For international nurses, understanding English exam requirements across the U.S. can feel confusing, especially when every state has its own rules.

This guide breaks down state requirements into simple categories so you can quickly understand where and how you may qualify.

Why Do International Nurses Need to Take an English Proficiency Exam?

International nurses need to take an English proficiency exam because most U.S. Boards of Nursing (BONs) require proof that they can communicate effectively in English before granting licensure. Strong English communication skills are essential for providing safe patient care, collaborating with healthcare teams, and understanding medical documentation and instructions.

Which English Proficiency Exams Are Accepted for International Nurses?

Several English proficiency exams are accepted by U.S. Boards of Nursing for international nurses seeking licensure in the United States, including:

• TOEFL (Test of English as a Foreign Language)
• IELTS (International English Language Testing System)
• PTE (Pearson Test of English)
• OET (Occupational English Test)
• In Select States: MET (Michigan English Test), TOEIC (Test of English for International Communication), Cambridge, CELBAN (Canadian English Language Benchmark Assessment for Nurses), iTEP (International Test of English Proficient) 

Many states use similar scoring benchmarks when evaluating English proficiency exam results.

Common examples include:

• TOEFL: 83 – 84 overall with 26 speaking
• IELTS: 6.5 overall, 7 speaking
• PTE: 55 overall

These benchmarks are commonly accepted in states such as Tennessee, Washington, Utah, Pennsylvania, and Oregon (when required). As a result, preparing for one exam may help you meet licensure requirements in multiple states.

English exams should be taken at the appropriate time in your immigration process since the results are only valid for two years. Most Boards of Nursing require an active (unexpired) English proficiency exam result when reviewing a licensure application.

However, not all states require the same exams, and some offer exemptions depending on your education or experience. Because requirements can change over time, it’s important to work with a trusted advisor to ensure you have the most up-to-date information so you can prepare for the right exam based on your goals.

U.S. States With Flexible Multi-Exam Options

These states accept multiple exam types and often provide flexibility with scoring options. This means that you have more choices in how you meet the requirements, which can make the process faster and more accessible.

• Alabama
• Alaska
• Arkansas
• Delaware
• District of Columbia (D.C.)
• Illinois
• Kentucky
• Louisiana
• Massachusetts
• Maryland
• Michigan
• Missouri
• Nebraska
• North Dakota
• South Carolina
• Utah
• Virginia
• Washington

TOEFL + IELTS Focused States

These states primarily rely on the two most widely recognized exams: TOEFL and iELTS. If you’ve already taken either of these exams, these states may provide a smooth path forward.

• Arizona
• Idaho
• Maine
• Nevada
• Pennsylvania
• Tennessee

Limited Exam Options

In California and Georgia, TOEFL is specifically required. However, English exams may not be required in California if you hold an active U.S. nursing license in another state.

U.S. States with Unique or Alternative Exams

Some states expand beyond standard exams and may include TOEIC, Cambridge, CELBAN, iTEP. This can be helpful if you’ve already taken a less common exam. Examples include: 

• District of Columbia (D.C.)
• Kentucky
• South Carolina
• Washington

U.S. States with No English Exam Requirement

There are some states that may not require English exam results at all. But keep in mind, even if the state doesn’t require it, immigration (such as VisaScreen) often does. Examples include:

• Colorado
• Connecticut
• Florida
• Guam
• Hawaii
• Indiana
• Minnesota
• Mississippi
• Montana
• New Jersey
• New Mexico
• New York
• Oregon
• Rhode Island
• South Dakota
• Texas 
• Vermont
• Wisconsin
• West Virginia
• Wyoming

U.S. States Offering English Exam Exemptions

This is one of the most important considerations for many international nurses. You may be exempt from English exams if:

• Your nursing education was taught in English
• You studied in certain countries (such as the UK, Canada, Australia, New Zealand, or Ireland)
• You hold a VisaScreen Certificate
• You already have U.S. nursing experience or licensure

Common exemption-friendly states include:

• Alabama
• Alaska
• Arkansas
• California
• Delaware
• District of Columbia (D.C.)
• Georgia
• Illinois
• Iowa
• Kansas
• Kentucky
• Maine
• Massachusetts
• Michigan
• Missouri
• Nevada
• Pennsylvania
• Tennessee
• Utah
• Virginia
• Washington

How to Choose the Right U.S. State

Choosing where to apply isn’t just about exam scores. At WWHS, we help match you with jobs that meet your goals as well as your experience. This includes:

• Your current qualifications
• Exam results (if already taken)
• Visa eligibility
• Your timeline goals
• Where you want to live and work

Your Journey Starts with WWHS

At WorldWide HealthStaff Solutions (WWHS), we believe your journey should feel clear, supported, and achievable. If you’re unsure whether you need to take an English exam, or which state is right for you, we’re here to help you understand your options clearly. With over 25 years of experience helping more than 12,000 international healthcare professionals immigrate to the U.S., we understand how complex this process can feel. Sign up to connect with a WWHS advisor today to discuss your options.