The Nursing and Midwifery Council (NMC) introduced a Test of Competence for internationally registered nurses and midwives in October 2014. The Test of Competence assesses candidates against the current UK pre-registration standards. Nursing in the UK is made up of separate and distinct fields of practice, each requiring three years of pre-registration undergraduate education.
The distinct nursing fields of practice are:
- Adult nursing
- Children’s nursing
- Learning disabilities nursing
- Mental health nursing
In the UK, midwifery is a separate and distinct profession, also requiring three years of pre-registration undergraduate education.
The Test of Competence is specific to a field of nursing practice or midwifery and consists of two parts.
- Part 1 being a multiple-choice Computer Based Test (CBT), which can be undertaken globally.
- Part 2 being the Observed Structured Clinical Examination (OSCE) which must be undertaken in the UK in one of the NMC approved test centres.
This handbook provides information on how best to prepare for the Part 2 of the Test of Competence.
General information about preparing for the OSCE is available on the website of your chosen NMC approved test centre site. You are encouraged to read this thoroughly to plan your preparation and to maximise your chances of passing this examination: Links to the OSCE centres websites can be found on NMC website https://www.nmc.org.uk/registration/joining-the-
Once you have chosen where you wish to take your OSCE, you will need to choose a date and make payment. You will then receive access to our internal learning platform which holds a range of useful information and preparation materials to support and prepare you for your exam.
This information booklet is in addition to these materials
The OSCE is designed to assess your ability to competently apply your professional nursing or midwifery skills and knowledge in the UK. It is set at the level expected of nurses and midwives as they enter the profession (at the point of registration, –not advanced skills). This means that you must show that you are capable of applying knowledge to the care of patients at the level expected of a newly registered nurse or midwife.
The examination is testing your ability to apply knowledge to the care of patients rather than how well you can remember and recite facts. All of the scenarios and any questions relate to current best practice and you should answer them in relation to published evidence and not according to local arrangements.
A reading list and further examples are on the learning platform.
The test centre is a full mock-up of a hospital ward with two ‘patient at home’ bays. Each bay is set up for individual station scenarios. The examination area of the centre is overseen by an invigilator. The invigilator will welcome you to the test centre and oversee your movements through the examination process. Please direct any questions, queries or requests to the invigilator. The assessor within the station will be able to answer any clinical questions. The lead assessor is there to coordinate the marking and moderation process.
Each station hosts a camera in the corner of the bay; we record the assessment for moderation and review purposes only.
The centre uses both professional actors and mannequins in order to conduct the assessments and make them as real life as possible
The video link below explains the importance of communicating with your patient and gives you examples of this skill:
You will be provided with all the equipment needed to complete the station successfully. Below are pictures of just some of the equipment you can expect to see in the bays which you may use throughout the examination. A full equipment list can be found on our NILE site and in the Candidate Information Booklet.
BLS Station – Mannequin, bag valve mask Nurse call bell system
Electronic bed controls British National Formulary (BNF)
ANTT Station – Thigh wound Vital signs monitor
All our equipment is standardised to mirror those used within a medical environment. If you see any equipment either here or on the internal learning site that you do not know how to use, do not worry as your assessor will explain the equipment at the start of each station. You will be given an orientation in each bay before your assessment starts, where you will have an opportunity to familiarise yourself with the equipment required for the particular bay you are in.
The video link below gives you a tour of our test centre which will help you familiarise yourself with the environment:
The OSCE is made up of six stations, each lasting between 10 – 20 minutes.
The OSCE is a scenario based approach which includes the following A – Patient Centred Assessment
P – Planning Care
I – Implementation E – Evaluation
There are also two skill stations which you will be tested on. The skills are based on the list provided in the Candidate Information Booklet. (also see page 9 in this document)
In each station you will be given information about what is expected of you and patient information for you to follow. Please read this information and ensure you understand what is expected of you within the station. Focus on the task and follow the requirements set out on the information sheet.
There are timers on the wall so you can keep track of your time. Within this time, you must demonstrate safe practice and competencies within each station. Any activity outside of the allocated time will not be assessed, so please
ensure you do everything
within the time frame. You
will be given prompts as to how much time you have left to help you manage your time within the station.
During each of the stations you need to verbalise what you are doing to the assessor.
We introduce new scenarios and skills regularly so
there is no guarantee you will sit the same scenario as a colleague or friend. We plan the examination to ensure
Tip: If you make a mistake do not panic, make sure you tell the assessor within the assessment time, share what you would do to correct it and this will be taken into account. However verbalisation will not overturn a critical fail.
candidates receive a variety of different scenarios and skills.
The OSCE Exam
The four nursing stations are scenario based
Your verbal communication and non-verbal communication will be assessed in this station and the ability to establish a rapport based on the 6Cs with your patient during the assessment station. You will be given 5 minutes to read the pre-filled admission form. This can provide you with a structure and systematic approach so use this to help you. You will need to take observations of the patient and record them on an observation chart (NEWS, Glasgow Coma Score etc) prior to completing the assessment station. You will need to verbalise this score to the assessor within this station. It is important to complete and record all observations before the time has run out in order to pass. You will then need to consider Activities of Daily Living within this station as this information will help you with the ongoing stations.
This is a silent writing bay and you will be monitored by the invigilator. You will have 15 minutes to write 2 relevant aspects of care related to the scenario from Assessment which should include associated/relevant self-care. Make sure you familiarise yourself with the template provided on NILE. Please note – you will be required to complete this form in a black pen which will be provided.
In this bay you will be implementing care such as drug administration or other nursing implementation. You will have 15 minutes to complete this station. In this bay your patient will be a mannequin and the assessor will respond to you as though they are the patient from a script. Please remember that your verbal and non-verbal communication will be assessed in this station. Communicate with the mannequin NOT the assessor as you would with a real patient.
This bay is a silent writing bay and you will be monitored
by the invigilator. You will have 15 minutes to write a transfer/discharge or other form of nursing evaluation in this station related to the scenario from the previous stations. You will have access to all your previous written notes in this station to help you. Make sure
you familiarise yourself with the template provided on NILE. You should avoid using unfamiliar abbreviations
that are not universally recognised within this station. Please note, you will be required to complete this form in a blue pen (not black), this will be provided for you.
Tip: Make sure your writing is clear, legible and that you have completed all elements of the document.
If we cannot read or understand what you have written, we cannot mark it
You will be assessed on two clinical skills, typical skills which you could be tested on, within a nursing/midwifery scenario include but are not limited to:
- Vital signs
- Calculating drug dosages
- Intramuscular and subcutaneous injections
- Basic life support – cardio-pulmonary resuscitation (adult, child, baby)
- Safe disposal of sharps
- Medication administration
- Peak expiratory flow rate
- Wound care
- Urinary catheterisation – including insertion, catheter care, obtaining a specimen of urine, removal of a catheter etc
- Hand hygiene
- Palpation (Midwifery only)
- Auscultation of fetal heart (Midwifery only)
- New born check (Midwifery only)
All clinical skills and how to conduct them are in the Royal Marsden Manual of Clinical Procedures (9th Edition), we recommend you read this. More detailed information can be found on the NILE site. You will have access to the online learning platform for your chosen OSCE centre for a minimum of 14 days once you have registered and paid for your OSCE.
We assess the full range of communication skills (verbal, nonverbal and written) by observing the interaction between the candidate and a simulated patient (this may be an actor or a nursing mannequin) and also by assessing your nursing or midwifery documentation. It is essential that you demonstrate all elements of the 6Cs within your exam.
The examiner will assess your approach to the simulated patient throughout the examination, and they will award marks for communication skills such as:
- Clearly explaining care, diagnosis, investigations and/or treatments Intervention?
- Involving the patient in decision-making
- Communicating with relatives and health care professionals
- Seeking and obtaining informed consent
- Active listening
- Dealing appropriately with an anxious patient or anxious relatives
- Giving clear instructions on discharge
- Giving advice on lifestyle, health promotion or risk factors
- Demonstrating compassion and care during communication
- Clear documentation which meets current NMC guidelines
- Professional behaviour
Further information on this can be found in the Candidate Information Booklet
We thought it would be helpful to provide you with some common things candidates often forget or miss during the OSCE examination to aid you in your preparation.
For all stations
- Lack of communication – verbal, non-verbal, not listening to patient
- Not reading the scenarios or instructions
- Not completing the paperwork or assessment requested within the 15 minutes
- Touching the patient before conducting hand hygiene techniques
- Not checking for allergies
- Not checking patient identity
- Not gaining consent from patient
- Not ensuring patient safety
- Not completing the station within the timeframe
- Not completing the vital signs accurately
- Not completing the documentation adequately
- Evaluation date not within the prescribed time frame
- Incomplete documentation
- Not considering elements of self-care for the patient
- Illegible documentation
- Abbreviations not recognised
- Errors not dealt with correctly
- Not checking the expiry date on drugs
- Not reading the medication chart properly
- Overdose/under dose patient
- Signing for medication prior to administration
- Reason for admission or date of admission omitted
- Illegible documentation
- Abbreviations not recognised
- Errors not dealt with correctly
- Contamination of sterile field
- Chest compressions are not deep enough or too fast or too slow
- Chest compressions not timely
- Discarding ampoule prior to administration of injection
- Incorrect documentation
- Breaching sterile field
When you enter a work station there will be an area for the assessor to mark you during your assessment. You will be marked only on your competences demonstrated during the assessment.
All our assessors are fully qualified nurses or midwives with full sign off mentorship registration and undergo full training prior to joining the assessor team for the OSCE.
Each OSCE station has a unique 20 criterion based assessment sheet which is matched to the scenario or skill being assessed, examiners will score each criteria.
The skills assessments are also mapped against the above but also mapped against the Royal Marsden Manual of Clinical Procedures (9th Edition). An e-book is available on NILE.
Your entire exam will be digitally recorded and assessed in live time and you will be marked as either a pass or a fail.
Once your full assessment has been completed, documents and videos are moderated by an independent examiner and confirmed by the Lead Assessor or Test Centre Manager before a final decision is made.
All results will be emailed by the NMC to your personal email address (as registered with the NMC) within 5 working days of your examination.
Pass = Candidates who pass all six scenarios and skills stations at the first attempt
Partial Fail (APIE) = Candidates fail a single scenario but pass ALL skills stations (Fail and will require a partial Re-sit at 50% cost) Therefore you will need to sit all APIE stations at your resit. You will be required to sit an entirely new scenario, not just the specific station(s) you have failed.
Partial Fail (Skills) = Candidates pass all scenario stations but fail one or more skills station (Fail and will require a partial Re-sit at 50% cost) Therefore you will need to sit 2 skills at your resit. You will be required to sit the station you failed to show competence in, plus another from the list of skills in your handbook.
Full Fail (1st attempt) = Candidates who fail more than one scenario or skills station (Fail and will require full Re-sit at full cost) Therefore you will need to sit all APIE & 2 skills stations at your resit.
Full Fail (Re-sit) = Candidates who fail either or both APIE or skills on their resit attempt will require 6mths to elapse before sitting the OSCE again (Full cost) in its entirety by way of a reapplication to the NMC.
Re-sit results are always a Pass or a Full Fail and the next OSCE attempt always requires a full re-sit.
If you have failed your re-sit, your NMC application closes and you will need to re-apply. Please contact email@example.com if you wish to re-apply. You will have to sit all 6 OSCE stations at your next attempt, regardless of whether you have had a partial or full re-sit.
You will receive an email from the NMC as outlined above. You will receive standardised feedback on the areas you fail. The feedback will not tell you how to make it right but it will tell you what areas you failed in and why, and if appropriate, will recommend resources to review to help you improve a specific area. This is to ensure consistency and equality in all candidate feedback and also aid you in preparation for your resit should you need to undertake one.
For example, if a candidate failed ANTT for contaminating their yellow bag when setting up the field, the feedback would read as follows:
“ANTT: You failed to show competence in this station. When setting out your sterile field you contaminated the yellow bag and as a result contaminated your sterile field. This is a patient safety risk resulting in a fail
- Try not to be nervous, stay calm – you know this
- Read, read and read again the paperwork for the stations and make sure you understand fully what is expected of you during the assessment.
- There is lots of information for you to help you when preparing for the OSCE –the Candidate Information Booklet and the NILE site has important information which will help you.
- You need to bring your passport and required documentation for your ID check by the NMC.
- Water is available throughout the centre and exam if needed
- If you don’t have a fob watch or forget to bring one, don’t worry we have spares at the test centre which you can use.
- Ensure you are presented as you would need to be in This includes: no jewellery, long hair tied up, no nail polish, flat shoes and short sleeves. You can arrive in your work tunic/scrubs if you wish. Refer to the Candidate Information Booklet for further details.
- Make sure you have eaten before your OSCE assessment. You may be in the test centre for up to 4 hours; once you are registered you are not allowed to go outside of the centre.
- Arrive in plenty of time to allow for traffic. It is recommended that you give yourself at least 30 minutes before the examination time to relax and find the centre
- Keep an eye on NILE, this is where you will be able to see any announcements, updates or changes to our guidance
- Reading tip – The assessment is based on the Royal Marsden, we advise you to read elements of this for reference purposes
- Make sure you prepare for your OSCE at the appropriate level, remember the OSCE is set at the level expected of nurses and midwives as they enter the
- Be aware you are asked to sign the Declaration of Confidentiality at the start of the OSCE. You must not discuss any elements of the OSCE with colleagues or
- You must not talk to other candidates whilst you are within the test