NCLEX or IELTS first: which one internationally educated nurses should take first
Written and reviewed by Rachel Goldberg, MSN, RN, CEN · 4 min read · Updated November 2026
Short answer
Take the IELTS first if your board of nursing wants an English score before it issues your Authorization to Test; otherwise the NCLEX can come first. The NCLEX itself has no IELTS requirement, but most boards check English before licensure, and VisaScreen needs a passed NCLEX-RN plus an English score unless you are exempt.
Three different gatekeepers, three different questions
People mix up three separate checks. The NCLEX is run by NCSBN and Pearson VUE and tests nursing knowledge only. Your state board of nursing decides whether you are eligible to test and later whether you get a license. TruMerit (the new name for CGFNS) issues the VisaScreen certificate that immigration requires for foreign health care workers.
Only the board and VisaScreen ask about English. NCSBN's Licensure of Internationally Educated Nurses manual (2023 edition) says licensing bodies must evaluate the English proficiency of internationally educated nurses as part of licensure. It treats English as a board requirement, listed beside education and background checks, rather than as a condition set by the exam.
So the real question is not NCLEX versus IELTS. It is when your chosen board wants the English score in its own application sequence, and when you will need VisaScreen for a visa.
When your board sets the order for you
Some boards collect the English score before they release you to test. The Texas Board of Nursing, as of November 2026, tells internationally educated NCLEX applicants to submit proof of a passing score on an English proficiency exam the board accepts if their program was not taught in English, alongside a credential evaluation report, fingerprints and the Texas Nursing Jurisprudence Exam.
Texas reviews the file for an Authorization to Test only after the last required item arrives. In that state, a missing IELTS result holds up your NCLEX date, so the English test effectively comes first. Other boards order things differently, so read your own board's application checklist before you book either exam.
How VisaScreen fits into the sequence
If you plan to work in the US on an occupational visa, VisaScreen needs both pieces. TruMerit's VisaScreen page states that registered nurses must show they passed either the NCLEX-RN or TruMerit's Nurse Qualifying Exam, and must present an approved English test score unless they qualify for an exemption.
The approved list is Cambridge English (B2 First, C1 Advanced or C2 Proficiency), TOEFL iBT, Academic IELTS, the Michigan English Test, OET and PTE Academic. Note that the page names Academic IELTS, not General Training. TruMerit publishes the minimum scores in a table it says was updated effective May 12, 2026, so check that table rather than an older blog post. TruMerit also does not accept the at-home versions of English exams.
Nurses whose entry-level education took place in the United Kingdom, Australia, Canada (except Quebec), New Zealand, Ireland or the United States, with English as the language of instruction and textbooks, can skip the English test for VisaScreen.
A quick way to decide your own order
If your board requires an English score before it issues the Authorization to Test, take the IELTS first and send the score straight from the test provider, since Texas, for example, will not accept applicant copies. If your board does not ask for English until licensure or at all, you can sit the NCLEX first and take the IELTS while you wait for VisaScreen paperwork.
If you studied in one of the exempt countries in English, you can skip the English test for VisaScreen, though you still need a passed NCLEX-RN and your board can set its own English rule. In every case, check how long each body accepts a score, because an IELTS result that expires before your file is complete means paying for a second sitting.
As a benchmark, NCSBN's recommended IELTS standard for nurse licensure, presented to its Delegate Assembly in August 2005, is a 6.5 overall band with no module below 6.0. Boards are free to set their own minimums, so treat that number as a reference point, not your target.
Sources
TruMerit (formerly CGFNS): VisaScreen Visa Credentials Assessment. NCLEX-RN or Nurse Qualifying Exam required for RNs, approved English tests incl. Academic IELTS, score table effective May 12, 2026, exempt countries.
Texas Board of Nursing: Licensure by Examination. English proficiency score, CES report, fingerprints and NJE required before an ATT for internationally educated applicants; reports must come from the issuing agency.
NCSBN: Licensure of Internationally Educated Nurses, A Resource Manual (2023). Licensing bodies must evaluate English proficiency of internationally educated nurses; CFR exemptions.
NCSBN: Recommending a Nursing-specific Passing Standard for the IELTS Examination. NCSBN recommended IELTS standard of 6.5 overall with no module below 6.0, presented to the Delegate Assembly in 2005.
Common questions
Do I need IELTS to take the NCLEX?
Not for the NCLEX itself. Whether you need an English score before testing depends on your board of nursing. Texas, for example, asks internationally educated applicants whose program was not taught in English for a passing English score before it issues an Authorization to Test.
Does VisaScreen accept IELTS General Training?
TruMerit's VisaScreen page lists Academic IELTS as the accepted IELTS version, not General Training. It also accepts TOEFL iBT, OET, PTE Academic, the Michigan English Test and the Cambridge B2, C1 and C2 exams.
Can I use OET or TOEFL instead of IELTS?
For VisaScreen, yes: both are on TruMerit's approved list. For your board, check its own list. Texas publishes a list of acceptable English proficiency exams and minimum scores, and other boards do the same on their application pages.