Why US nurses need an English test
Foreign-educated healthcare workers seeking an occupational visa need a VisaScreen certificate, and TruMerit (formerly CGFNS) is the only organisation USCIS approves to issue it for all nine covered professions, including registered nurses and licensed practical/vocational nurses (TruMerit). VisaScreen includes passing an English language proficiency exam, and for registered nurses also passing the TruMerit Nurse Qualifying Exam or the NCLEX-RN (TruMerit).
The accepted exams are Cambridge English (B2 First, C1 Advanced or C2 Proficiency), TOEFL iBT, Academic IELTS, MET, OET and PTE Academic, and TruMerit does not accept the at-home versions of any of them (TruMerit).
VisaScreen scores for tests from 12 May 2026
The Health Resources and Services Administration published new exams and scores effective 12 May 2026, and TruMerit applies them to every exam taken on or after that date; earlier exams are certified under the previous criteria (TruMerit) (previous scores). TOEIC is no longer accepted. The table is copied from TruMerit's chart.
| Test | Registered nurses and other B.S.-level workers | Below-B.S.-level health care workers |
|---|---|---|
| TOEFL iBT | 4.5 overall, 4.5 Speaking, 3.5 Reading, Listening and Writing | 4 overall, 4.5 Speaking, 3 Reading, Listening and Writing |
| IELTS | 6.5 overall, 7 Speaking | 6 overall, 7 Speaking |
| PTE | 55 overall, 76 Speaking, 62 Reading, Writing and Listening | 47 overall, 76 Speaking, 52 Reading, Writing and Listening |
| OET | 360 Speaking, 340 Reading, 350 Writing, 320 Listening | 360 Speaking, 310 Reading, 290 Writing, 290 Listening |
| Cambridge B2 First, C1 Advanced or C2 | 169 overall, 194 Speaking | 161 overall, 194 Speaking |
| Michigan English Test (MET) | 58 overall, 59 Speaking | 53 overall, 59 Speaking |
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Exemptions and practical points
You may be exempt if your entry-level professional education took place in the UK, Australia, Canada (except Quebec), New Zealand, Ireland or the United States and English was the language of instruction, including the textbooks (TruMerit). For VisaScreen renewal only, at least 27 months' US employment in the profession can also exempt you.
Occupational and physical therapists need the same TOEFL scores as registered nurses. Because the Home Edition is excluded, book TOEFL iBT at a test centre (ETS). If you are choosing a test, compare OET vs IELTS for nurses and IELTS for nurses in the USA.
Frequently asked questions
What TOEFL score do nurses need for VisaScreen?+
For tests from 12 May 2026: 4.5 overall, 4.5 Speaking and 3.5 in Reading, Listening and Writing for registered nurses and other B.S.-level workers.
Is TOEFL Home Edition accepted for VisaScreen?+
No. TruMerit says it does not accept the at-home versions of English language proficiency exams.
Does CGFNS still exist?+
CGFNS now operates as TruMerit, which issues the VisaScreen certificate. Its statement describes it as 'TruMerit (formerly CGFNS)'.
What if I took TOEFL before 12 May 2026?+
TruMerit certifies exams taken before 12 May 2026 under the previous score criteria, which it links from its VisaScreen page.
Is TOEIC still accepted for US nurses?+
No. TruMerit stopped accepting TOEIC after 12 May 2026 because HRSA no longer lists it.
Keep reading
Related
- IELTS for nurses in the USA
- OET vs IELTS for nurses
- TOEFL 1–6 score scale explained
- Free PTE mock test
- Free IELTS mock test
- All 1712 guides
Verified against the linked official sources on 14 October 2026. Rules change: confirm on the official page before you book or apply.
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