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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
Candidates need to pass both a computer-based test (CBT) and an objective structured clinical examination (OSCE) to demonstrate that their nursing practice meets the required standard to enter the NMC register. This article explores what to expect in the adult nursing OSCE.
What is an OSCE?
An objective structured clinical examination, or OSCE, is a practical assessment to evaluate clinical and communication skills. Candidates move around timed OSCE stations and complete different assessments. The examination is designed to be objective and standardised.
OSCEs take place in a controlled, simulated clinical environment, such as a simulated ward or bedspace.
Before the candidate enters a station, they are given candidate instructions to read. There is a short amount of time for the candidate to prepare for the station.
In each station, candidates are expected to demonstrate a key clinical skill in the context of a clinical scenario. All required equipment to perform the specific skill is provided. Candidates are expected to act as they would in genuine clinical practice, including using hand hygiene, introducing themselves, gaining consent and using compassionate communication skills. This applies whether there is a patient actor or manikin!
Stations can be practical, or silent and written. The stations are strictly timed, and candidates must immediately move on when the time is up.
Within each station, a trained examiner assesses the nurse’s performance against a standardised scoring sheet.
The Test of Competence OSCE
The NMC Test of Competence (ToC) OSCE is taken in the UK at one of five NMC-approved locations. The examination must be arranged in advance.
Candidates will sit an OSCE specific to their area of practice: adult nursing, children’s nursing, mental health nursing, learning disability nursing, or midwifery. This article focuses on the adult nursing ToC OSCE.
The ToC OSCE has 10 stations and takes around three hours to complete:2-3
- 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 station has its own specific mark scheme. Candidates are expected to demonstrate their professional, clinical, and communication skills throughout, in line with the NMC Standards of Proficiency for Registered Nurses and the NMC Code. Nurses should familiarise themselves with these documents as part of their exam preparation.
APIE stations
The APIE stations are four stations linked around one clinical scenario and are designed to mimic the patient journey through nursing care. The APIE is divided as follows:3
1. Assessment: 20 minutes
2. Planning: 14 minutes
3. Implementation: 15 minutes
4. Evaluation: 8 minutes
Assessment station
This station is the candidate’s first meeting with the patient and the opportunity to establish rapport. The candidate is expected to perform a holistic assessment of the patient by both talking to and examining them. They should elicit any key aspects of the case (e.g. the patient has pain or low mood). Examination includes an ABCDE examination with vital signs and any extra relevant assessments (e.g. assessing a Glasgow Coma Score). These observations need to be documented appropriately on the paperwork provided (e.g. a NEWS chart or neurological observation chart).
Planning station
This is a silent, written station. The candidate will be expected to identify at least two nursing needs for the patient and document care plans, including aims, evaluation dates, and appropriate nursing interventions.
The document will need to be written according to standard guidelines, including being dated and signed, professionally and clearly worded, and legible.
Implementation station
This station acts as a care plan. Often, this is medication administration, in which case a prescription chart is available. Candidates must take all usual steps, including introducing themselves, practicing hand hygiene, checking consent, checking the prescription chart and prescription, correctly administering medication, correctly omitting drugs that are not to be administered, and accurately documenting.
Evaluation station
This is the final APIE station. It assesses communication skills within the framework of the SBAR handover: situation, background, assessment, recommendation. The candidate will have the paperwork from the previous stations available and a blank SBAR template on which they can make preparatory notes (not assessed). The candidate will then deliver the SBAR handover verbally to the assessor.
Possible APIE scenarios
The NMC have specified the possible clinical frameworks for the APIE, though this is not necessarily an exhaustive list:3
- Alzheimer’s disease
- Anxiety and depression
- Asthma
- Chronic heart failure
- Community assessment
- Ectopic pregnancy
- End of life
- Fall and fracture
- Hernia
- Homelessness
- Pneumonia
- Subdural haematoma
The frameworks listed above are non-specific, and there are multiple possible clinical scenarios and associated nursing care plans. Note that the proposed stations are different for different branches of nursing (e.g. children’s nursing).
Skills stations
Candidates will be assessed on four clinical skills in two pairs of linked stations, each lasting 21 minutes. The skills assessed are within what would be expected of a newly qualified UK nurse as per the NMC Standards of proficiency for registered nurses. Throughout the stations, communication skills and professional behaviour are also assessed.
Each skill will be presented in the context of a clinical scenario, such as a post-op patient. Candidates will have a short period of time to prepare for the station, and all required equipment is provided.
Possible skills stations
Below is a list of possible clinical skills that could be assessed in the NMC OSCE, along with the station timings. This list is not exhaustive.3
- Administration of inhaled medication (AIM): 12 minutes
- Administration of suppository: 10 minutes
- Aseptic non-touch technique (ANTT) and wound assessment: 21 minutes (linked stations)
- Blood glucose monitoring: 8 minutes
- Bowel assessment: 8 minutes
- Catheter specimen of urine (CSU): 8 minutes
- Female urinary catheter insertion: 8 minutes
- Fine-bore nasogastric tube insertion: 12 minutes
- Fluid balance: 14 minutes
- In-hospital resuscitation (IHR): 6 minutes
- Intramuscular (IM) injection: 12 minutes
- Intravenous (IV) flush and visual infusion phlebitis (VIP) assessment: 12 minutes
- Mid-stream sample of urine (MSU) and urinalysis: 12 minutes
- Nasopharyngeal suctioning: 10 minutes
- Nutritional assessment: 8 minutes
- Oral care plan: 8 minutes
- Oxygen therapy: 10 minutes
- Pain assessment: 6 minutes
- Peak expiratory flow rate (PEFR): 8 minutes
- Pressure area assessment: 8 minutes
- Removal of urinary catheter (RUC or ROC): 8 minutes
- Stoma bag change: 8 minutes
- Subcutaneous injection: 12 minutes
These skills are specific to the adult nursing OSCE.
Silent written stations
There are two silent written stations in the OSCE, each lasting 10 minutes. One station will be on the subject of professional values (PV), and the other on evidence-based practice (EBP). In both stations, written material is provided, followed by points for written discussion.
Professional values station
In the professional values (PV) station, a candidate must demonstrate professional accountability, ethical awareness, and communication skills.5 They will need to show that their behaviour and attitudes are in line with the NMC Code: prioritise people, practice effectively, preserve safety, and promote professionalism and trust.4
The candidate will be given a short ethical, legal or professional dilemma. The candidate is expected to document what actions they would take in the situation, making reference to the NMC code. They will also be expected to mention possible consequences of not taking appropriate actions.6
Possible scenarios include:3
- Bullying
- Concealment of bed status
- Confidentiality
- Drug error
- Drug misuse
- False representation
- Falsifying observations
- Falsifying timesheets
- Hospital food
- Impaired performance
- Laboratory results
- Possible abuse
- Professional confrontation
- Racism
- Social media
- Witnessed abuse
Evidence-based practice station
The other silent written station is the evidence-based practice (EBP) station, where the candidate’s critical appraisal of research and evidence will be assessed. In this station, you will be given a summary of research on a specific topic and a related clinical scenario. The candidate is expected to critically appraise the evidence provided and apply this to their practice in the context of the clinical scenario. In practical terms, this means documenting a summary of the evidence provided, followed by the advice or care plan for the patient in the context of the evidence.6
Possible topics include:3
- Ankle sprain
- Autism spectrum disorder
- Bedside Handover
- Cervical screening
- Cranberry juice and urinary-tract infections (UTIs)
- Dementia and music
- Diabetes
- Female myocardial infarction (MI)
- Fever in children
- Pressure ulcer prevention
- Restraint
- Saline vs tap water
- Sleep in intensive care
- Smoking cessation
- Honey-dressing
How is the ToC OSCE marked?
Each individual OSCE station is marked at the time of the exam by the assessor present at the station. Materials from written stations may be marked after the exam.
The assessor uses an objective and specific checklist to mark the candidate, with each item on the checklist being marked as ‘demonstrated’, ‘partially demonstrated’, or ‘not demonstrated’. The candidate is expected to behave professionally at all times in line with the NMC Code, and they are specifically marked on this.1
The assessor can also give a ‘red flag’ if a candidate has behaved in an unsafe or unacceptable way or in a way which has caused harm to the patient. This is an automatic fail for that station.1
From November 2023, a Viva option was also applied to the OSCE exam. A Viva in the ToC OSCE is a single question asked by the examiner at the very end of the station to allow the candidate to rectify an error they have made in that station. The idea of the Viva is to give the candidates the opportunity to correct themselves and, in doing so, pass rather than fail the station. An example might be where the candidate has forgotten to sign their documentation. A Viva can only be used once per OSCE exam and cannot be used to correct for unsafe behaviour.7
Each station is judged as a pass or fail based on a combination of the above. The specific passing grade for each station is variable depending on the station itself, and not all items on the checklist are weighted equally.
To pass the OSCE overall, the candidate must pass every station. Results are generally communicated within 5 working days of the exam. If less than 8 stations are failed then the candidate can resit the failed stations only. If 8 or more stations are failed then that candidate will need to redo the whole OSCE.2
Summary
In summary, the ToC OSCE is a 10-station practical examination that assesses a candidate’s clinical, professional, and communication skills in line with the NMC Code and NMC Standards of proficiency for registered nurses. The examination marking criteria are strict and exacting to ensure that candidates applying to join the NMC register have the appropriate skills and knowledge, but passing the exam is achievable with preparation.
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: Nursing (all fields); Candidate information booklet. 2025. Available from: [LINK].
- NMC. NMC ToC21 OSCE Station Timings for Nursing. 2025. 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: Marking criteria; Adult nursing. 2025. Available from: [LINK].
- NMC. Test of Competence 2021: OSCE Evidence Based Practice and Professional Values stations. 2021. Available from: [LINK].
- NMC. OSCE Viva Go Live Statement. 2023. Available from: [LINK].
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