Nurses moving abroad usually sit one of three exams: the NMC Test of Competence (UK), NCLEX-RN (United States, Canada and the Australian pathway) or a Gulf regulator's computer-based licensing exam. Local graduates in countries such as Japan, South Korea and the Philippines sit national nursing exams. India registers nurses by qualification, with no national licensing exam.
How nurses are licensed around the world
Nursing regulation is more fragmented than medicine. In the United States and Canada, state or provincial boards licence nurses, but most use the same exam, NCLEX-RN, from NCSBN. In the UK the Nursing and Midwifery Council runs a two-part Test of Competence for nurses trained outside the UK. In Australia the Nursing and Midwifery Board uses an Outcome-Based Assessment. Gulf states each run their own computer-based test.
A few countries register nurses by qualification, with no exam at all. India is one: the Indian Nursing Council and state councils register graduates, and the NORCET exam is a recruitment test for AIIMS posts, not a licence. An Indian nurse who wants to work abroad therefore meets a licensing exam for the first time in the destination country.
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Exams by destination
United Kingdom: NMC Test of Competence
Part 1 is a computer-based test (CBT) taken at a Pearson VUE centre, including centres outside the UK. It has two parts: Part A is numeracy with 15 short-answer questions, and Part B is clinical with 100 multiple-choice questions. That is 115 items in three hours. Part 2 is an OSCE of 10 stations, held in the UK. For first sittings, the NMC lists the CBT at £83, the OSCE at £794, the qualification evaluation fee at £140 and the registration fee at £153, a total of £1,170, excluding visa, flights and accommodation. The English language requirement is IELTS Academic 7 in listening, reading and speaking and 6.5 in writing, or OET grades of B in listening, reading and speaking and C+ in writing, with all four met in one test or by combining two sittings of the same test.
United States and Canada: NCLEX-RN
NCLEX-RN is a computer-adaptive test that includes Next Generation NCLEX case studies. Its length varies with your performance, up to five hours. NCSBN lists the registration fee at USD 200 for US licensure and a further USD 150 international scheduling fee if you sit it outside the United States. Canadian candidates pay CAD 360 plus a CAD 150 international fee. You also apply to the state or provincial board, which decides if you may test.
Australia: NMBA Outcome-Based Assessment
Internationally qualified registered nurses sit NCLEX-RN first, with a registration fee of USD 200 for Australian licensure, and then an OSCE at an assessment centre in Adelaide. Midwives follow a separate assessment.
Ireland, New Zealand and Germany
Ireland: the NMBI Overseas Aptitude Test, run through RCSI, has a theory MCQ and an OSCE, and is a compensation measure for nurses whose qualification is not recognised. New Zealand: the Nursing Council's competence assessment has a theory exam and an OSCE. Germany: non-EU nurses may take an oral and practical Kenntnisprüfung, while German graduates sit the state exam.
Gulf states
Saudi Arabia: the Saudi Nursing Licensure Examination has 200 single-best-answer questions in two 100-question blocks (up to 10% pilot items), at Prometric. Qatar: Registered General Nurse, 150 MCQs in three hours, 50% cut. Abu Dhabi: DOH Registered Nurse, 150 MCQs in three hours, with some nursing titles assessed only orally. Dubai: DHA professional assessment, a Prometric test and sometimes an oral. UAE federal: MOHAP evaluation exam with a 60% pass mark. Bahrain: NHRA, 2.5 hours at Prometric. Oman: OMSB at Pearson VUE. Kuwait: a Ministry of Health nurse exam has been reported at 150 questions in 170 minutes, but confirm with the ministry.
Home-country national exams
Japan: 240 items in one day (50 required and 190 general and situational). South Korea: about 295 items across 8 subjects in one day. Philippines: the Nurse Licensure Examination, five Nursing Practice subjects of 100 items each over two days. Singapore: the SNB licensure exam is a computer-based MCQ.
Comparison of the major nursing exams
| Exam | Country | Format | Items and time | Fee |
|---|---|---|---|---|
| NMC CBT | UK | Numeracy short answer plus clinical MCQ | 115 items, 3 hours | £83 (first sitting) |
| NMC OSCE | UK | Practical, 10 stations | 10 stations | £794 (first sitting) |
| NCLEX-RN | USA, Canada, Australia pathway | Computer-adaptive plus case studies | Variable length, up to 5 hours | USD 200 + USD 150 international |
| SNLE | Saudi Arabia | Single best answer | 200 items, 2 blocks of 100 | See SCFHS |
| DHP RGN | Qatar | MCQ | 150 items, 3 hours, 50% cut | See DHP |
| DOH RN | Abu Dhabi | MCQ | 150 items, 3 hours | See DOH |
| NLE | Philippines | MCQ, 5 subjects | 5 x 100 items, 2 days | See PRC |
| National exam | Japan | MCQ | 240 items, 1 day | See MHLW |
Fees were taken from the regulator pages listed below. "See" means we did not confirm a figure.
International mobility: common routes
- Choose the destination by exam format. If you prefer one long adaptive test, NCLEX-RN opens the United States, Canada and Australia with one exam. The UK needs a CBT and then an OSCE.
- Check your education against the regulator's rules. Hours, clinical placements and the nursing programme are reviewed first.
- Sit the knowledge test at home. NCLEX-RN and the NMC CBT are available at test centres outside their home countries. NMC OSCE and the Australian OSCE need travel.
- Take the language test. IELTS Academic or OET for English-speaking destinations.
- Apply for registration, a job and a visa. These steps depend on the employer and the immigration rules, not on the exam.
A nurse in Kerala can take the NMC CBT or NCLEX-RN without leaving India.
Choose a pass for NCLEX-RN
Basic, Pro and Premium passes for 1, 3 or 6 months. One exam per pass, from $30, no auto-renewal.
What to prepare
- The destination's standards of practice. The NMC tests the Code and UK practice. NCLEX-RN tests US nursing practice and priorities, including delegation and prioritisation.
- Numeracy and drug calculations. The NMC CBT Part A is numeracy. It is short answer, so there are no options to work back from.
- Clinical judgement. NCLEX-RN case studies check how you recognise cues, prioritise hypotheses and act.
- OSCE technique. Practise the stations aloud, against a checklist, with a partner.
- Units. Know the units the exam uses and be able to convert quickly.
Planning your route: a few decisions that change the cost
The same nurse can reach different destinations at very different cost and effort, so decide the order before you pay for anything.
- One exam, several destinations. NCLEX-RN serves the United States, Canada and the Australian pathway. If you are undecided between those three, preparing for NCLEX-RN keeps every option open. The NMC route is a separate exam with a separate OSCE.
- Two stages, two budgets. The knowledge test is the cheaper stage. The UK OSCE is the larger fee, and in Australia the OSCE means travel to Adelaide. Add flights and accommodation to your plan early.
- Language test timing. IELTS Academic and OET results are valid only for a limited time. Book the language test so the result is still current when the regulator reviews your application.
- Documents first. Regulators review your transcript, clinical hours and registration history before they let you test. Start document requests early, because universities and councils can be slow.
Common mistakes
- Studying only your home country's practice. The NMC expects UK practice and NCLEX-RN expects US priorities, including delegation to unlicensed assistive personnel.
- Skipping numeracy. The NMC CBT Part A is short-answer, so a rounding error costs the mark.
- Practising untimed. The CBT has 115 items in three hours, which is under two minutes per item on average.
- Booking the OSCE before the knowledge test result is secure.
- Paying for material that targets a different exam from yours.
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Frequently asked questions
What is the NMC CBT?
It is Part 1 of the NMC Test of Competence for nurses trained outside the UK. It has a numeracy section of 15 short-answer questions and a clinical section of 100 multiple-choice questions, 115 items in three hours, at a Pearson VUE centre.
How much does the NMC process cost?
For first sittings the NMC lists £83 for the CBT, £794 for the OSCE, £140 for the application and £153 for registration, a total of £1,170. Visas and travel are extra.
Does NCLEX-RN lead to registration in Australia as well?
Yes. Under the NMBA Outcome-Based Assessment, internationally qualified nurses sit NCLEX-RN and then an OSCE in Adelaide.
How much is the NCLEX-RN?
NCSBN lists a USD 200 registration fee for US licensure, plus a USD 150 international scheduling fee outside the United States. Canadian fees are in Canadian dollars.
Can I take these exams from my home country?
The NMC CBT and NCLEX-RN can be taken at test centres outside the UK and US. The NMC OSCE and the Australian OSCE are held in the UK and Australia.
Do nurses in India need a licensing exam?
Not for registration in India, which is by qualification. Nurses who move abroad must pass the destination country's exam.
What English score do I need for the NMC?
IELTS Academic 7 in listening, reading and speaking and 6.5 in writing, or OET grades B, B, B and C+ in writing. Check the NMC page for the current rules.
Which Gulf nursing exams exist?
Saudi Arabia's SNLE, Qatar's DHP exam, Abu Dhabi's DOH exam, Dubai's DHA assessment, the UAE MOHAP exam, and exams from Bahrain's NHRA and Oman's OMSB.