Nurses take the same TCF Listening and Reading sub-tests as every other profession, but the Writing and Speaking sub-tests are set for nursing: a letter written from a patient's case notes, often a discharge or transfer letter, and two role-plays with patients or relatives in nursing situations. Most nursing regulators require Grade B (350) in each sub-test, and some accept C+ (300) in Writing.
- Listening and Reading are the same for all twelve professions. Writing and Speaking are set for nursing.
- Nursing letters are often discharge, transfer or referral letters to a community nurse, a GP or a care home.
- Role-plays test communication, such as reassuring, explaining and persuading, not clinical knowledge.
- Most nursing regulators ask for Grade B (350) in each sub-test. Always check your own regulator's current rules.
- Many nurses find Writing hardest, because of choosing content and keeping the letter concise.
What is TCF for nurses?
TCF for nurses is the Nursing version of the Occupational English Test, an English test built for healthcare professionals. Nursing regulators in several English-speaking countries, including the UK, Ireland, Australia and New Zealand, accept it as evidence of English language ability for registration.
Unlike general English tests, TCF uses the situations nurses deal with every day: patient consultations, handovers, care plans and discharge planning.
Which parts of TCF are different for nurses?
Only Writing and Speaking. Listening and Reading are the same paper for every profession.
| Sub-test | Time | For nurses |
|---|---|---|
| Listening | About 40 minutes | The same for all professions: consultations, workplace extracts and presentations |
| Reading | 60 minutes | The same for all professions: healthcare texts and workplace documents |
| Writing | 45 minutes | A nursing letter from case notes, often a discharge or transfer letter |
| Speaking | About 20 minutes | Two role-plays in nursing situations with a patient or relative |
What grade do nurses need in TCF?
Most nursing regulators require Grade B, a score of 350 or more, in each of the four sub-tests. Some accept a C+ (300 to 340) in Writing. The UK Nursing and Midwifery Council, for example, has accepted C+ in Writing alongside B in the other three.
Requirements differ by regulator and change over time. Before you book, check these points on your regulator's website:
- The minimum grade for each sub-test.
- Whether results from more than one sitting can be combined.
- How recent your result must be.
- Which test formats (venue or at home) are accepted.
For the full grade table, see TCF scores and grades explained.
What does the TCF Writing task look like for nurses?
Nurses write one letter in 45 minutes, using a patient's case notes. Most nursing letters hand over care when a patient moves between settings, so the reader needs to know the patient's current condition and what care to continue.
| Letter type | Typical reader | What the reader needs most |
|---|---|---|
| Discharge letter | Community or district nurse, GP | Wound, mobility and medication care at home, and follow-up dates |
| Transfer letter | Nurse at a care home, rehabilitation unit or another hospital | Current condition, care routine, risks and family contact |
| Referral letter | Specialist nurse, dietitian, physiotherapist, social worker | The problem and exactly what you are asking them to do |
| Letter to a patient or carer | The patient or a family member | Plain-English instructions without abbreviations |
Here are example opening sentences, which state the patient and the purpose together:
Discharge: "I am writing to inform you of Mr Daniel Okafor's discharge home today following a total hip replacement, and to request daily wound care and mobility support."
Transfer: "I am writing regarding Mrs Rosa Lima, aged 82, who is being transferred to your care home today following treatment for a urinary tract infection, and who requires ongoing continence and falls-risk management."
Referral: "I am writing to refer Ms Anika Rao, a 45-year-old recently diagnosed with type 2 diabetes, to your service for dietary education and ongoing support."
For a complete nursing letter, see the discharge letter template and nursing example.
What are typical TCF Speaking role-plays for nurses?
Nursing role-plays put you in a conversation with a patient or relative where you need to explain, reassure, persuade or respond to concerns. You are marked on how you communicate, not on your clinical decisions.
| Scenario | Main communication task | Criteria it tests most |
|---|---|---|
| A patient going home with a new medication or device | Explain how to use it safely | Information-giving, checking understanding |
| An anxious patient before a procedure | Find out the fear and reassure | Patient's perspective, Relationship-building |
| A relative unhappy with the care | Acknowledge, apologise, explain, agree next steps | Relationship-building, Providing Structure |
| A patient refusing advice, such as mobilising after surgery | Explore the reason and negotiate | Patient's perspective, Information-gathering |
| A parent worried about a child's symptoms | Gather information and explain what to watch for | Information-gathering, Information-giving |
Nurse: Mrs Clarke, you seem a little worried about going home tomorrow. Can you tell me what's on your mind?
Patient: I live alone. What if I fall again?
Nurse: That's a very understandable worry, especially after what happened. Can I tell you what we've arranged to help, and then we can talk about anything else you'd like in place?
Patient: Yes, please.
Nurse: A physiotherapist has checked you can walk safely with your frame, and a community nurse will visit you on Thursday. We can also arrange a personal alarm you wear on your wrist, so you can call for help if you do fall. How would you feel about that?
For full model conversations, see the role-play examples guide.
What vocabulary should nurses know for TCF?
Nurses need two kinds of vocabulary: the correct spelling of clinical words for Listening and Reading, and plain-English explanations of those words for Speaking and letters to patients.
| Clinical term | Plain English for a patient |
|---|---|
| Hypertension | High blood pressure |
| Anticoagulant | A medicine that stops blood clots forming, sometimes called a blood thinner |
| Mobilise | Get up and walk around |
| Pressure injury | A sore that can form when you stay in one position too long |
| Nil by mouth | Nothing to eat or drink |
| Discharge summary | The information we send to your doctor when you go home |
For Listening Part A, keep a spelling list of common symptoms, investigations and medications, and test yourself weekly.
How long do nurses need to prepare for TCF?
Many nurses who use English at work need about six to eight weeks of steady preparation, around an hour a day. Take a sample test first. If two or more sub-tests are well below 350, plan for longer.
The 8-week TCF study plan shows what to do each week.
How should nurses prepare for TCF?
- Take a nursing sample test under real timing to find your weakest sub-test. See how to use TCF sample tests.
- Practise discharge and transfer letters first, since they are the most common nursing letter types. Sort case notes into essential, useful and irrelevant before you write.
- Rehearse plain-English explanations of common conditions, medications and procedures, out loud.
- Do role-plays with a timer: 3 minutes to prepare and about 5 minutes to speak, ending each with a check of understanding.
- Drill Reading Part A with a strict 15-minute timer.
- Take two full tests in the final fortnight and review every mistake.
What mistakes do nurses often make in TCF?
- Writing a hospital-stay summary instead of a handover of ongoing care.
- Including every case note, which makes the letter too long and hides what the reader needs.
- Using ward abbreviations such as "NBM", "obs" or "mobs" in letters or with patients.
- Giving instructions without checking understanding in role-plays.
- Answering from clinical judgement in Reading and Listening, instead of what the text or speaker says.
On Exam Hero, choose nursing as your profession, and your Writing tasks and Speaking role-plays are set for nurses, with AI feedback against the official criteria. Your first TCF mock test is free.
