Short answer: As of September 2026, a foreign-educated registered nurse needs IELTS 6.5 overall with at least 7.0 in Speaking for a US VisaScreen certificate. That is HRSA's minimum, applied by TruMerit (formerly CGFNS).
HRSA's table changed on 12 May 2026: IELTS stayed the same, but OET, TOEFL iBT, PTE and Cambridge got new minimums and TOEIC was dropped. Confirm on the official pages.
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 | Registered nurses: minimum from 12 May 2026 | Previous minimum (24 May 2022 to 12 May 2026) |
|---|---|---|
| IELTS | 6.5 overall, 7.0 in Speaking | 6.5 Academic, 7.0 in Speaking |
| OET (healthcare-specific) | 360 Speaking, 340 Reading, 350 Writing, 320 Listening | Grade C+ in Reading, Writing and Listening; Grade B in Speaking |
| TOEFL iBT | 4.5 overall and 4.5 Speaking; 3.5 in Reading, Listening and Writing (new 1 to 6 scale) | 81 overall; 57 in Reading, Listening and Writing; 24 in Speaking |
| Pearson PTE Academic | 55 overall, 76 Speaking, 62 in Reading, Writing and Listening | 55 overall, no section below 50 |
| Cambridge English (B2 First / C1 Advanced / C2) | 169 overall, 194 Speaking | 176 overall, 185 Speaking |
| Michigan English Test (MET) | 58 overall, 59 Speaking | 55 overall, 55 Speaking |
| TOEIC | Not on the list | 725 Listening and Reading, plus 160 Speaking and 150 Writing |
Source: HRSA's list of tests and scores for foreign health care workers, as of 12 May 2026 (checked September 2026). TruMerit says the new scores apply to anyone who took an English exam after 12 May 2026. It also does not accept at-home versions of any English test.
Note one wording change: the previous table said "IELTS Academic" for registered nurses, while the 2026 table lists IELTS without naming a module. Until TruMerit confirms that General Training is accepted for your profession, book Academic.
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.
What IELTS score is required for US nurses? The 7.0 Speaking trap
The 6.5 overall is rarely what stops nurses. The Speaking minimum is. Your overall band is an average, so a high overall can hide a Speaking score below 7.0, and VisaScreen checks both numbers. Here is how three real-looking profiles come out:
| Listening | Reading | Writing | Speaking | Overall | VisaScreen (RN) |
|---|---|---|---|---|---|
| 6.5 | 6.5 | 6.0 | 7.0 | 6.5 | Meets both minimums |
| 7.0 | 7.0 | 6.5 | 6.5 | 7.0 | Fails: Speaking is below 7.0 |
| 6.0 | 6.0 | 6.0 | 7.5 | 6.5 (6.375 rounds up) | Meets both minimums |
The second nurse has the strongest overall band and is the only one who fails. Treat 7.0 in Speaking as a hard floor, then check that your other three skills keep the average at 6.5 or above. You can test combinations in seconds with the Band Score Calculator.
Step by step: the English part of VisaScreen
- Check the exemption first. If your entry-level nursing programme was taught in English in one of the countries TruMerit lists, you may not need a test at all. Confirm with TruMerit before paying for one.
- Pick the test. IELTS and OET are the usual choices. Book a test at a test centre, because TruMerit does not accept at-home versions. Since paper-based IELTS ended in mid-2026, IELTS is taken on computer, and Speaking is still a face-to-face interview with an examiner.
- Target the full profile. For IELTS that means at least 7.0 in Speaking and 6.5 overall on the same report.
- Send the scores directly. The testing organisation must send your result to TruMerit. Uploaded copies and self-reported scores are not accepted.
- Watch the date. A result is generally accepted only while it is under two years old. If your exam was after 12 May 2026, the new score table applies to it.
- Finish the other two hurdles. Pass the NCLEX-RN or the TruMerit Qualifying Exam, and meet your state board of nursing's licensing rules. Both are separate from the English check.
IELTS or OET for US nursing?
Both are on HRSA's 2026 list, and neither is easier across the board. OET builds its tasks around clinical work, such as a referral letter and a role-play with a patient.
From 12 May 2026 its minimums differ by skill: 360 in Speaking, 350 in Writing, 340 in Reading and 320 in Listening. IELTS uses general and academic topics, with one condition that matters: 7.0 in Speaking.
As a decision rule, if Speaking is your weakest skill, price in the chance of a retake on either test. If you write clinical English every day at work, OET's Writing task will feel familiar. Our comparison of IELTS vs OET goes through the formats side by side.
What if you miss the score?
If only one skill is short, usually Speaking, IELTS offers a One Skill Retake at many centres, so you can resit that section without sitting the whole test again.
Ask TruMerit whether it accepts a One Skill Retake result before you book one, because acceptance is decided by the organisation receiving the score. If two or more skills are short, a full retake is usually the cleaner route. Before either, practise the section that failed.
Our Speaking practice gives an estimated band on the four Speaking criteria, and the Writing Checker does the same for Writing tasks.
Common mistakes that delay VisaScreen
- Sitting an at-home test. TruMerit does not accept at-home versions of any English exam.
- Using the old minimums for OET, TOEFL, PTE or Cambridge on an exam taken after 12 May 2026.
- Sending a scan or photocopy instead of having the test provider send the result.
- Assuming NCLEX-RN covers English. It does not. The English exam is a separate requirement inside VisaScreen.
- Letting the result expire while the rest of the file is still in progress.
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 checked against the HRSA table effective 12 May 2026 in September 2026. Check both pages before you book any exam.