Nursing education in the United States began in the 1870s with hospital training schools modeled after the Nightingale plan. Presently there are three educational paths that students may take to become a registered nurse （RN）. These are the baccalaureate degree （BS）

the associate degree （AD） and the diploma. Accelerated nursing programs are also available for people who have a baccalaureate degree in another field. Nursing education and nursing practice in the United States is regulated by each of the 50 states. The focus of nursing education is the preparation of nurses who use critical thinking skills to provide comprehensive patient-centered care to a variety of clients. It is expected that nurses will function using evidence-based practice in a culturally competent

safe manner. Nursing schools must be approved by the state in which they exist. In addition to this

most nursing schools are also accredited

a voluntary process that is done by a non-governmental association. All graduates take the same licensing exam

a computer adaptive test that is from 75 to 265 items long. In 2008 almost 120

000 US educated graduates were first time test takers; 85.5% passed the exam. Trends in nursing education include a focus on evidence based practice

an emphasis on safety and quality

patient education and management of chronic conditions

genetics and genomics and the use of simulation in nursing education.