English Speaking Score Reduced to 50 for International Nurses Seeking U.S. Visa

The Commission on Graduates of Foreign Nursing Schools (CGFNS) has reverted to the existing Health Resources and Services Administration (HRSA) standard, lowering the Pearson Test of English (PTE) speaking score requirement from 63 to 50 for healthcare workers seeking U.S. employment-based visas. This change follows CGFNS’s September 2024 decision to raise the score to 63, driven by concerns over patient safety and a noticeable increase in healthcare workers entering the U.S. with lower speaking scores.

The decision to revert comes amid a series of challenges and changes surrounding English Language Proficiency (ELP) standards for healthcare professionals, including registered nurses, aiming to work in the United States. Immigration regulations require these workers to present a certificate from an authorized credentialing organization, known as a Visa Screen, which includes a passing English exam score for issuance. The PTE is one of several English exams used to meet this requirement.

CGFNS had previously raised the PTE speaking score to 63 in response to an alarming rise in applicants entering the U.S. with lower speaking scores, despite the potential impact on patient safety. This shift led to a significant increase in PTE applicants, from 7% in 2022 to 50% in 2024. However, despite CGFNS’s interim decision, other organizations issuing health worker certificates continued to accept lower PTE speaking scores, which allowed healthcare workers with less proficiency to enter the U.S.

Following a convening of English language proficiency test providers, CGFNS has joined other organizations in advocating for more standardized ELP scores to ensure that healthcare professionals meet the necessary communication standards.

The convening, held in January 2025, sought to develop a consensus on appropriate scores that align with patient safety needs. While the results of these discussions are expected to influence HRSA’s final decision, CGFNS’s decision to revert to the 50 score reflects a desire to align with the current HRSA standard until a more uniform approach is reached.

HRSA could soon increase the standardized English exam score across all providers. To determine the appropriate English exam score requirement to protect patient safety and safeguard healthcare professionals entering the U.S. workforce, HRSA had requested comments through the Federal Register. The agency will also review a comprehensive report on English proficiency standards in the coming month.