Short answer: As of 2026, foreign-educated registered nurses seeking a US VisaScreen certificate typically need IELTS Academic 6.5 overall with a minimum of 7.0 in Speaking — the benchmark published by HRSA and applied by TruMerit (formerly CGFNS). OET, TOEFL iBT, PTE Academic and Cambridge are also accepted; confirm on the official site.
To work as a registered nurse in the United States, an internationally educated nurse must clear three separate hurdles: prove nursing knowledge (by passing the NCLEX-RN or the TruMerit Qualifying Exam), prove credentials and English through a VisaScreen certificate required for the occupational visa, and obtain a license from a US state board of nursing.
English proficiency sits inside the VisaScreen step, which is mandated by federal law (Section 343 of the 1996 IIRIRA). The required scores are set by the Health Resources and Services Administration (HRSA) and were last revised effective 12 May 2026.
English test scores accepted for VisaScreen (registered nurses)
| English test | Minimum score for registered nurses (as of 2026) |
|---|---|
| IELTS Academic | 6.5 overall, with a minimum of 7.0 in Speaking |
| OET (healthcare-specific) | Grade C+ in Reading, Writing and Listening; Grade B in Speaking |
| TOEFL iBT | 81 overall, with at least 57 in Reading, Listening and Writing and 24 in Speaking |
| Pearson PTE Academic | 55 overall, with no section below 50 |
| Cambridge English (B2 First / C1 Advanced / C2) | 176 overall on the Cambridge scale, with 185 in Speaking |
| TOEIC | No longer accepted for VisaScreen (removed by HRSA effective 12 May 2026) |
What this means for you
Most internationally educated nurses reach the English bar through either IELTS Academic or the OET, which is written around clinical tasks such as referral letters and patient histories and is often the friendlier option for nurses.
Whichever test you choose, the score report must be sent to TruMerit directly by the testing organisation — self-reported scores or photocopies are not accepted — and is generally only valid if it is under two years old.
You may be exempt from the English exam altogether if your entry-level nursing education was taught in English in a country such as the United Kingdom, Ireland, the United States, Australia, New Zealand, South Africa, Jamaica, Barbados, Trinidad and Tobago, or Canada (except Quebec, apart from a short list of approved schools).
Remember that VisaScreen English proof is separate from your state board of nursing's own licensure requirements, and some states set additional English rules on top of the federal screen.
Before you rely on these numbers
Requirements are set by the relevant authority and change; always confirm the current requirement on the official source: HRSA — Foreign Health Care Worker Requirements and the TruMerit (CGFNS) VisaScreen page. Scores and accepted tests here were reviewed against the HRSA table effective 12 May 2026; check both pages before you book any exam.