International nurses preparing to move to the U.S. for work must now be aware of new English proficiency testing requirements set forth by the U.S. Department of Health Resources and Services Administration (HRSA).

These requirements were updated and took effect on May 12, 2026, affecting several English proficiency exams and minimum score requirements. As part of the immigration and certification process, HRSA establishes English-language requirements for foreign healthcare workers, including nurses.

This article explains what changed, who is affected, and what steps you should take next.

Why Did the Requirements Change?

According to HRSA, the updates were made to strengthen communication standards for healthcare professionals working in the United States.

Strong English communication skills are important for:

• Patient safety 
• Communication with healthcare teams 
• Understanding medical instructions 
• Documentation and reporting 

Several of the new requirements focus on speaking and communication skills.

What Are the Changes & Which English Exams Are Affected?

Several English proficiency exams now require higher minimum scores.

The Pearson PTE Academic exam introduced higher score requirements:

• The minimum Speaking score increased significantly to 76 from 50.
• Reading, Writing, and Listening now each require a minimum score of 62 instead of 50.
• However, the overall required score remains unchanged at 55.

The Occupational English Test (OET) increased its minimum score requirements across all four sections:

• Speaking increased to 360 from 350.
• Writing increased to 350 from 300.
• Reading increased to 340 from 300.
• Listening increased to 320 from 300.

Michigan Language Assessment (MET) requirements also changed:

• The Speaking score increased to 59 from 55.
• The overall minimum score increased to 58 from 55.

The Test of English for International Communication (TOEIC) is no longer accepted for Registered Nurses and other bachelor-level healthcare workers entering the United States.

Which English Exams Have Stayed the Same?

Some English proficiency exams did not receive new score changes. IELTS, which stands for the International English Language Testing System, still requires a minimum overall score of 6.5 and a minimum Speaking score of 7.0. There are currently no specific minimum sub-scores required for Listening, Reading, or Writing.

The TOEFL Internet-Based Test (iBT) also did not receive new passing score changes. TOEFL iBT now uses a revised scoring scale, but the HHS passing standards remain aligned with a minimum overall proficiency score of 4.5. Candidates must also achieve a minimum Speaking score of 4.5 and minimum Reading, Listening, and Writing scores of 3.5 each.

Because State Boards of Nursing may still have their own licensing requirements, candidates should always confirm requirements with their recruitment advisor, credentialing organization, or state licensing board before scheduling or retaking an exam.

For additional information, you can review the newest HRSA official requirements here.

What If You Took Your Exam Before May 12, 2026?

All candidates who completed their English exams before May 12, 2026 still qualify under the previous scoring requirements.

However, you may still need to:

• Submit existing scores before expiration deadlines. 
• Retake an exam if scores no longer qualify. 
• Complete additional testing if required by your certification organization. 

Because every case is different, it is important to confirm your status as soon as possible by speaking with your advisor.

What Should You Do Next?

1. Check Which Exam You Took or Plan to Take
2. Confirm whether your exam is affected by the new rules.
3. Remember:
4. IELTS requirements remain unchanged 
5. TOEIC is no longer accepted for nurses 
6. PTE, OET, and MET score requirements may be higher now 
7. Review Your Scores Carefully
8. If you have already completed an exam, compare your scores against the newest requirements. Pay special attention to the speaking and communication sections.
9. Talk to Your Advisor
10. Do not guess about your eligibility status. Your recruitment advisor can help you understand:
11. Whether your scores still qualify. 
12. Whether you need to retest. 
13. Which exam options are available to you. 
14. Prepare Early if You Need to Retest
15. Testing appointments can fill quickly. If you need a new exam or updated scores, it is best to prepare and schedule your test early.

How WWHS Is Supporting Candidates

These English proficiency requirements apply to healthcare worker certification programs authorized by U.S. Citizenship and Immigration Services (USCIS). All USCIS-authorized organizations that issue Health Care Worker Certificates must follow the updated federal standards.

WorldWide HealthStaff Solutions (WWHS) is actively monitoring these updates and helping candidates understand the new requirements. Additionally, we have an ESL coaching program to help you prepare for and pass your English exams. Our English Support program includes:

• Targeted Exam Strategies
• Practical Exercises
• Real-Time Feedback

Our team will continue supporting international nurses throughout the immigration and onboarding process by helping candidates:

• Understand testing updates. 
• Review next steps. 
• Prepare for required exams. 
• Stay informed about future changes. 

Changes to immigration and certification requirements can feel stressful, especially when English is not your first language. The most important thing is to stay informed and ask questions early!