International nurse has trouble passing English proficiency exam, seeks waiver

[Nurse Beth, MSN]

Language proficiency in nursing is not just about speaking English; it's about ensuring safe, effective, and compassionate care. It directly impacts patient safety, care quality, patient trust, and clinical outcomes.

Every state requires some means to ensure your English proficiency, which includes an assessment by credentialing agencies such as CGFNS (Commission on Graduates of Foreign Nursing Schools) to verify whether your nursing education was conducted in English. 

For contact information for all U.S. BONs, visit the NCSBN (National Council of State Boards of Nursing).

Alternative Exams

Each state's Board of Nursing (BON) has different requirements, including which language comprehension test is necessary and whether they accept waivers. 

The Test of English as a Foreign Language (TOEFL) is generally widely accepted by state BONs. TOEFL is computer-based and uses American English.

Some states accept the International English Language Testing System (IELTS), which uses British English elements (spelling, accent). Check with Florida, New York, and Oregon BONs. Some find the speaking part of the test easier the TOEFL, but this may depend on your country of origin.

States that May Not Require TOEFL Under Specific Conditions

Some states may waive the TOEFL requirement if your education was conducted in English. However, this decision is made individually and at the BON's discretion.

For example, California is a popular state for internationally educated nurses (IENs). It is generally more lenient regarding language proficiency than other states. English proficiency may be waived if you completed your nursing education in English, and this is verified through the CGFNS or other credentialing bodies.

Here is a list of states that are not the most strict. This list is not exhaustive, but it is a starting point. Be sure to verify the most recent guidelines with each licensing board, as these are subject to change.

• Texas
• Florida
• New York
• Georgia
• Virginia
• Michigan
• Illinois

Improve Language Skills

Even if you obtain a waiver, visa screening and potential employers may require testing.

Another option is to improve your English skills. There are many online study aids and courses to prepare for language comprehension tests.

Best advice? Regularly take full-length practice tests under timed conditions. Practice answering questions within the time limits. Each section has specific time constraints, so it's important to pace yourself. This will help you build stamina and familiarize yourself with the test format. Review your mistakes carefully to understand areas that need improvement.

• Set a study schedule. Plan your time. Create a study plan that breaks down your preparation into manageable daily sessions. Start early to avoid cramming.
• Use TOEFL prep materials. Invest in official TOEFL books or prep courses. These often come with practice tests.
• Reading. Practice reading academic articles, journals, or news websites to improve your comprehension.
• Listening. Listen to podcasts, TED Talks, or news in English to get accustomed to different accents and topics.
• Speaking. Record yourself speaking on various topics, then listen and critique your pronunciation and fluency. Try to mimic native speakers.
• Writing. Write essays or summaries of articles and get feedback from teachers or peers.
• Focus on vocabulary. Learn academic vocabulary, as the TOEFL often tests your understanding of complex terms.
• Use flashcards, apps, or word lists to help you memorize new words.
• Consider a TOEFL preparation course. If you need more structured help, consider a TOEFL prep course, available either online or in person, to receive targeted guidance.

Finally, consistency is key! Even if you only practice for an hour a day, regular practice is more effective than cramming sessions.

By following these steps, you'll be better equipped to tackle the TOEFL with confidence.

Best wishes,

Nurse Beth