Hi HYA,
The purpose of IELTS exam is to assess the language abilities of candidates who need to study or work in countries where English language is the only medium of communication. Specially in your case,you are a nurse,you have to interact with patients and their families,most of the time. Employers have to know that you can communicate well with clients and co-workers to ensure no mishaps happen. Kasi 90% of the time,naka-english lahat ng kausap mo. Some countries,not sure of Canada, TOEFL is not accepted