialized
$174,420
The national median is $132,300 a year, and even the bottom tenth earn around $101,340. There are very few jobs in the country where the lowest paid tenth still clears six figures.
About $101,000 to $115,000
First job after your graduate degree and certification
Primary care pays least, hospital specialties and urgent care pay more. Rural clinics and community health centers often add signing bonuses and loan repayment because they cannot fill the post.
About $70,000 to $95,000
The job you do for a few years before or during graduate school
This is the part that makes the path affordable. Most people work as a registered nurse while studying, so they earn a full wage through the expensive years instead of borrowing for all of it.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a nursing bachelor's degree at a public university in your own state, about 11,000 dollars a year, then a master's where your hospital pays a large share of the tuition, which many hospitals do for nurses studying part time while still working. The high end is the same bachelor's degree at 15,000 dollars a year plus a doctorate in nursing practice or a private master's, together with the national nursing licence exam and the nurse practitioner certification exam, a few hundred dollars each. Certification has to be renewed every five years. Nonprofit and government employers count toward the Public Service Loan Forgiveness program, which cancels what is left of federal loans after ten years of payments.
Fill out the FAFSA (Free Application for Federal Student Aid). Many hospitals pay tuition for nurses studying part-time, and nonprofit and government employers count toward the Public Service Loan Forgiveness program.
Employer paid graduate school
Large hospital systems routinely pay a nurse's tuition toward an advanced practice degree in exchange for a work commitment.
Federal loan repayment
Working in a designated shortage area or a community health center can wipe out a large share of your loans.
Flexible schedules
Clinic hours are usually daytime, and many practitioners work four longer days instead of five.
You can change specialty
A certification in another population area is a course and an exam, not another degree.
The exact path from high school to qualified.
Six to eight years after high school, and you are paid as a nurse for most of the second half.
High school
Grades 11 and 12
Biology, chemistry and math. Volunteering in a care home or hospital helps your nursing application more than you expect.
BSN (Bachelor of Science in Nursing)
4 years
Four years, with clinical placements built in. Some people start with a two-year nursing degree and bridge up later.
Pass the NCLEX (National Council Licensure Examination)
Weeks after graduating
The national exam for registered nurses, run by the board that represents every state nursing board. Then you get your state license.
Work as a registered nurse
1 to 3 years
Most graduate programs want real bedside experience, and it is where you learn to recognize a sick patient on sight.
Graduate degree
2 to 3 years
A master's or a doctorate in nursing practice, in a population focus like family, pediatrics, psychiatric or acute care.
National certification and state license
Months
Pass the certification exam for your population focus, then register with the state board as an advanced practice nurse.
Biology
The core of everything that follows, and the hardest part of first-year nursing for people who skipped it.
Chemistry
Pharmacology is chemistry. You will prescribe drugs, so you need to understand how they behave.
Math
Drug dose calculations are simple arithmetic that must be right every single time.
Psychology
A huge share of primary care is mental health, whatever the appointment was booked for.
Working as a registered nurse while studying is the norm, which is why this path leaves people with far less debt than medical school.
Every state licenses nurse practitioners through its board of nursing, and the rules vary a lot. The national association sorts states into three groups. In full practice states you evaluate patients, order and read tests, and prescribe medication under the nursing board alone, which means you can run your own clinic. In reduced practice states you must keep a formal collaborative agreement with a physician for your whole career. In restricted practice states a physician must supervise or delegate your work. Roughly half the country falls in the first group. Check the state you want to live in before you choose a program, because it changes the job completely.
State universities
The cheapest route for residents, and almost all of them run both the nursing degree and the graduate program.
Online graduate programs
Common in this field, with clinical hours done near where you live. Check the program is accredited before you pay anything.
Hospital sponsored study
Your employer pays and you commit to staying for a few years afterward.
Community college then bridge
A two-year nursing degree gets you working sooner, then you finish the bachelor's part-time while employed.
Things you don't need, but that help.
Family practice
The broadest and most portable. Newborns to the elderly, and the easiest certification to find a job with.
Psychiatric mental health
Enormous demand, often the best paid, and much of it can be done by video.
Acute care
Hospital based, looking after seriously ill adults. Closer to medicine than to clinic nursing.
Pediatrics or neonatal
Children's hospitals and newborn intensive care. Specialized and hard to move out of later.
Bedside experience
Years as a registered nurse are what make a good practitioner. Rushing past this part shows.
Spanish or another second language
In primary care it changes how many patients you can actually help.
Comfort saying I do not know
The best practitioners refer early. The dangerous ones guess.
Business sense
In full practice states you can own a clinic, and then you are running a small company.
There is a long running political fight between nursing organizations, which want full practice authority in every state, and physician organizations, which say the training is not equivalent. It gets argued in state legislatures every year, and the rules where you live can change during your career. It is worth understanding both sides before you commit, because it affects your pay, your independence and sometimes the atmosphere in the clinic you work in.
Day to day, pros and cons, where you'd work.
Clinic opens at 8am with a full schedule of fifteen and twenty minute slots. A sore throat, a diabetes check, a two year old with an ear infection, a woman who booked about her blood pressure and finally mentions she has not slept in six months. You examine, decide, prescribe, and refer the ones who need more than you can give. Lunch is spent on messages and lab results. You finish seeing patients at 5pm and the notes take you to six.
The good
The hard parts
Things people don't tell you.
In some states a nurse practitioner can open a clinic and practice independently. Drive across one border and the same person legally needs a physician agreement for their entire career. Nothing about their training changed.
The government flags this occupation as rapidly growing with very likely new openings. Very few well paid jobs carry that rating at the same time as a six figure median.
Every registered nurse in the United States sits the same licensure examination, written by the body that represents all the state nursing boards. Your state license comes afterward.
Unlike medical school, most of this path is done while employed. Working as a registered nurse during graduate study is normal, which is why practitioners finish with a fraction of a doctor's debt.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.