NCLEX for Nursing

The TOEFL Exam and the NCLEX

Educational Testing Service (ETS) produces the TOEFL, which stands for the Test of English as a Foreign Language. It is an examination intended to assess the academic English language proficiency of non-native English speakers. It is an essential component for non-native English speakers who are planning to work or study as nurses in an English speaking country. The test is generally not necessary if you are coming from a country in which English is a first language or if you attended a nursing school in which the textbooks were in English.

Many schools, licensing boards, and institutions require a passing TOEFL score from foreign students and employees. Both the NCLEX Examination Committee and the CGFNS (the Commission on Graduates of Foreign Nursing Schools, who are occupied in the education, registration, and licensure of healthcare professionals worldwide) are among those that accept the TOEFL as proof of English language ability.

Test Areas Covered

According to the Educational Testing Service, the TOEFL exam measures reading, listening, speaking, and writing skills.


The reading section may test your ability to identify a main idea, to have enough of a vocabulary to deduce meaning from reading, to tell the difference between important and less important information, and to understand tones of writing.


The listening section may evaluate your ability to identify main points, to respond correctly to and identify the point of a discussion; and to have enough of a foundation of grammar and vocabulary to be able to identify important details. It may also test your ability to understand meaning from context, to make appropriate connections, to identify emotion or intent from tone, and to distinguish between more and less important information.


The speaking section tests for clarity of speech and how well the meaning and intent of your words come across to a listener. It covers areas such as grammar, context appropriate vocabulary, pronunciation, intonation, clarity, flow of words, and volume. It may also review your ability to stay on topic, to structure sentences, and to speak without excessive difficulty.


This section will generally cover areas of skill such as spelling, grammar, order, and appropriate word choice. It may also examine your ability to stay on topic, to provide relevant details, and to identify fact versus opinion.

Test Taking

There are TOEFL testing centers available in 180 different countries including the United States. The TOEFL comes in a paper-based format at some locations, but is more frequently given as an internet based test referred to as the TOEFL iBT. Test takers are allowed up to a total of four hours to complete the exam.

Exam Breakdown

The reading section takes from 60 to 100 minutes and the listening section is 60 to 90 minutes long. The speaking section is 20 minutes long and consists of six tasks, each of which you will have 30 seconds to prepare for and one minute to respond to. The writing section is broken up into two sections; one you will have 20 minutes to complete, and for the other you will have 30 minutes to finish.

Preparing for the NCLEX

The NCLEX state boards is an examination that is required in order to get your nursing license in the United States. In order to take the NCLEX most state licensing boards will require foreign nurses to have gone through an exam and visa screen process provided by CGFNS. Part of that process includes the requirement of a passing TOEFL score.

Several testing steps must be completed before taking the NCLEX:

Step one

The first step to preparing for the NCLEX is taking the TOEFL. A passing score for the web-based test is a 207. If you do not score high enough you may take the test again. There is no limit for the amount of times it may be taken. If a local TOEFL testing facility is unavailable, you may be able to take a similarly accepted English language test such as the IELTS to meet the English proficiency requirement.

Step two

After taking the TOEFL you can have those results sent to the CGFNS (Commission on Graduates of Foreign Nursing Schools) and move on to the second step of taking the CGFNS exam and going through their verification process. This must be done within two years of taking the TOEFL. The CGFNS can be taken in your country of residence if testing centers are available. Most state licensing boards in the United States will require you to have both the CGFNS exam results as well as the NCLEX results; however, some states have different requirements so make sure to check with your state licensing board where you plan to practice nursing to check their requirements. Even if the state you intend to practice in does not require the CGFNS you may want to take it anyway as it will help you to obtain an occupational visa.

Step three

Upon successful completion of both the CGFNS and the TOEFL you will be ready to take the NCLEX exam, which is given in the United States to visa holders who have applied to take the exam and intend to work in the US as nurses.