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My English is fluent. Is this still relevant?

Often yes. Conversational and professional fluency are not the same as reading dense clinical stems at speed for six hours, and the candidates most surprised by this are usually the most fluent ones. The test is whether you finish comfortably in time on a full-length timed run, not how your English feels day to day.

This comes up on NCLEX for Internationally Educated Nurses, where it is answered in the context of the work itself.

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