Fact sheet: English language skills registration standard

To practise safely in Australia, nurses and midwives must have competent English language skills. This includes being able to communicate effectively with clients, consumers, relatives and carers, as well as collaborate with other healthcare professionals and keep clear and accurate health records.

The ELS registration standard sets the requirements for English language skills to make sure all nurses and midwives can provide safe care and communicate effectively in English.

Yes. To become registered as a nurse or midwife in Australia, you must meet the requirements of the ELS registration standard to demonstrate that your English language skills are at a level that will enable you to practise safely. This is required under the National Law. The ELS registration standard helps to ensure that everyone who registers as a health practitioner in Australia has these skills, regardless of their language background.

You need to meet the ELS registration standard if:

• you are applying for registration as a nurse or midwife in Australia for the first time, or
• you are applying for registration as a nurse or midwife (including moving from non-practising to another registration type) and have not used English as your main language for a period greater than five years.

The revised ELS registration standard outlines three pathways that you can use to demonstrate your English language competence:

• Primary language pathway,
• English language test pathway, or
• Extended education pathway (intended as an exceptional pathway).

The Pathways diagram: English language skills registration standard can help you find the most appropriate pathway for your individual circumstance. 

The key changes to the NMBA ELS registration standard include:

• expanding the list of countries recognised as part of pathways to meet the standards
• removing South Africa from the recognised country list
• reducing the writing component score for the approved English language tests from IELTS 7 to 6.5 (or equivalent)
• adding the Cambridge English language skills test
• widening grounds for extending the validity of English language test results to include continuously working in appropriate roles in recognised countries
• extending the timeframe for accepting English language test results from two sittings from six months to 12 months

A comprehensive scheduled review and two wide-ranging public consultations informed the changes in the revised ELS registration standard. The revised ELS registration standard aims to provide more flexibility for applicants to meet the standard, while keeping the public safe.

If you grew up and completed all your education in Australia, the most appropriate pathway for you is the Primary language pathway.

You can either:

• demonstrate you meet the ELS registration standard through the English language test pathway or
• demonstrate you meet the ELS registration standard through the Extended Education pathway if you have completed and can provide evidence for at least five (5) years (full-time equivalent) continuous education, in English in a recognised country, which includes tertiary qualifications in the relevant professional discipline.

If your qualification as a nurse or midwife was not taught and assessed in English in one of the recognised countries, you will need to demonstrate that you meet the ELS registration standard through the English language test pathway.

The information you provide in your application for registration about your English language skills may be checked by Ahpra.

It is up to you to ensure that you maintain your level of English language proficiency once you are registered, even if you frequently communicate with patients in a language other than English.

The NMBA and Ahpra may reassess your English language skills if specific concerns arise, for example if a complaint is made about you.

Recognised countries for the purpose of the ELS registration standard means one of the following countries or territories:

• Antigua and Barbuda
• Anguilla
• Australia
• The Bahamas
• Barbados
• Belize
• Bermuda
• British Indian Ocean Territory
• Canada
• Cayman Islands
• Dominica
• Falkland Island
• Gibraltar
• Grenada
• Guernsey
• Guyana
• Isle of Man
• Jamaica
• Jersey
• Malta
• New Zealand
• Republic of Ireland
• Saint Helena, Ascension and Tristan da Cunha
• South Africa*
• St Kitts and Nevi
• St Lucia
• St Vincent and the Grenadines
• Trinidad and Tobago
• United Kingdom
• United States of America
• US Virgin Islands

* In the revised ELS standard, South Africa has been removed as a recognised country however there will be a 12-month transition period for removing South Africa as a recognised country. South Africa will no longer be considered a recognised country from 18 March 2026 

Other recognised countries may be approved by the NMBA from time to time and published on the NMBA website. The NMBA reserves the right at any time to revoke their approval of a recognised country. 

When considering expanding the recognised country list, the NMBA considered the findings of the Independent review of overseas health practitioner regulatory settings, endorsed by National Cabinet; as well as the approaches of similar regulators in the United Kingdom and New Zealand. This identified opportunities to expand the recognised country list while keeping the public safe. The countries that are recognised in the revised ELS registration standard typically deliver health and education services in English. This means the NMBA can be confident that people who qualified in these countries have a level of English that is safe for practise in Australia. 

The list of countries recognised was expanded as part of the recent review of the English language skills registration standards. Limited feedback on countries missing from the proposed list of countries was received during the consultation process and there was no supporting evidence provided in response to support including the countries that were suggested. You can read more about the consultation responses in the consultation report available on the Ahpra website.

To add new countries to the recognised countries list we need objective evidence that shows that adding the country is a safe thing to do. We also need to be able to show that the evidence can be consistently applied to applications for registration. This is to make sure we are protecting the public by only allowing people with a safe level of English to be registered and practise in Australia.

The ELS registration standard applies to all applicants who are applying for registration as a nurse or midwife in Australia. This means that all new applicants for registration must meet the ELS registration standard, regardless of their language background or visa status. The ELS registration standard aligns closely with the Department of Home Affairs (DoHA) English language requirements for skilled migration visas.

The NMBA accept a number of English language tests and these tests are also used by DoHA to assess English language skills. If you sat one of these tests as part of your application for a skilled migration visa in the past two years and you met the requirements and achieved the minimum score requirements specified in the ELS registration standard, you can use those results and do not need to sit another test.

Why is South Africa no longer a recognised country?

In the most recent review, the NMBA consulted on whether South Africa should be removed from the recognised country list. After careful consideration of the available evidence and stakeholder feedback, the NMBA decided that South Africa should be removed from the list of recognised countries to align with DoHA English language requirements at the time of the review.

The review found that qualifications across the professions are offered in South Africa by multiple education providers. In some cases, they have different entry requirements and many of these are substantially below the equivalent Australian entry level English language skills requirements. It was also found that some education providershave no English language skills minimum requirements for entry.

When will South Africa be removed from the recognised country list?

There will be a 12-month transition period for removing South Africa as a recognised country. Applicants relying on their education or work experience in South Africa as a recognised country must submit their application for registration before 18 March 2026. Applicants who are unable to submit an application by this time may need to sit an English language test to meet the revised ELS registration standard.

While the NMBA’s ELS registration standard is similar to the common ELS registration standard of most National Boards, key differences ensure that registered nurses, enrolled nurses and midwives are not disadvantaged compared with other registered health professions in the assessment of their English language skills.

The NMBA has taken the following issues into consideration in developing a professions-specific ELS registration standard:

• the different cohorts of applicants (enrolled nurses, registered nurses and midwives)
• the different lengths of courses for enrolled nurses, registered nurses and midwives
• the number of nurses and midwives who studied their profession as mature age students
• the large number of applicants for nursing and midwifery registration, including internationally qualified applicants, and
• the NMBA experience with its previous ELS registration standard, which had some key differences from the previous common ELS registration standard.

All nurses and midwives, including enrolled nurses, must be able to demonstrate the same level of English language competency to become registered and safely practise the profession. However, the NMBA has taken differences in the education of enrolled nurses into consideration when developing the ELS registration standard. Although enrolled nurses are required to demonstrate the same number of total years of education in English as registered nurses and midwives in order to meet the requirements of the Primary language pathway and the Extended education pathway, they are only required to have successfully completed a minimum of one year of a full-time equivalent pre-registration program of study in English, as part of their total education in English in a recognised country.

If English is your primary language, it is likely that you meet the ELS registration standard through the Primary language pathway.

For this pathway, you do not need to demonstrate continuous education in English over a specified number of years, however you must be able to show that you have attended and satisfactorily completed at least six years of primary and secondary education taught and assessed in English. This education must have been attended and completed in one of the recognised countries, including at least two years of education between years seven and twelve.

In addition, you must have successfully completed your relevant qualification as an enrolled nurse, registered nurse or midwife in English in one of the recognised countries. It does not matter if you have had a break from study or if you did not complete all six years of high school, if you meet the other criteria specified in the ELS registration standard.

If you sat one of the English language tests listed in the ELS registration standard within the past two years and you achieved the results specified in the ELS registration standard, you do not need to sit another test.

If your results were lower than the requirements listed in the ELS registration standard, or you sat the test more than two years ago, you may have to sit another test.

The Extended education pathway specifies that you must provide evidence that you have successfully completed at least five (5) years of continuous education taught and assessed solely in English, in a recognised country, which includes tertiary qualification in the relevant professional discipline. If you can demonstrate that you meet the ELS registration standard through this pathway, then you do not need to sit another English language test.

• Cambridge English C1 Advanced and C2 Proficiency
• IELTS Academic (paper and computer at test centre only), including One Skill Retake (OSR)
• OET (paper and computer at test centre only, any profession specific OET test is accepted)
• TOEFL iBT (paper and computer at test centre only) and
• PTE Academic (paper and computer at test centre only).

These tests are also used by DoHA to assess English language skills. If you sat one of these tests as part of your application for a skilled migration visa in the past two years and you achieved the results specified in the ELS standard, you can use those results and do not need to sit another test.

The NMBA reserves the right to review and update the list of tests accepted at any time. An up-to-date list of accepted English language tests is published on the Ahpra website. We will continue to review and update this list as new test options continue to evolve.

Some English language test providers have tests that you can take at home, such as, TOEFL iBT − Home Edition, OET@Home and IELTS Indicator. These tests are currently not accepted by the NMBA however we will continue to monitor whether these tests introduce enough safeguards to be accepted in the future. Any additional tests accepted to those listed in the ELS registration standard will be added to the list of accepted English language tests published on the Ahpra website.

The English language tests used by the NMBA to determine English language competence are also used by DoHA to determine visa eligibility. The minimum scores required to demonstrate English language competence for each test are specified in the ELS registration standard. Each test is slightly different, however the minimum scores required to meet the ELS registration standard have been benchmarked so they are set at equivalent levels across all the tests. It is not easier to achieve the required minimum scores on one test, compared with any of the others.

Test providers may offer different options to accommodate different needs. In choosing which test to sit, you should determine which test is the most suitable or convenient for you. The list of accepted English language tests published on the Ahpra website includes links to each of the test providers.

The scores required to demonstrate English language competence for the Cambridge, IELTS, OET, TOEFL iBT or PTE Academic test differ between the tests. However, the scores required to meet the ELS registration standard have been benchmarked so they are set at equivalent levels across all the tests. It is not easier to achieve the required scores on one test, compared with any of the others.

Test scores are as advised by test providers and set out in the NMBA ELS registration standard. Any changes to score requirements will be published on the NMBA’s website.

Ideally, you will be able to demonstrate that you meet the requirements of the ELS registration standard in one test sitting. However, the NMBA will accept results from a maximum of two test sittings in a twelve-month period so long as certain minimum scores are achieved in each sitting. These vary from test to test and are outlined in the ELS registration standard.

Note: This does not mean that you can only sit the test twice in the twelve-month period; you may sit the test more than twice if you wish (although this is not recommended by the testing authorities). However, only the results from two sittings will be considered by the NMBA.

The NMBA now accepts the IELTS One Skill Retake to provide further flexibility to applicants applying for registration. This is not available for the other accepted English language tests.

The IELTS One Skill Retake allows eligible test takers to re-sit one component of the test within a 60-day period if all other components and certain requirements are met. Successful completion of an IELTS One Skill Retake is not considered an additional test sitting by National Boards; however, if you are relying on results from two test sittings and an IELTS One Skill Retake, all three of these tests must have been completed within a 12-month period.

Generally, yes.

However, there are certain circumstances in which you may not have to sit another test.

1. If, within two years of sitting the test, you have been continuously working:
1. as a registered health practitioner (starting within 12 months of the test date) where English was the main language of practice in one of the recognised countries, or
2. in another relevant health, disability or aged-care related role where English was the main language of practice in one of the recognised countries and your role requires you to read, write, listen to and speak English in the working environment, and
   
   lodge your application for registration within 12 months of finishing your last period of employment,

OR



2. If, in the period since the test result was obtained, you:
1. have been continuously enrolled in a Board approved program of study (which started within 12 months of the test date) and successfully completed subjects in each semester, with no break from study apart from the education provider’s scheduled holidays, and
   
   lodge your application for registration within 12 months of finishing your last period of employment,

For the purposes of calculating time, if an applicant relies on test results from two sittings in a 12-month period, time begins to run from the date of the earlier sitting.

Results from different test providers cannot be combined.

For further information on the evidence you will need to verify your test result and your period of employment or study, please see the English language skills registration standard evidence guide.

No. If you have demonstrated that you meet the ELS registration standard through the English language test pathway, you do not need to sit another test as long as you remain registered. However, it is up to you to ensure that you maintain your level of English language proficiency once you are registered, even if you frequently communicate with patients in a language other than English.

If the two tests were taken within a twelve-month period, and the first test was taken less than two years ago, then it is possible that you now meet the ELS registration standard. Your results will need to be assessed to ensure that they meet all the criteria for multiple test sittings specified in the ELS registration standard. You should contact Ahpra to check the status of your application.

The IELTS One Skill Retake allows eligible test takers to re-sit one component of the test within a 60-day period, if all other components and certain requirements are met. Successful completion of an IELTS One Skill Retake is not considered an additional test sitting by the NMBA; however, if you are relying on results from two test sittings and an IELTS One Skill Retake, all three of these tests must have been completed within a 12-month period.

The evidence required to demonstrate secondary education taught and assessed in English in one of the recognised countries listed in the ELS registration standard may vary, depending on where it occurred.

For detailed information about the evidence you need to provide, please see the English language skills registration standard evidence guide.

The evidence required to demonstrate tertiary and/or vocational education taught and assessed in English in one of the recognised countries listed in the ELS registration standard may vary, depending on where it occurred.

You will need to provide certified copies of your transcripts for all education you are relying on to meet the ELS registration standard.

For detailed information about the evidence you need to provide, please see the English language skills registration standard evidence guide.

You should provide as much information as possible in the application form. Ahpra will consider whether the information you have provided is sufficient evidence of meeting the ELS registration standard. If not, you may need to sit an English language test.

Full-time equivalent for the purpose of education, is the successful completion of a course load which meets the education provider’s definition of full-time enrolment and does not include recognised prior learning. For example, a student enrolled in a full-time four-year undergraduate degree would be expected to complete the degree in four years. This is set by the relevant educational provider. This could include a combination of part-time courses, which together make up a full-time course load. For example, two part-time courses taken at the same time, each consisting of a 50 per cent course load that together meet the full-time load requirement. This pathway requirement is to show exposure to English in the education environment. For that reason, concurrent education, accelerated courses, fast track courses and/or additional education taken during semester breaks cannot be counted for more than one full-time equivalent course load.

For example, an applicant that has studied two programs in a year concurrently, one at half full-time equivalent and the other at three quarters full-time equivalent, could only count a maximum of one full-time equivalent year. Where a course is delivered in a shorter time such as an accelerated or fast-tracked course (for example a four-year course delivered over three years) only the duration of the delivery of the course is to be counted (i.e. the three-year course delivery period in this example).

Course loads for particular programs of study are set by educational providers.

Full time equivalent for the purpose of work means the equivalent to working full time. Full time hours typically range from 35-38 hours per week.

One year of full-time equivalent study is the maximum that you can claim in a single year, even if your subject load would normally be considered to be more than full-time.

If your course load is greater than full-time, you cannot count the additional study towards the total number of years you are claiming. For example, if you are undertaking full-time study for a particular course, but are also studying another course part-time, you cannot claim the equivalent of 1.5 times the duration of study in English.

You can count part-time studies if your overall course load is full-time equivalent. For example, you may be studying one part-time course with a 40 per cent course load and another part-time course with a 60 per cent course load. Together, this would be considered a full-time equivalent course load.

If your part-time education does not add up to a full-time equivalent course load, it cannot be counted in the Extended education pathway. You can only count your part-time course if you were studying another part-time course at the same time, and together the courses made up a full-time equivalent course load.

How the length of time of a program/course is counted may depend on the type of program/course it is. For tertiary education, a three-year undergraduate degree would be counted as three years if successfully completed full-time. For shorter vocational education programs/courses these may be counted in months or days dependent on the program/course successfully completed.

You can only count online study if the course meets the requirements in the definition for vocational education in the ELS registration standard:

Vocational education for the purpose of this ELS registration standard is education that is taught and assessed solely in English in a recognised country where:

• the level of vocational education was at the Australian Qualifications Framework Level 3 or Certificate III or higher, and
• the vocational education was delivered primarily face-to-face and required students to use English speaking, writing, reading and listening skills.

Some online courses will not meet the requirement for you to use English language speaking, writing, reading and listening skills. Courses that are delivered entirely online and do not require students to use all these English language skills to communicate are not acceptable. You may be required to provide further evidence about the program and delivery method.

It is unlikely. Traineeships and apprenticeships generally involve full-time work and workplace-based training by an employer, which is added to by some formal education with a Registered Training Organisation, whereas the Extended education pathway considers a full-time course of study that is formally assessed.

• English language skills information on the NMBA website
• Visit www.nursingmidwiferyboard.gov.au under Contact us to lodge an online enquiry form
• For registration enquiries: 1300 419 495 (in Australia) +61 3 9275 9009 (overseas callers)