English Proficiency Exam Requirements for Foreign-Educated Nurses

To work as a nurse in the United States on an occupational visa, a foreign-educated nurse must pass one of seven approved English proficiency exams and meet the minimum score set by federal regulation. These English proficiency exam requirements for foreign-educated nurses are enforced through the VisaScreen certificate issued by CGFNS International, and no consular officer can admit a healthcare worker without that certificate.¹ Nurses who completed their nursing education in English in a small list of approved countries are exempt from testing entirely.

Who Can Skip the English Exam

You do not have to sit for an English proficiency test if you completed your entry-level professional nursing education in an approved English-speaking country and English was the language of instruction, including textbooks. Both conditions have to be true.²

The approved countries are:

Australia
Canada (except Quebec)
Ireland
New Zealand
United Kingdom
United States

The United States counts, which matters for nurses who trained originally in a non-English-speaking country and later completed a U.S. nursing program. CGFNS verifies the exemption by reviewing an official transcript. If instruction was not in English, or if the school sits outside these countries, the exemption does not apply and you have to test.

One boundary worth flagging: some state boards of nursing keep their own, sometimes broader, lists of exempt countries for state licensure. The list above governs the federal VisaScreen requirement only.

The Seven Accepted Tests and Passing Scores

CGFNS currently accepts seven standardized English proficiency exams for VisaScreen. Each one covers reading, writing, listening, and speaking, but the formats and scoring scales differ. The minimums below apply to registered nurses and other healthcare workers whose occupation requires a bachelor’s degree.²

TOEFL iBT

The internet-based Test of English as a Foreign Language is the most widely used option. Registered nurses need a total score of at least 83, with a minimum speaking score of 26.³ The federal regulation itself lists the older paper-based (540) and computer-based (207) TOEFL formats for RNs, so the iBT thresholds reflect CGFNS’s conversion to the current format.⁴

IELTS Academic

This has to be the Academic module, not General Training. You need an overall band score of 6.5 with a spoken band of 7.0.⁴ The speaking threshold sits higher than the overall requirement, so plan practice accordingly.

TOEIC

The Test of English for International Communication comes in two parts. The Listening and Reading section requires a combined 725. The Speaking and Writing section requires 160 in speaking and 150 in writing.⁴ Both parts have to be completed. TOEIC content leans toward workplace rather than academic English.

PTE Academic

The Pearson Test of English Academic is computer-based with fast score turnaround. The overall minimum is 55, with no individual section below 50. Effective December 1, 2024, CGFNS added a separate speaking requirement of 63, up from the previous floor of 50.² Anyone who tested before that date under the old thresholds should confirm with CGFNS whether their scores are still accepted.

OET

The Occupational English Test is the only accepted exam built specifically for healthcare professionals. Tasks mirror real clinical work: writing referral letters, taking patient histories, explaining treatment plans. Because CGFNS periodically updates the required grade, verify the current minimum on the CGFNS VisaScreen page before you register.

Cambridge English

CGFNS accepts three Cambridge Assessment English qualifications: B2 First, C1 Advanced, and C2 Proficiency. The minimum on the Cambridge English Scale is 176 overall with 185 in speaking.⁵

Michigan English Test

The MET, developed by the University of Michigan, requires an overall score of 55 and a speaking section score of 55.⁵ It is less commonly used than TOEFL or IELTS but fully recognized.

What the Exams Cost

Registration fees vary by test and by country. In the United States, approximate costs are:

TOEFL iBT: around $270, though fees range from roughly $173 to $475 depending on country.
IELTS Academic: $280 to $340 depending on the test center.
OET: $455 for the full four-subtest exam at a U.S. venue or through OET@Home.⁶
PTE Academic: roughly $180 to $250 depending on location.

Sending official score reports to CGFNS costs extra. Each additional TOEFL iBT score report is $29.⁷ Other providers charge similar per-report fees, and retakes cost the full registration each time.

How Long Scores Stay Valid

English proficiency scores are not permanent. IELTS scores are valid for two years from the test date, and most other major exams follow a similar two-year window. For the CGFNS Certification Program specifically, English scores must come from a test taken within one year of the qualifying exam date.⁵ Test too early and your scores can expire before your credentialing wraps up.

There is no cap on retakes. OET lets you resit individual subtests instead of the whole exam, which helps if you cleared three sections and fell short on one.⁸ TOEFL iBT and IELTS require you to take the entire test again. Before booking an OET resit, confirm with CGFNS that scores from single-subtest retakes will be accepted for your file.

Sending Scores to CGFNS

The testing provider has to send your score report directly to CGFNS. Self-reported scores and photocopies are rejected. Log into your provider’s portal (ETS for TOEFL, IDP or British Council for IELTS, Pearson for PTE, and so on) and request an official score send.

For TOEFL iBT, use CGFNS institutional code 5907. Entering the wrong code is one of the most common causes of delay. The name on your test registration has to match your passport exactly. Material discrepancies like a different surname or a missing middle name can cause CGFNS to reject or delay your file; smaller variations like an initial versus a full middle name should be documented with supporting identification.

Electronic delivery typically takes five to ten business days to appear in the CGFNS system. Keep your confirmation email and any tracking number, and monitor the status through your CGFNS online account until scores are matched to your application.

If You Do Not Meet the Minimum Score

Without a qualifying English score, CGFNS will not issue the VisaScreen certificate, and without VisaScreen a consular officer or immigration judge cannot admit you as a healthcare worker.¹ There is no alternative pathway around the requirement for visa-based nursing employment.

If your scores fall short, you can retake the exam as often as you need. CGFNS does not issue a denial that blocks future applications; the file stays incomplete until qualifying scores arrive. Federal regulation requires CGFNS to maintain published due-process policies allowing applicants to question eligibility determinations and test results.⁴

One more thing to plan for: even after your VisaScreen certificate is in hand, your state board of nursing may impose its own English proficiency requirement for licensure. Some boards accept the VisaScreen scores; others ask for separate proof or set higher thresholds. Check the specific requirements of the state where you intend to practice before you schedule an exam, so you take a test that satisfies both the federal and the state bar.

1
Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens
2
CGFNS International. VisaScreen Visa Credentials Assessment
3
National Council of State Boards of Nursing. A Minimum English Proficiency Standard for the Test of English as a Foreign Language Internet-Based Test (TOEFL iBT)
4
eCFR. 8 CFR 212.15 – Certificates for Foreign Health Care Workers
5
CGFNS International. CGFNS Certification Program
6
OET. How Much Does OET Cost
7
ETS. TOEFL iBT Test Registration Fees
8
OET. Test Regulations