IELTS Speaking 7 in All Five Countries: the English Scores Nurses Need, and Why Studying in English Is Not Enough

Published 17 October 2026 · Luke, co-founder of NCLEX BANK · 11 min read

Start preparing to work as a nurse abroad and the numbers arrive early: "IELTS 7", "OET B", "TOEFL 4.5". What is harder to find is which country wants which score, from which test, at which step. This article lines up the English requirements for nurses in the United States, the United Kingdom, Australia, New Zealand and Ontario, Canada, each from the regulator's own page. Put side by side, one line runs through all five: IELTS Speaking 7 in every one of them. And one thing surprises most people trained in English: studying nursing in English in the Philippines, India, Nigeria or Kenya does not, on its own, excuse you from the test.

1. The minimums side by side: Speaking is the line

Start with IELTS Academic, the test accepted in the most places:

Now the OET, the test written for health professionals. Its scores run from 0 to 500, and grade B starts at 350:

The pattern is plain. Speaking never drops below IELTS 7 or OET 350, and the US and Australia ask 360. Writing is where regulators relax: IELTS 6.5 almost everywhere, and OET 300 (grade C+) in the UK and New Zealand. Nurses' English requirements are drawn around speaking.

The bigger differences are not in the scores. They are in which tests count and at which step the score is checked. Before those, one question most readers of this page will have.

2. Studied in English? You probably still need a score

If your nursing degree was taught in English, it is natural to assume you are excused. For the US visa screen, that is true only for a short list of countries. TruMerit, which issues the VisaScreen certificate, exempts an applicant from the English test only if both of these are true:

• The entry-level professional education took place in the United Kingdom, Australia, Canada (except Quebec), New Zealand, Ireland or the United States
• English was the language of instruction, including the textbooks

The Philippines, India, Nigeria, Kenya, Ghana, Pakistan and the Gulf states are not on that list. A nurse who studied entirely in English in Manila or Kochi still needs a passing score for VisaScreen.

The other regulators have their own routes. The UK's NMC also accepts evidence of being "qualified in English" or of recent practice in English, and the Nursing Council of New Zealand has English evidence pathways for nurses educated or registered in certain countries, at the Council's discretion. Every one of them always accepts the test route. If you are unsure whether a pathway fits you, the test is the route that never fails on a technicality.

3. United States: the visa screen asks, the NCLEX does not

The NCLEX itself does not require an English test score. NCSBN's candidate bulletin (April 2026) leaves eligibility to each state board of nursing and says nothing about English tests. In the US the exam is in English only, and dictionaries are not allowed. (The first article in this guide covers how the exam itself works.)

The score is asked for in two other places.

The visa: VisaScreen

To get a US work visa as a nurse educated abroad, you need a VisaScreen certificate from TruMerit. One of its checks is English, and the scores are set by the US Department of Health and Human Services. HRSA publishes them. For registered nurses, for tests taken from 12 May 2026:

• IELTS (Academic only): Overall 6.5, Speaking 7
• TOEFL iBT: Overall 4.5, Speaking 4.5, Reading / Listening / Writing 3.5
• OET: Speaking 360, Reading 340, Writing 350, Listening 320
• PTE Academic: Overall 55, Speaking 76, Reading / Writing / Listening 62
• Cambridge (B2 First, C1 Advanced, C2): Overall 169, Speaking 194
• MET (Michigan English Test): Overall 58, Speaking 59

TOEIC and the paper TOEFL dropped off the list in that update. Three practical points:

• No at-home tests. TruMerit does not accept the at-home versions of English tests
• Scores go directly from the test provider to TruMerit, not from you (TOEFL institution code 9988)
• VisaScreen also needs the NCLEX-RN. For RNs, TruMerit needs proof that you passed either its Nurse Qualifying Exam (NQE) or the NCLEX-RN

HRSA also notes that a certificate meeting these standards does not by itself prove you can enter the US or work as a nurse. The score is one document on the way to a visa.

The licence: some states ask, some do not

• New York lists no English test in its licence requirements for nurses educated abroad. Its FAQ says a graduate of a school that did not teach in English may be asked for one before a limited permit is issued
• California's board FAQ asks for TOEFL from applicants whose first nursing education was not in English, with minimums of Reading 22, Listening 22, Speaking 26 and Writing 22 on the old 0–30 sections. The FAQ gives no IELTS score
• Texas requires a test, with the same scores as HRSA's 2026 table (Cambridge not accepted)

In NCSBN's 2024 survey of state boards, 51 boards (98%) accepted TOEFL and 41 (79%) accepted IELTS. Some boards do not take IELTS. Once you know your state, check its board directly.

4. Doctors use a different line, on the same test

Doctors heading to US residency do not use HRSA's table. Their English requirement comes from ECFMG, as part of ECFMG Certification, and it is OET Medicine for everyone, whatever their native language or language of medical school. Put the two US lines next to each other:

In speaking and writing, the nurse's line is higher, by 50 points in writing. In listening and reading, the doctor's line is higher. Neither body explains the difference. One more rule separates them: ECFMG requires all four scores in one test administration, and a doctor who misses one sub-test retakes all four.

Notice the doctor's row: 350, 350, 300, 350. It is exactly the line the UK and New Zealand set for nurses. The lesson works in both directions: check the line for your profession and your destination, not the one a colleague passed.

5. Which test: where each one is accepted

• IELTS Academic: all five, and VisaScreen. Ontario is the only one of the five that also accepts IELTS General Training, and it accepts the IELTS One Skill Retake
• OET: all five, and VisaScreen. Writing and speaking use nursing tasks; speaking is a role-play with an interlocutor
• TOEFL iBT: the US and Australia. Not the UK, New Zealand or Ontario. For Australia, select "Taking TOEFL for Australia" when you book
• PTE Academic: the US, Australia and Ontario. Not the UK or New Zealand

The NMC explains why it accepts only IELTS Academic and OET: it requires a test in which the speaking element is tested by a person, not by a computer. TOEFL has you speak into a headset; PTE is scored mainly by machine.

The practical rule is simple. If you have not settled on one country, take IELTS Academic or OET, which work everywhere. If you are certain it is the US, TOEFL is also open to you, and it is the test California's board names.

6. TOEFL moved to a 1–6 scale in January 2026

Since 21 January 2026, TOEFL iBT reports scores from 1 to 6 in half-point steps instead of 0 to 120. The overall score is the average of the four skills, and HRSA's new "4.5 overall" is on this scale.

On ETS's concordance table, a new 4.5 overall corresponds to 86 or above on the old scale, and 5.0 to 95 or above. HRSA's old line was 81 with Speaking 24, so the overall bar has effectively moved up.

Some regulators still write the old scale. Australia's table for tests from 23 April 2026 still says 91 overall, Speaking 24, and California still uses the old 0–30 sections. ETS says new score reports will show an estimated 0–120 total for a two-year transition. Check which scale your regulator reads.

7. Two years, and the rules for retakes

Scores generally last two years. ETS will not send TOEFL scores more than two years old. The UK, Australia and Ontario take results from the last two years; New Zealand wants all sittings within the three years before you apply.

For the US this interacts with the order of steps. VisaScreen needs your NCLEX-RN pass and takes scores straight from the test provider. A score from years before your NCLEX may no longer be sendable when you need it.

• Combining two sittings: Australia allows two sittings within 12 months (same test, with floors in each sitting). The UK allows two sittings of the same test within 12 months, both no more than two years old. New Zealand allows scores achieved within 12 months of your first sitting. Ontario wants all components in one complete attempt
• IELTS One Skill Retake: accepted by Australia and Ontario (Ontario: within 60 days of the original test); not by the UK
• At-home or online tests: not accepted by TruMerit, Australia or New Zealand. The UK does not accept IELTS Online but does accept OET@Home

8. The English no test measures: one NCLEX question

An IELTS 7 does not mean you are used to the English of the NCLEX. NCLEX questions are written in the English of American wards and American daily life. One question from the bank shows the difference:

NCLEX BANK explains every question this way: the correct option, each distractor, and the everyday American words a question can turn on.

Summary

1. Speaking is the line. IELTS Speaking 7 in all five; OET Speaking 350, and 360 for the US visa screen and Australia. Writing is usually IELTS 6.5
2. Studying in English is not an exemption by itself. VisaScreen waives the test only for education in the UK, Australia, Canada (except Quebec), New Zealand, Ireland or the US, taught in English
3. In the US, the NCLEX does not ask for a score. VisaScreen does (from 12 May 2026: IELTS 6.5 with Speaking 7; TOEFL 4.5; OET Speaking 360), and some states do for the licence
4. Doctors have a different OET line (ECFMG: 350, 350, 300, 350, all in one sitting)
5. Undecided on a country? IELTS Academic or OET. TOEFL and PTE do not work for the UK or New Zealand
6. Scores last about two years, so do not sit your English test too long before the NCLEX

If you are aiming at the US, your English score and your NCLEX-RN pass end up on the same VisaScreen file. Ten NCLEX questions are free if you want to see the exam's English for yourself, and the pass-rate article shows why the first attempt matters most.

Frequently asked questions

What IELTS score do nurses need to work in the USA?

For the VisaScreen certificate needed for a US work visa, HRSA's table for registered nurses, for tests taken from 12 May 2026, is IELTS Academic 6.5 overall with Speaking 7. TOEFL iBT needs 4.5 overall, 4.5 in Speaking and 3.5 in the other three skills; OET needs Speaking 360, Reading 340, Writing 350 and Listening 320. TruMerit accepts only the Academic version of IELTS and no at-home tests. The NCLEX itself does not require an English score, but some state boards do for the licence.

What OET score do nurses need?

It depends on the destination. For the US visa screen: Listening 320, Reading 340, Writing 350, Speaking 360. Australia (tests from 23 April 2026): Listening 350, Reading 360, Writing 350, Speaking 360. The UK and New Zealand: 350 in Listening, Reading and Speaking and 300 in Writing. Ontario: Listening 350, Reading 330, Writing 320, Speaking 350. Doctors applying for ECFMG Certification need OET Medicine with 350 in Listening, Reading and Speaking and 300 in Writing, in one sitting.

Do nurses from the Philippines or India need an English test if they studied in English?

For the US VisaScreen, yes. TruMerit exempts applicants from the English test only if their professional education was in the United Kingdom, Australia, Canada (except Quebec), New Zealand, Ireland or the United States and was taught in English, including the textbooks. Nursing education in the Philippines, India, Nigeria or Kenya does not qualify, even if it was entirely in English. Other regulators have their own evidence routes, such as the NMC's in the UK, but the test route is always accepted.