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Introduction
The Nursing and Midwifery Council (NMC) Test of Competence is a two-part examination taken by international nurses seeking to join the UK register and UK nurses returning to practice after time away.1
This assessment evaluates whether candidates possess the necessary skills and knowledge to provide safe, effective, and compassionate care in a UK healthcare setting. This article provides an overview of the Test of Competence examination and the standards to which candidates are assessed.
The NMC Standards and Code
The Nursing and Midwifery Council (NMC) is the independent regulator for nurses, midwives, and nursing associates in the UK. Membership of the NMC register is a pre-requisite to working in the UK. The NMC ensures public safety by verifying that those on the register meet the required standards of competence, conduct, and ethics to practice safely and effectively.
The Test of Competence (ToC) is designed to assess whether nurses meet the required level to join the NMC register.2 Candidates applying to the ToC must already have achieved the relevant nursing or midwifery qualification.
The ToC evaluates candidates against the NMC Standards of proficiency for registered nurses. These standards, divided into seven platforms, represent the skills, knowledge and behaviours that all UK nurses are expected to demonstrate:3
1. Being an accountable professional
2. Promoting health and preventing ill health
3. Assessing needs and planning care
4. Providing and evaluating care
5. Leading and managing nursing care and working in teams
6. Improving safety and quality of care
7. Coordinating care
The above are evaluated in one or both parts of the ToC exam.2 Candidates are also expected to demonstrate that their nursing practise is in line with the NMC Code, i.e. the professional standards of practice and behaviour to:2, 4
- Prioritise people
- Practise effectively
- Preserve safety
- Promote professionalism and trust
Further information about the NMC standards and code can be found on the NMC website.
Test of Competence
The Test of Competence (ToC) consists of two parts: the 115-question computer-based test (CBT) and the 10-station objective structured clinical examination (OSCE). These two parts are taken separately. A candidate must pass both parts of the ToC within a two year period to join the NMC register.1
Candidates take the ToC specific to the area of the register to which they are applying:
- Adult nurse (RNA)
- Children’s nurse (RNC)
- Mental health nurse (RNMH)
- Learning disabilities nurse (RNLD)
- Midwife (RM)
- Nursing associate (NAR)
Most of the questions and assessments in the ToC are the same regardless of which area of nursing is examined; however, a proportion of the examination is specific to the candidate’s area of expertise, e.g. children’s nursing.
Computer-based test (CBT)
The computer-based test (CBT) is an online examination which assesses the candidate’s knowledge.5 Although it is referred to as “part one” of the ToC, the test can be taken after the OSCE if preferred. The CBT is delivered by Pearson Vue and can be taken in many countries worldwide.
The CBT has 115 questions in total. Three hours are allocated for the exam, which is split into two parts:
- Part A: numeracy (15 questions; 30 minutes). Candidates are expected to answer numeracy questions, such as drug dosing or fluid balance calculations. Answers are typed into the answer box.
- Part B: clinical (100 questions; 2 hours 30 minutes). This part is made up of multiple-choice questions, designed to assess a wide breadth of clinical and professional nursing knowledge.
The passing standard for the exam varies depending on the selected questions. Results are usually communicated within 48 hours, with a pass or fail given for Part A and Part B. If a candidate fails just one part of the exam, they can resit that part alone.5
Objective structured clinical examination (OSCE)
The objective structured clinical examination (OSCE) is a practical examination that assesses a candidate’s hands-on clinical, communication, and professional skills in a controlled clinical environment. Unlike the CBT, the OSCE is taken in the UK at one of five NMC-approved locations.6
The OSCE is made up of 10 stations and takes around 3 hours to complete. On the exam day, the candidate will move between different rooms or environments as they change stations. At each station, there will be an assessor, candidate instructions, and the equipment required to carry out the task. This might include paper documents, a manikin or patient actor, and/or medical equipment. Timings are strict, and the candidate must move on once the time is up for their specific station.
Although there are multiple possible clinical scenarios, the OSCE station types are well-defined:6
- Four assessment, planning, implementation and evaluation (APIE) stations: linked around one scenario and takes an hour to complete.
- Four skills stations: split into two pairs of two skills stations, e.g. IM injection. These stations are 21 minutes per pair.
- Two silent written stations: to assess the candidate’s values and behaviours and evidence-based practice. 10 minutes is allocated per station.
Each OSCE station is assessed against clear criteria and checklists, and a pass or fail is awarded for each station. Candidates are expected to demonstrate their professional competence throughout. To pass the OSCE overall, the candidate must pass every station. If less than 8 stations are failed then the candidate can resit the failed stations only.6
Summary
The NMC Test of Competence is a two-part examination consisting of the CBT and the OSCE, testing both theoretical knowledge and practical skills. A pass must be achieved in both parts of the exam to apply for registration with the NMC and work in the UK. The ToC is rigorous but achievable and ensures that applicants joining the register meet the NMC Standards of proficiency and work in accordance with the NMC Code.
NMC Test of Competence resources
At Geeky Medics, we have a range of resources available to help you pass your ToC, including:
Happy revising!
Editor
Dr Jamie Scriven
References
- NMC. Test of competence 2021: Nursing Test Specification for Candidates. 2021. Available from: [LINK].
- NMC. Test of competence 2021: Adult nursing blueprint. 2021. Available from: [LINK].
- NMC. Standards of proficiency for registered nurses. 2024. Available from [LINK].
- NMC. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. Available from: [LINK].
- NMC. Test of competence 2021: Part 1; Nursing; Candidate information booklet; The computer-based test (CBT). 2024. Available from: [LINK].
- NMC. Test of competence: Nursing (all fields); Candidate information booklet. 2025. Available from: [LINK].
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