PA, RN and NP pathways
Three routes into patient care, each with its own exams.
Physician assistants, registered nurses and nurse practitioners train, test and license differently. Here is each route step by step, with every exam and requirement linked to the body that sets it.
Three different professions
Physician Assistant (PA)
Route: Bachelor's degree with prerequisites and patient-care experience, then an accredited PA program
Credential: PANCE, then the PA-C credential and a state PA license
A separate profession from nursing; you do not need to be an RN first.
Registered Nurse (RN)
Route: An approved associate (ADN) or bachelor's (BSN) nursing program
Credential: NCLEX-RN, then a state RN license
The licensed nursing role, and the starting point for every NP.
Nurse Practitioner (NP)
Route: RN license, usually a BSN, then an MSN or DNP program in an NP specialty
Credential: National certification in a population focus, then state APRN authorization
An advanced practice registered nurse (APRN) role built on RN preparation.
Physician assistant
A bachelor's degree, prerequisites and patient-care experience, then an accredited PA program. The PA guide covers letters, interviews and fellowships.
01Bachelor's degree
Any major, as long as you complete each program's prerequisites.
02Prerequisites
Commonly anatomy, physiology, microbiology, general chemistry, biology, statistics and psychology, and sometimes organic chemistry or biochemistry.
03GPA
Programs set their own minimum overall and science GPAs; a minimum is not the same as a competitive GPA.
04Patient-care experience
Most programs expect direct patient care; required hours vary widely and some set no fixed minimum.
05Apply
CASPA serves about 95% of accredited PA programs. The 2026 to 2027 cycle opened April 30, 2026 and closes April 1, 2027. Source
06Interview
Traditional panels, multiple mini interviews (MMI), group exercises or other formats.
07PA school
Programs average 27 months of classroom and supervised clinical education. ARC-PA lists 340 accredited programs. Source
08Certify and license
Pass the PANCE through NCCPA to earn the PA-C, then apply for a state license. Source
The MCAT is not a general PA requirement. NCCPA certification is kept with 100 CME credits every two years and a recertification exam in each ten-year cycle. NCCPA
Registered nurse: ADN or BSN
Both degrees lead to the NCLEX-RN and an RN license. The BSN is the more direct base for graduate study.
| ADN | BSN | |
|---|---|---|
| Degree | Associate Degree in Nursing | Bachelor of Science in Nursing |
| Where | Usually a community college | A university or approved nursing school |
| Length | AACN describes a three-year associate degree Source | AACN describes a four-year degree Source |
| Prerequisites | Commonly anatomy, physiology, microbiology and English | Similar sciences and general education, school by school |
| Admissions test | TEAS or HESI A2 at some schools; others use neither | TEAS or HESI A2 at some schools; others use neither |
| Licensing exam | NCLEX-RN | NCLEX-RN |
| Next steps | RN-to-BSN bridge programs lead toward NP study | Direct path to MSN or DNP programs |
From application to license
- 01
Find state-approved nursing programs and check each one's accreditation and admission requirements.
- 02
Complete the prerequisite and general education courses.
- 03
Take the TEAS, HESI A2 or another assessment only if your program asks for it.
- 04
Apply with transcripts and any essays, recommendations, background check or interview the school requires. Some schools use NursingCAS.
- 05
Complete the nursing courses, skills labs and supervised clinical experiences.
- 06
Graduate and apply to your state Board of Nursing for authorization to test.
- 07
Register for the NCLEX-RN with Pearson, schedule and sit the exam.
- 08
Pass, and complete your state's remaining licensure requirements before practising as an RN.
Nurse practitioner: MSN or DNP
An NP is an advanced practice registered nurse. Every route starts with RN education and licensure.
- Step 1
Become an RN
Complete an approved ADN or BSN program, pass the NCLEX-RN and hold an RN license.
- Step 2
Complete a BSN if needed
Most NP programs ask for a BSN; ADN-prepared nurses often use an RN-to-BSN bridge, and some schools offer RN-to-MSN routes.
- Step 3
Gain nursing experience
Many programs prefer or require RN experience, often in a related clinical area; the amount varies by specialty and school.
- Step 4
Apply to graduate school
An accredited MSN or DNP program in your NP specialty, with your license, transcripts, recommendations, essays and an interview.
- Step 5
Complete graduate education
Advanced health assessment, pathophysiology and pharmacology, evidence-based practice and specialty care, plus supervised clinical hours.
- Step 6
Get certified
Pass the national certification exam for your population focus.
- Step 7
Get state authorization
Apply for APRN or NP licensure in your state and meet its prescribing and practice requirements.
- APRN roles
- Four: nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist and clinical nurse specialist, each certified in one of six population foci Source
- Clinical hours today
- Accredited NP programs provide at least 500 direct patient care hours Source
- Clinical hours ahead
- The 2022 national NP education standards call for 750; NCC applies 750 to graduates from January 1, 2030 Source
- DNP practice hours
- At least 1,000 post-baccalaureate hours, with NP clinical hours counting toward them Source
Specialties and who certifies them
| Focus | Patients | Certified by |
|---|---|---|
| Family (FNP) | Care across the lifespan | AANPCB, ANCC |
| Adult-gerontology primary care (AGPCNP) | Adults and older adults in primary care | AANPCB, ANCC |
| Adult-gerontology acute care (AGACNP) | Acutely and critically ill adults | ANCC, AACN Certification Corporation |
| Pediatric (PNP) | Primary or acute care for children | PNCB |
| Psychiatric-mental health (PMHNP) | Mental health across the lifespan | ANCC, AANPCB |
| Women's health (WHNP) | Women's and gender-related health | NCC |
| Neonatal (NNP) | Newborns, often in intensive care | NCC |
Certification and state authorization are separate steps: a national certificate does not by itself let you practise. ANCC · AANPCB · PNCB · NCC · AACN Certification Corporation
Admissions tests and licensing exams
Admissions tests come before a program, and only where it asks for one. Licensing and certification exams come after you graduate.
| Exam | For | What it is | Key facts |
|---|---|---|---|
| GRE | Some PA and graduate nursing programs | Graduate admissions test, only where a program requires or accepts it; scores go to CASPA from ETS. | Source |
| PA-CAT | Some PA programs | A PA admissions test from Exam Master, required or recommended by some programs. | 240 items across 9 science subjects in a 4.5-hour window; $257. Source |
| ATI TEAS | Some RN programs | Nursing school admissions test, before entry if your school requires it. | Version 7: 170 questions in 209 minutes across reading, math, science, and English and language usage. Source |
| HESI A2 | Some RN programs | Elsevier's nursing admissions assessment; the subjects tested vary by school. | Source |
| NCLEX-RN | RN | The licensing exam for registered nurses, after an approved program and your board's authorization to test. | 85 to 150 items within 5 hours; $200, rising to $350 on February 1, 2027; retake after 45 days, or longer where your board sets it. Source |
| NCLEX-PN | LPN and LVN | The licensing exam for practical and vocational nurses, not the RN exam. | 85 to 150 items within 5 hours; same fee and retake rules as the NCLEX-RN. Source |
| PANCE | PA | The national PA certifying exam, taken after graduating from an ARC-PA accredited program. | 300 questions in five 60-minute blocks; $550; up to 6 attempts within 6 years, once in any 90 days and 3 times a calendar year. Source |
| NP certification | NP | A national exam in your population focus, from AANPCB, ANCC, PNCB, NCC or the AACN Certification Corporation. | AANPCB $240 for AANP members, $315 otherwise; ANCC FNP $295 for ANA members, $395 otherwise. Source |
NCLEX fee change: NCLEX fees. Retake waits: NCLEX results. ANCC fees: ANCC FNP.
Requirements side by side
| PA | RN | NP | |
|---|---|---|---|
| College prerequisites | Yes | Program-specific | Yes |
| Bachelor's degree | Usually, before PA school | For the BSN route only | Usually a BSN, or a bridge route |
| GPA review | Overall and science GPA | Program-specific | Graduate program GPA |
| Experience | Patient care, often expected | Not usually required for entry | RN experience, often preferred or required |
| Entrance exam | GRE or PA-CAT where required | TEAS or HESI A2 where required | Program-specific; often none |
| Letters and statement | Common | Varies | Common |
| Interview | At many programs | Varies | Varies |
| Supervised clinical education | Required | Required | Required |
| Final credential | PANCE, PA-C, state license | NCLEX-RN, state license | National certification, state APRN authorization |
Know your starting point
- PA
- Your bachelor's status, prerequisites completed, overall and science GPA, patient-care hours, test requirements and target programs.
- RN
- Whether you want the ADN or BSN, which state-approved programs fit, and how their prerequisites, tests, clinical placements and NCLEX results compare.
- NP
- Your RN license, nursing degree, clinical experience, intended population focus and whether you prefer an MSN or DNP.
Timelines
The order of steps on each route. Program lengths vary with full- or part-time study.
PA
- Bachelor's degree with prerequisites
- Paid patient-care hours, often alongside college
- CASPA application, from late April
- PA program, 27 months on average
- PANCE, then a state license
RN
- Prerequisites
- ADN (about three years) or BSN (four years)
- Board authorization to test
- NCLEX-RN, then a state license
NP
- RN license, usually with a BSN
- RN experience
- MSN or DNP program with at least 500 clinical hours
- National certification
- State APRN authorization
- PA and NP are different roles, with different education, certification, licensing and scope-of-practice rules.
- Check that a nursing program is approved by your state Board of Nursing and accredited by ACEN, CCNE or CNEA.
- Check that a PA program is accredited by ARC-PA; only its graduates can sit the PANCE.
- For NP programs, check accreditation, certification eligibility for your focus, how clinical placements are arranged and your state's authorization rules.
- US credentials do not automatically authorise practice in Canada; plan each country's route separately.
Official bodies
- PAEA and CASPA
PA program directory and the central PA application.
- ARC-PA
Accredited PA programs.
- NCCPA
PANCE and the PA-C credential.
- NursingCAS
The central nursing application, run by AACN with Liaison.
- NCSBN
Boards of nursing and the APRN Consensus Model.
- NCLEX
NCLEX-RN and NCLEX-PN registration, fees and results.
- AANPCB
FNP, AGNP, PMHNP and ENP certification.
- ANCC
FNP, AGPCNP, AGACNP and PMHNP certification.
- PNCB
Pediatric primary and acute care NP certification.
- NCC
Women's health and neonatal NP certification.
- AACN
Nursing education, degrees and CCNE accreditation.