We approve pre-registration nursing associate programmes in England only.

Applicants to the nursing associate part of our register who do not hold an NMC-approved qualification will follow an alternate route to the register.

This route includes an evaluation of the qualification they hold. If their qualification is found not to be comparable to an NMC-approved nursing associate qualification, the applicant will be required to complete a test of competence, or undertake an approved compensation measure if trained in the EEA but outside the UK.

This blueprint gives an overview of how each of the standards for proficiency for nursing associates and associated skills and procedures may be tested in the test of competence.

How to use

The test of competence is made up of two parts: a multiple-choice computer based test (CBT) and a practical objective structured clinical examination (OSCE).

The blueprint shows how the standards of proficiency and associated skills and procedures for nursing associates may be tested in either the CBT, OSCE or both parts.

Applicants can use the blueprint to prepare for each part of the test.

The blueprint is mapped to the six platforms in our standards of proficiency for nursing associates (2018).

The six platforms are:

  1. Being an accountable practitioner
  2. Promoting health and preventing ill health
  3. Provide and monitor care
  4. Working in teams
  5. Improving safety and quality of care
  6. Contributing to integrated care

The nursing associate skills and procedures identified in Annexe A and B are also mapped in the blueprint to the six platforms.

Proficiencies marked with ‘PSP’ are patient safety proficiencies – these must be passed in the OSCE.

Platform 1: Being an accountable practitioner



May be tested by CBT

May be tested by OSCE

1.1 Understand and act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates, and fulfil all registration requirements (PSP)


1.2 Understand and apply relevant legal, regulatory and governance requirements, policies and ethical frameworks, including any mandatory reporting duties, to all areas

of practice (PSP)


1.3 Understand the importance of courage and transparency and apply the duty of candour, recognising and reporting any situations, behaviours or errors that could result in poor care outcomes



1.4 Demonstrate an understanding of, and the ability to, challenge or report discriminatory behaviour



1.5 Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or colleagues and the

action required to minimise risks to health



1.6 Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and wellbeing required to meet

people’s needs for mental and physical care



1.7 Describe the principles of research and how research findings are used to inform evidence based practice



1.8 Understand and explain the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care



1.9 Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges (PSP)

Annexe A

1.         Underpinning communication skills for providing and monitoring care:


1.1            actively listen, recognise and respond to verbal and non-verbal cues

1.2             use prompts and positive verbal and non­verbal reinforcement

1.3             use appropriate non-verbal communication including touch, eye contact and personal space

1.4             make appropriate use of open and closed questioning

1.5             speak clearly and accurately

1.6             use caring conversation techniques

1.7            check understanding and use clarification techniques

1.8             be aware of the possibility of own unconscious bias in communication encounters

1.9             write accurate, clear, legible records and documentation

1.10         clearly record digital information and data

1.11         provide clear verbal, digital or written information and instructions when sharing information, delegating or handing over responsibility for care

1.12         recognise the need for translator services and material

1.13         use age appropriate communication techniques


1.10 Demonstrate the skills and abilities required to develop, manage and maintain appropriate relationships with people, their families, carers and




1.11 Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times. Reflect on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments


1.12 Recognise and report any factors that may

adversely impact safe and effective care provision (PSP)


1.13 Demonstrate the numeracy, literacy, digital and technological skills required to meet the needs of people in their care and ensure safe and

effective practice (PSP)



1.14 Demonstrate the ability to keep complete, clear, accurate and timely records (PSP)



1.15 Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and




1.16 Act as an ambassador for their profession

and promote public confidence in health and care services


1.17 Safely demonstrate evidence based practice in all skills and procedures stated in Annexes A and B.

These have been mapped to the proficiencies and

integrated across the platforms. See individual platforms for full details.


Platform 2: Promoting health and preventing ill health



May be tested by CBT

May be tested by OSCE

2.1 Understand and apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging

with people


2.2   Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing

Annexe A

2.        Communication skills for supporting people to prevent ill health and manage their health challenges

2.1           effectively share information and check understanding about:

–        preventative health behaviours that help people to make lifestyle choices and improve their own health and wellbeing

–        a range of common conditions including: anxiety, depression, memory loss, diabetes, dementia, respiratory disease, cardiac disease, neurological disease, cancer, skin problems, immune deficiencies, psychosis, stroke and arthritis in accordance with care plans.

2.2           clearly and confidently explain to the individual and family how their lifestyle choices may influence their health. This includes the impact of common health risk behaviours including smoking, diet, sexual practice, alcohol and substance use

2.3           use appropriate materials, making reasonable adjustments where appropriate to support people’s understanding of what may have caused their health condition and the implications of their care and treatment

2.4           use repetition and positive reinforcement strategies

2.5           recognise and accommodate sensory impairments during all communications



2.6           support and monitor the use of personal communication aids

2.7          address and respond to people’s questions, recognising when to refer to others in order to provide accurate responses

2.8           identify the need for and manage a range of alternative communication techniques

2.9           engage in difficult conversations with support from others, helping people who are feeling emotionally or physically vulnerable or in distress, conveying

compassion and sensitivity.


2.3 Describe the principles of epidemiology, demography and genomics and how these may

influence health and wellbeing outcomes



2.4 Understand the factors that may lead to inequalities in health outcomes



2.5 Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural

health and wellbeing



2.6 Understand and explain the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health




2.7 Explain why health screening is important and identify those who are eligible for screening



2.8 Promote health and prevent ill health by understanding the evidence base for

immunisation, vaccination and herd immunity



2.9 Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance (PSP)

Annexe B

8.                  Preventing and managing infection:

8.1          observe and respond rapidly to

potential infection risks using best practice guidelines


8.2         use standard precautions protocols

8.3         use aseptic, non-touch techniques

8.4         use appropriate personal protection equipment

8.5         implement isolation procedures

8.6         use hand hygiene techniques

8.7        safely decontaminate equipment and environment

8.8         safely handle waste, laundry and sharps


Platform 3: Provide and monitor care



May be tested by CBT

May be tested by OSCE

3.1 Demonstrate an understanding of human development from conception to death, to enable delivery of person-centred safe and effective




3.2 Demonstrate and apply knowledge of body systems and homeostasis, human anatomy and

physiology, biology, genomics, pharmacology, social and behavioural sciences when delivering care


3.3 Recognise and apply knowledge of commonly encountered mental, physical, behavioural and cognitive health conditions when delivering care


3.4   Demonstrate the knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions

Annexe A

3.   Communication skills and approaches for providing therapeutic interventions

3.1     identify the need for and use appropriate approaches to develop therapeutic relationships with people

3.2      demonstrate the use of a variety of effective communication strategies:

–        reassurance and affirmation

–        de-escalation strategies and techniques

–        distraction and diversion strategies

–        positive behaviour support approaches.


3.5 Work in partnership with people to encourage shared decision-making, in order to support individuals, their families and carers to manage

their own care when appropriate



3.6 Demonstrate the knowledge, skills and ability to perform a range of nursing procedures and manage devices, to meet peoples’ need for safe, effective and person centred care (PSP)



Annexe B

7.   Provide support with respiratory care:

7.1    manage the administration of oxygen using a range of routes and approaches

7.2     take and be able to identify normal peak flow and oximetry measurements

7.3     use appropriate nasal and oral suctioning techniques

7.4     manage inhalation, humidifier and nebuliser devices


3.7 Demonstrate and apply an understanding of how and when to escalate to the appropriate

professional for expert help and advice (PSP)


3.8   Demonstrate and apply an understanding of how people’s needs for safety, dignity, privacy, comfort and sleep can be met (PSP)

Annexe B

2.    Provide support in meeting the needs of people in relation to rest, sleep, comfort and the maintenance of dignity:

2.1     observe and monitor comfort and pain levels and rest and sleep patterns

2.2      use appropriate bed-making techniques, including those required for people who are unconscious or who have limited mobility

2.3      use appropriate positioning and pressure relieving techniques

2.4      take appropriate action to ensure privacy and dignity at all times

2.5      appropriate action to reduce or minimise pain or discomfort

2.6      support people to reduce fatigue, minimise insomnia and take appropriate rest.


3.9 Demonstrate the knowledge, skills and ability required to meet people’s needs related to nutrition, hydration and bladder and bowel health

Annexe B

4.     Provide support with nutrition and hydration:

4.1     use contemporary nutritional assessment tools


4.2   assist with feeding and drinking and use appropriate feeding and drinking aids

4.3   record fluid intake and output to identify signs of dehydration or fluid retention and escalate as necessary

4.4   support the delivery of artificial nutrition and hydration using oral and enteral routes

5.     Provide support with maintaining bladder and bowel health:

5.1     observe and monitor the level of urinary and bowel continence to determine the need for ongoing support and intervention, the level of independence and self-management of care that an individual can manage

5.2      assist with toileting, maintaining dignity and privacy and use appropriate continence products

5.3      care for and manage catheters for all genders

5.4      recognise bladder and bowel patterns to identify and respond to incontinence, constipation, diarrhoea and urinary and

faecal retention


3.10 Demonstrate the knowledge, skills and ability to act as required to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity

Annexe B

3.   Provide care and support with hygiene and the maintenance of skin integrity:

3.1     observe and reassess skin and hygiene status using contemporary approaches to determine the need for support and ongoing intervention.

3.2        identify the need for and provide appropriate assistance with washing, bathing, shaving and dressing

3.3        identify the need for and provide appropriate oral care, dental, eye care and nail care and suggest to others when an onward referral is needed

3.4        prevent and manage skin breakdown through appropriate use of products

3.5      identify and manage skin irritations and rashes


3.6 monitor wounds and undertake wound care using appropriate evidence-based techniques.

6.   Provide support with mobility and safety:

6.1       use appropriate risk assessment tools to determine the ongoing need for support and intervention, the level of independence and self-care that an individual can manage

6.2        use appropriate assessment tools to determine, manage and escalate the ongoing risk of falls

6.3        use a range of contemporary moving and handling techniques and mobility aids

6.4        use appropriate moving and handling equipment to support people with impaired



3.11 Demonstrate the ability to recognise when a person’s condition has improved or deteriorated by undertaking health monitoring. Interpret, promptly respond, share findings, and escalate as needed (PSP)

Annexe B

1.   Demonstrate effective approaches to monitoring signs and symptoms of physical, mental, cognitive, behavioural and emotional distress, deterioration and improvement:

1.1      accurately measure weight and height, calculate body mass index, recognise healthy ranges and clinically significant low/high readings

1.2     use manual techniques and devices to take, record and interpret vital signs including temperature, pulse, respiration (TPR), blood pressure (BP) and pulse oximetry in order to identify signs of improvement, deterioration or concern

1.3     undertake venepuncture and routine ECG recording

1.4       measure and interpret blood glucose levels

1.5     collect and observe sputum, urine, stool and vomit specimens, interpreting findings and reporting as appropriate

1.8 undertake and interpret neurological observations


1.9     recognise signs of mental and emotional distress including agitation, or vulnerability

1.10     administer basic mental health first aid

1.11     recognise emergency situations and administer basic physical first aid, including basic life support.


3.12 Demonstrate the knowledge and skills required to support people with the commonly encountered symptoms including anxiety,

confusion, discomfort and pain


3.13 Demonstrate an understanding of how to deliver sensitive and compassionate end of life care to support people to plan for their end of life, giving information and support to people who are dying, their families and carers, and the bereaved. Provide care to the deceased

Annexe B

9.   Meeting needs for care and support at the end of life:

9.1  recognise and take immediate steps to respond appropriately to uncontrolled symptoms and signs of distress including pain, nausea, thirst, constipation, restlessness, agitation, anxiety and depression.

9.2   review preferences and care priorities of the dying person and their family and carers, and ensure changes are communicated as appropriate

9.3   provide care for the deceased person and the bereaved respecting cultural

requirements and protocols


3.14 Understand and act in line with any end of life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of

attorney for health



3.15 Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies (PSP)

Annexe B

10 Procedural competencies required for administering medicines safely:


10.1  continually assess people receiving care and their ongoing ability to self-administer their own medications. Know when and how to escalate any concerns.

10.2   undertake accurate drug calculations for a range of medications

10.3   exercise professional accountability in ensuring the safe administration of medicines to those receiving care

10.4   administer medication via oral, topical and inhalation routes.

10.5   administer injections using subcutaneous and intramuscular routes and manage injection equipment

10.6   administer and monitor medications using enteral equipment

10.7  administer enemas and suppositories

10.8   manage and monitor effectiveness of symptom relief medication

10.10 undertake safe storage, transportation and disposal of medicinal products


3.16 Demonstrate the ability to recognise the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions (PSP)

Annexe B

10 Procedural competencies required for administering medicines safely:

10.9 recognise and respond to adverse or

abnormal reactions to medications, and when and how to escalate any concerns


3.17 Recognise the different ways by which medicines can be prescribed



3.18 Demonstrate the ability to monitor the effectiveness of care in partnership with people, families and carers. Document progress and

report outcomes


3.19 Demonstrate an understanding of co-

morbidities and the demands of meeting people’s holistic needs when prioritising care



3.20 Understand and apply the principles and processes for making reasonable adjustments



3.21 Recognise how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent (PSP)


3.22 Recognise when capacity has changed and understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld



3.23 Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk (PSP)

Annexe B

1.   Demonstrate effective approaches to monitoring signs and symptoms of physical, mental, cognitive, behavioural and emotional distress, deterioration and improvement:

1.6     recognise and escalate signs of all forms of abuse

1.7    recognise and escalate signs of self-harm and/or suicidal ideation


3.24 Take personal responsibility to ensure that relevant information is shared according to local policy and appropriate immediate action is taken to provide adequate safeguarding and that

concerns are escalated. (PSP)


Platform 4: Working in teams



May be tested by CBT

May be tested by OSCE

4.1 Demonstrate an awareness of the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary

team, and their own role within it



4.2   Demonstrate an ability to support and motivate other members of the care team and interact confidently with them

Annexe A

4.   Communication skills for working in professional teams. Demonstrate effective skills when working in teams through:

4.1     active listening when receiving feedback and when dealing with team members’ concerns and anxieties

4.2     timely and appropriate escalation

4.3     being a calm presence when exposed to situations involving conflict

4.4     being assertive when required

4.5     using de-escalation strategies and techniques when dealing with conflict.


4.3 Understand and apply the principles of human

factors and environmental factors when working in teams (PSP)



4.4 Demonstrate the ability to effectively and responsibly access, input, and apply information and data using a range of methods including digital technologies, and share appropriately

within interdisciplinary teams



4.5 Demonstrate an ability to prioritise and manage their own workload, and recognise where

elements of care can safely be delegated to other colleagues, carers and family members



4.6 Demonstrate the ability to monitor and review the quality of care delivered, providing challenge and constructive feedback, when an aspect of

care has been delegated to others


Annexe A

5.    Demonstrate effective supervision skills by providing:

5.1     clear instructions and explanations when supervising others

5.2      clear instructions and checking understanding when delegating care responsibilities to others

5.3      clear constructive feedback in relation to care delivered by others

5.4      encouragement to colleagues that helps them to reflect on their practice.


4.7 Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the

quality of the care they provide, promoting reflection and providing constructive feedback



4.8 Contribute to team reflection activities, to promote improvements in practice and services


4.9 Discuss the influence of policy and political drivers that impact health and care provision



Platform 5: Improving safety and quality of care



May be tested by CBT

May be tested by OSCE

5.1 Understand and apply the principles of health

and safety legislation and regulations and maintain safe work and care environments (PSP)


5.2 Participate in data collection to support audit activity, and contribute to the implementation of

quality improvement strategies



5.3 Accurately undertake risk assessments, using contemporary assessment tools (PSP)



5.4 Respond to and escalate potential hazards that may affect the safety of people



5.5 Recognise when inadequate staffing levels impact on the ability to provide safe care and

escalate concerns appropriately



5.6 Understand and act in line with local and national organisational frameworks, legislation and regulations to report risks and implement actions as instructed, following up and escalating

as required



5.7 Understand what constitutes a near miss, a serious adverse event, a critical incident and a

major incident



5.8 Understand when to seek appropriate advice to manage a risk and avoid compromising quality

of care and health outcomes (PSP)


5.9 Recognise uncertainty, and demonstrate an awareness of strategies to develop resilience in

themselves. Know how to seek support to help deal with uncertain situations


5.10 Understand their own role and the roles of all other staff at different levels of experience and

seniority, in the event of a major incident



Platform 6: Contributing to integrated care



May be tested by CBT

May be tested by OSCE

6.1 Understand the roles of the different providers of health and care. Demonstrate the ability to work collaboratively and in partnership with professionals from different agencies in

interdisciplinary teams


6.2 Understand and explore the challenges of providing safe nursing care for people with

complex co-morbidities and complex care needs (PSP)


6.3 Demonstrate an understanding of the complexities of providing mental, cognitive,

behavioural and physical care needs across a wide range of integrated care settings


6.4 Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary

interventions and disruptions to their lives



6.5 Identify when people need help to facilitate equitable access to care, support and escalate concerns appropriately



6.6 Demonstrate an understanding of their own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals,

settings or services



Patient safety proficiencies (PSP)

Proficiencies marked with ‘PSP’ must be passed in the OSCE.