As the U.S. population ages, the country demands more nursing professionals and qualified healthcare workers. The healthcare industry has been anticipating and preparing for millions of baby boomers transitioning into retirement. To meet this demand for skilled nurses, schools have adapted their academic programs to offer hybrid and online nursing degrees. Many nursing schools in North Carolina offer online nursing degrees from the associate to the doctoral levels.
Three million registered nurses currently work in the United States, and the U.S. Bureau of Labor Statistics (BLS) projects the nursing workforce will grow by 15% between 2016 and 2026. The retirement of older registered nurses (RNs), which creates more opportunities for new nurses, is contributing to this rapid rate of expansion. The BLS also projects the supply of qualified nurses will likewise increase in the coming years, creating a competitive field. An online nursing degree that leads to a BSN or advanced degree will surely benefit those who want to pursue administrative roles and teaching positions in this field.
How to Become a Nurse in North Carolina
You'll need to earn a nursing license to become a nurse in North Carolina. The process resembles that used in other states, with three potential paths to licensure: nursing diploma, an associate degree in nursing (ADN), or bachelor's in nursing (BSN). All first-time licensed practical nurse (LPN) and RN licensees must pass the National Council Licensure Examination (NCLEX), a standardized exam that qualifies a nursing candidate to enter the field. The North Carolina Board of Nursing regulates the practice of nursing in North Carolina.
1. Choosing The Right Path For You
The online nursing degree you choose depends on your career goals. To practice nursing in North Carolina, you at least need an ADN or nursing diploma. If you want to work in a specialized area of the field, then you may want to earn a BSN or a master of science in nursing (MSN). If you want to teach nursing, then you should set your sights on a doctor of nursing practice (DNP) degree or a nursing Ph.D. You can earn a BSN at any point during your career. For example, most online RN-to-BSN programs in North Carolina allow you to earn your degree in just two years while continuing to work full time.
2. Earn Your Nursing Degree
Many nursing programs in North Carolina have acquired technological advancements that make it possible to offer distance learning programs. Accelerated nursing programs in North Carolina allow aspiring nurses to earn an ADN in just two years or a BSN in four years. Online programs also allow students to enroll in nursing programs outside their geographical area. Location no longer limits students, even for a degree that requires clinicals. Proctored exams, local internships, and asynchronous learning make it possible for future RNs to pursue online nursing degrees in a manner that best suits their personal schedule and life commitments.
3. Pass the Licensing Exam and Earn Your License
North Carolina nursing schools prepare students to sit for the NCLEX-RN examination. Within five hours, students must complete 75-265 questions on the multiple-choice test. After the test taker answers the first 75 questions, the exam calculates a score on a pass or fail basis. If the computer can not determine an answer, then you will need to continue answering questions until a definitive score returns. Due to the $200 cost of the exam, many students pursue additional forms of study to ensure they are fully prepared.
Nursing Licensure in North Carolina
Guided by the Nursing Practice Act, the North Carolina Board of Nursing (NCBON) requires licensure "to ensure minimum standards of competency and to provide the public safe nursing care." To qualify for the NCLEX-RN, you will need at minimum a nursing diploma, an ADN, or a BSN, and to obtain an Authorization to Test. The test breaks down into four major client needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity.
NCBON does not limit the number of times you can take the exam, but you must wait 45 days between attempts of the same test. This waiting period is waived if you wish to take the NCLEX-RN and NCLEX-PN successively. Licensure also requires a mandatory criminal background check.
You can earn your online nursing degree from one of the nursing schools in North Carolina or from another Nurse Licensure Compact (NLC) state. As an NLC member, North Carolina recognizes multistate licensure. If you passed the NCLEX-RN in another NLC state, then you can apply for a license by endorsement with NCBON for only $150 (the license must be notarized). Currently, 26 NLC states exist, including the North Carolina border states of Tennessee, Virginia, and South Carolina.
Nursing Licensing Costs in North Carolina
State Requirements by Nursing Type
The North Carolina Board of Nursing establishes the state requirements for the different levels of nursing in the state, including registered nurses. Those pursuing a nursing career in North Carolina must complete a board-approved RN program, culminating in an ADN, BSN, or a nursing diploma. The program must include coursework in biological, social, and behavioral sciences, in addition to theory and clinical practice related to caring for children, women in maternity, adults, the aged, and individuals with mental health challenges.
Candidates must apply for licensure by examination four to six weeks before program completion, at a cost of $75 remitted to the North Carolina Board of Nursing. Before they can take the NCLEX-RN exam, applicants must submit a North Carolina Board of Nursing Identification Document (received following submission of the examination application), school transcripts, a registration payment of $200 to Pearson VUE Testing Centers, and an Authorization to Test. The nursing board recognizes pre-licensure out-of-state programs approved by other State Boards of Nursing. Nursing graduates from outside North Carolina must submit school transcripts and go through the same process. Upon receipt of all documents, the nursing board declares the applicant eligible to take the NCLEX-RN exam through an Authorization to Test sent via email, an authorization valid for 180 days. The computerized test, taken by appointment, requires a minimum of 75 questions covering four areas (with some subcategories): safe, effective care environment; psychosocial integrity; physiological integrity; and health promotion and maintenance.
Since North Carolina is a Compact State, nurses licensed in the state receive reciprocity, meaning they need no additional licensure from North Carolina. RNs must renew their license every two years by requesting licensure by renewal at a cost of $100. Nurses must hold an active license in the state, meet the Continuing Competence requirement, and apply within 90 days of the license's expiration.
Certified nursing assistants (CNAs) do not require licensure in North Carolina. They do, however, need certification, a process overseen by the North Carolina Department of Health and Human Services. Aspiring CNAs must pass the National Nurse Aide Assessment Program (NNAAP) exam for placement on the State Aides Nurse Registry. They acquire the knowledge necessary to pass the test by enrolling in a DHHS-approved program. However, some learners may receive “training waivers," which allows them to take the NNAAP exam within 45 days. These exemptions may cover nursing students, EMTs, and those who complete out-of-state nurse aide programs.
Once students complete a program or receive a training waiver, they schedule the test, administered by Pearson VUE Testing Centers. The NNAAP exam, comprising written and skills sections, costs $120 for registration. Test takers may choose either a written or oral NNAAP examination. The written examination consists of 70 multiple-choice questions; the oral alternative consists of 60 multiple-choice questions and 10 multiple-choice reading comprehension questions administered through a recording on an MP3 player. The skill evaluation requires the applicant to perform five randomly selected nurse aide skills, rated by a Nurse Aide Evaluator.
Once candidates pass the NNAAP exam, they automatically get placed on North Carolina's State Nurse Aide I Registry as a certified CNA in the state. CNAs remain on the registry for 24 months. Renewal requires that CNAs demonstrate employment under RN supervision in the 24 months. If CNAs do not meet this requirement, then they must undergo training or retraining and pass a new competency examination. Learners may access a free practice exam and candidate handbook from Pearson.
The process for licensed practical nurse licensure in North Carolina mirrors the one required for RNs. The North Carolina Board of Nursing requires that candidates complete a board-approved program that usually lasts three semesters. Before completing the program, learners must apply to the North Carolina Board of Nursing for licensure by examination, which requires a $75 application fee. They will receive a North Carolina Board of Nursing Identification Document following submission of the examination application. LPN candidates must submit the Identification Document and official school transcripts to the nursing board, and pay a registration payment of $200 to Pearson VUE Testing Centers.
When the applicant meets all the requirements, the nursing board declares him or her eligible to take the NCLEX-PN exam and sends an Authorization to Test through email. The computerized test, valid for 180 days, requires a minimum of 85 questions that cover four areas (with some sub-categories): safe, effective care environment; psychosocial integrity; physiological integrity; and health promotion and maintenance.
Nursing candidates from out of state who have completed a program approved by other State Boards of Nursing submit their transcripts and go through the same process. Renewal of LPN licensure requires an application through the Nurse Gateway 90 days before the license expires. LPNs seeking renewal must hold an active license in North Carolina, meet the required Continuing Competence requirements, and pay a $100 fee to the North Carolina Board of Nursing.
Nurse practitioners (NPs) in North Carolina begin the NP registration process as registered nurses with a postgraduate certificate from a nationally accredited NP program and a master's degree in nursing. NPs, jointly regulated by the North Carolina Board of Nursing and the North Carolina Medical Board, must obtain Nurse Practitioner Registration and Approval to Practice to work in North Carolina. RNs complete a one-time application for NP registration and pay a $25 fee. They must submit another online application for Approval to Practice. This requires that NPs supply information about RN licensure in North Carolina or a Compact State. Since NPs work under a physician's approval, they must also provide information about the collaborating/supervising physician and the affiliated practice.
In addition, applicants must mail the following documents to the NC Board of Nursing: Identification Document, NP education documents, verification of national nurse practitioner certification, verification of NP license/practice from other states, and disclosure of any malpractice claims. They must also pay a $100 fee per physician for NP non-volunteer status, or $20 per physician for NP volunteer status.
Once the board accepts all documents and processes the application, RNs receive the Approval to Practice and certificate by email. NPS must renew the Approval to Practice annually by providing evidence of RN licensure in North Carolina or one held in a Compact state valid for practice in North Carolina.
Career Outlook for Nurses in North Carolina
As of May 2017, North Carolina employed over 99,000 registered nurses, with the annual mean salary for this group rounding out at $61,330. According to BLS, North Carolina offers the best job prospects for nursing professionals in the region, employing more RNs than Virginia, Kentucky, Tennessee, or South Carolina. Many nursing schools in North Carolina, such as UNC's School of Nursing, have enrolled a greater number of nursing students in recent years thanks to new online RN programs. In North Carolina, the location quotient for nurses also ranks above the national average at 1.15.
While hospitals still serve as the main employer of registered nurses, graduates can also gain employment at long-term care facilities and outpatient care centers. North Carolina boasts the third and fifth highest-concentrated metropolitan areas for RNs in the country. Greenville represents the third, with a location quotient of 2.48, while Durham-Chapel Hill is fifth and employs 13,070 nurses alone. What's more, Piedmont secures the highest employment of RNs of any nonmetropolitan area in the United States.
Employment Data For RNs in North Carolina
As of May 2017, North Carolina employed 99,210 registered nurses earning an annual mean wage of $62,560, according to the BLS. North Carolina's location quotient for nurses stands at 1.13. The state offers the highest RN employment opportunities compared to the following states in the region -- South Carolina, Virginia, Kentucky, West Virginia and Tennessee.
RNs considering where to live in North Carolina should consider that Durham-Chapel Hill and Greenville enjoy the highest concentration of jobs in the state's metro areas, with 11,700 and 4,150, respectively. Piedmont and the southeast coastal areas boast the highest nonmetro employment in this occupation with 6,200 and 4,620 jobs, respectively. Across the nation, the majority of RNs work in hospitals, which also pay the highest annual mean wage of $75,820 compared to outpatient care centers, $75,680; home health care services, $70,230; and offices of physicians, $66,890.
Employment Data For CNAs in North Carolina
Certified nursing assistants, or nursing aides, provide basic patient care under the direction of nursing staff. The BLS notes that North Carolina employed 62,820 CNAs in May 2017, who earned an average mean wage of $24,680. North Carolina's location quotient for CNAs stands at 1.43. The state offers much higher CNA employment opportunities compared to states in the region -- South Carolina, Virginia, Kentucky, West Virginia, and Tennessee.
CNAs find the most employment in the state's metropolitan areas, with the highest concentration of jobs in Asheville and Hickory-Lenoir-Morganton with 4,200 jobs each; Greenville, 1,970; and Goldsboro, 1,200. The southeast coastal area ranks at the top of BLS's national list of nonmetropolitan areas with the highest employment at 6,350. Also on that list is Piedmont with 5,370. Across the nation, the majority of CNAs work in nursing care facilities with 594,460 positions, followed by hospitals with 365,360. Hospitals also happen to pay the highest annual mean wage at $30,640 followed by nursing care facilities at $27,470.
Employment Data For NPs in North Carolina
Nurse practitioners around the the country have a rosy job growth rate of 31% between 2016 and 2026, way above the 7% national average, and also much higher than that of registered nurses at 15%. As of May 2017, BLS notes that 4,130 NPs hold employment in North Carolina, earning an average mean wage of $106,320. North Carolina's location quotient for NPs stands at 0.82. Compared to four neighboring states, North Carolina offers more employment opportunities for NPs compared to South Carolina, West Virginia, and Kentucky.
BLS does not provide data on areas in the state with the most employment numbers for NPs. However, nurses in the Piedmont, Winston-Salem, Jacksonville, Hickory-Lenoir-Morganton, Wilmington, and southeast coastal areas earn more than other areas in the state topping $100,000 in annual mean wages. Durham-Chapel Hill takes the top spot with $124,120. Across the nation, doctors' offices employ the most NPs with 77,840 positions, followed by hospitals with 42,220, and outpatient care centers at 15,500. Hospitals and outpatient centers pay the most with annual mean wages at $111,850 and $111,690, respectively.
Biggest Hospitals in North Carolina
State, local, and private hospitals account for 61% of all nurse employment in the U.S., followed by ambulatory healthcare services at 18%. The presence of bigger hospitals in a state translates to more opportunities for nursing professionals and represent the first places graduates look for employment; hospitals also serve as many students' first choices for fellowships and internships. Several nursing schools in North Carolina partner with area hospitals, such as the Brody School of Medicine at East Carolina University and Vidant Health. Charlotte features the most hospitals in the state with seven.
- Duke University Medical Center: This flagship teaching hospital of the Duke University Health System boasts about 11,000 full-time employees. In FY18, the Durham-based hospital admitted roughly 42,000 patients and serviced over 1,000,000 outpatient visits. It has more than 940 hospital beds and 59 operating rooms, and it is equipped to receive Level I trauma cases.
- Vidant Medical Center: This flagship of Vidant Health boasts 900-plus hospital beds and 35 operating rooms, providing patient care to 29 counties in eastern North Carolina. In 2013, Vidant Medical Center, which employs a workforce of 7,000, received Magnet designation for nursing excellence. Currently, it stands as the third-largest Level I Trauma Center in the nation.
Additional Nursing Resources in North Carolina
- North Carolina Nurses Association: This ANA affiliate helps graduates of nursing schools in North Carolina thrive in their nursing careers by providing networking opportunities, mentorships, and continuing education. NCNA helps nurses, many of whom may have graduated from online nursing degree programs, remain on the cutting edge of the latest industry developments and innovations.
- NAPNAP - North Carolina Chapter: The North Carolina chapter of NAPNAP advocates nationally for child health and advanced nursing practice. NAPNAP amplifies the voice of several outreach efforts and promotes optimal health for children.
- North Carolina Association of Nursing Students: This student branch of the North Carolina Nurses Association helps new nurses transition from nursing school in North Carolina to full-time careers. NCANS remains a fixture for all nursing students, from those who earn an online nursing degree to those who choose to pursue a diploma, ADN, or BSN program in North Carolina.
- Area Health Education Centers in North Carolina: NC AHEC works with nursing students and nursing schools in North Carolina to support improvement and innovation in healthcare education and services in the region, especially for underserved populations. It was established in 1972 in partnership with the UNC-CH School of Medicine and is responsible for tripling the number of AHECs in the state in just three years.
Accredited Online Nursing Programs in North Carolina
If you're interested in an online nursing degree, then you should start by taking a comprehensive look at all of the available options. The following database includes information on all of the ADN, BSN, RN-to-BSN, MSN and DNP online nursing programs in North Carolina. This tool can help you compare your options and choose the right school based on your long-term career goals.