Internationally trained nurses who want to practice in the United States must prove English proficiency as part of the licensure process. Each state board of nursing sets its own English requirement, and the two tests nurses most commonly choose between are the Michigan English Test (MET) and the Test of English as a Foreign Language (TOEFL iBT). Both are recognized, but they differ meaningfully in cost, format, difficulty, and how many state boards accept them. This guide compares MET and TOEFL iBT directly — score requirements, test format, key differences, state board acceptance, and a clear framework for deciding which one to book.
Table of Contents
Score Requirements Comparison
Most state boards of nursing set per-skill minimums for English proficiency rather than relying on a single overall score. The thresholds below reflect the typical ranges published by boards that accept each test — but exact numbers vary by state, and some boards impose an overall minimum on top of the per-skill minimums. Always confirm the current requirement with your specific board before booking your test.
| Requirement | MET | TOEFL iBT |
|---|---|---|
| Listening | 56+ (varies by state) | 22+ |
| Reading | 55+ (varies by state) | 22+ |
| Writing | 57+ (varies by state) | 21+ |
| Speaking | 48+ (varies by state) | 26+ |
| Overall minimum | Varies — often 57–62 | Varies — often 83–84 total |
A notable point for nurses: TOEFL iBT tends to demand a higher Speaking threshold (26+) than MET, and many internationally trained nurses find the TOEFL speaking section harder because it requires you to read or listen to a source before responding. MET speaking, by contrast, is recorded and asks you to respond more directly to prompts without integrating outside material. This can make the speaking bar easier to clear on MET — provided your state board accepts it.
Format Comparison
Beyond the score thresholds, the two tests are structured very differently. MET uses four separately timed sections plus an explicit grammar component; TOEFL iBT integrates skills across sections, meaning you may have to read a passage, listen to a lecture, and then write about both in a single task. The table below summarizes every format dimension side by side.
| Feature | MET | TOEFL iBT |
|---|---|---|
| Cost | ~$150 | ~$200+ |
| Duration | 155 min (2hr 35min) | ~200 min (3hr 20min) |
| Sections | 4 separate timed | 4 integrated |
| Speaking | 10 min, recorded, 5 tasks | ~17 min, recorded, 4 tasks |
| Writing | 45 min, 2 tasks (email + essay) | 50 min, 2 tasks (integrated + essay) |
| Reading | 65 min, 50 MCQ | 54–72 min, 30–40 questions |
| Listening | 35 min, 50 MCQ | 41–57 min, 28–39 questions |
| Grammar section | Yes (25 questions) | No |
| Results | ~5 business days | ~6 days |
The format differences have real consequences for preparation. Because MET is shorter and its sections are independent, you can prepare for each skill in isolation and walk into the test with a clear sense of what each section demands. TOEFL's integrated tasks require you to hold information from multiple sources in your head and synthesize it under time pressure — a skill that takes dedicated practice to build. MET also returns scores slightly faster (~5 business days vs ~6 days), which matters when you are racing a licensure deadline.
Key Differences
While both tests measure the same underlying English proficiency, the way they measure it creates practical advantages and disadvantages for different types of test takers. Four differences matter most for nurses.
MET has an explicit grammar section (25 questions)
MET is one of the few English proficiency tests that tests grammar directly with a dedicated 25-question section embedded in the Reading component. If you studied English formally in school — as many internationally trained nurses did — this is a genuine advantage. Grammar points are predictable (verb tenses, articles, prepositions, sentence structure), and a few weeks of focused practice can lift your score meaningfully. TOEFL has no grammar section; grammar is assessed only indirectly through your Writing and Speaking output.
TOEFL has integrated tasks (read-listen-write)
TOEFL iBT asks you to read a passage, listen to a related lecture, and then write or speak about both — all within a tight time limit. These integrated tasks are harder for many test takers because they require you to synthesize information from multiple sources while the clock runs. MET keeps each skill separate, so you never have to combine listening and writing in a single timed task. If you struggle with multitasking under pressure, MET is the friendlier format.
MET speaking is a simpler, recorded format
MET Speaking lasts 10 minutes and involves 5 tasks, all recorded into a microphone with no examiner interaction. You describe pictures, talk about personal experience, give opinions, and try to persuade. There is no live conversation and no need to read or listen to a source before responding. The format is predictable and self-paced within each task. Many nurses find this far less stressful than a live interview.
TOEFL speaking requires reading/listening then responding
TOEFL Speaking runs about 17 minutes with 4 tasks. Several tasks require you to read a short passage or listen to a conversation or lecture, and then respond orally within a strict time window. The cognitive load is higher: you must comprehend the source material, organize your thoughts, and deliver a coherent answer before the timer cuts you off. This complexity is a major reason some nurses prefer MET.
State Board Acceptance
Acceptance is the single biggest factor in choosing between MET and TOEFL for nursing licensure. TOEFL is accepted by all 50 state boards, while MET is accepted by 34. If your target state does not accept MET, the decision is made for you — you must take TOEFL. If your state accepts both, the other factors (cost, format, your strengths) come into play.
| Factor | MET | TOEFL |
|---|---|---|
| States accepting | 34 state boards | 50 state boards (all states) |
| TruMerit/CGFNS | Yes | Yes |
| At-home accepted for licensure | No | Yes (but check board) |
| Nursing-specific content | No | No |
Neither test includes nursing-specific content — both are general English proficiency exams. The nursing knowledge is tested separately through the NCLEX-RN. Both MET and TOEFL are accepted by TruMerit (formerly CGFNS International), which is the credential evaluation gateway most state boards rely on. One important difference: TOEFL's at-home option (TOEFL iBT Home Edition) may be accepted for licensure by some boards, whereas MET Digital (remote, at-home proctoring) is not accepted for U.S. nursing licensure — only in-person, proctored MET scores count. Always check with your specific board before relying on an at-home test.
Which Should You Choose?
If your state board accepts both tests, the choice comes down to cost, format preference, and your personal strengths. Here is a simple framework.
Choose MET if:
- Your state board accepts it — this is the first box to check. See our state-by-state MET acceptance guide for the full list.
- You want a lower cost — MET is roughly $150 vs $200+ for TOEFL, a meaningful saving if you need to retake.
- You prefer an all-MCQ format in Listening and Reading, with no mixed question types to learn.
- You are strong in grammar — MET's 25-question grammar section rewards nurses who studied English formally.
- You want a shorter test day — 155 minutes vs ~200 minutes for TOEFL.
Choose TOEFL if:
- Your state doesn't accept MET — TOEFL is accepted in all 50 states, so it always works.
- You need maximum flexibility across states — if you may apply to multiple states or are unsure where you will practice, TOEFL keeps every door open.
- You are comfortable with integrated tasks — reading, listening, then writing or speaking about the material suits your learning style.
- You need an at-home testing option that some boards accept for licensure (MET Digital is not accepted for licensure).
Preparation Tips
Whichever test you choose, targeted practice beats generic study. Here are the highest-leverage preparation steps for nurses.
- Practice MET's grammar section specifically. It is 25 questions and many nurses miss points here unnecessarily. Drill verb tenses, articles, prepositions, and sentence structure until they are automatic.
- Practice professional email writing. MET Writing includes an email task — a format TOEFL does not use. Learn the conventions of a structured professional email (greeting, purpose, body, closing) and practice completing one in 15–20 minutes.
- Time your full-length practice tests. MET is 155 minutes and TOEFL is ~200 minutes. Build stamina by sitting a full mock test under timed conditions at least twice before your real test date.
- Use our free MET practice tests for each skill: Listening, Reading, Writing, and Speaking. They mirror the official MET format and include AI-powered scoring so you can track your progress.
- Identify your weak areas early. Take a diagnostic practice test first, then spend 70% of your study time on your weakest section. A focused approach lifts your overall score faster than studying everything evenly.
For a deeper dive into MET nursing requirements, see our complete U.S. nursing licensure guide and the full list of states that accept MET.