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Introduction
The Test of Competence (ToC) is the assessment used by the Nursing and Midwifery Council (NMC) to determine whether internationally educated nurses (IENs) and returning-to-practice nurses possess the skills, knowledge, and values required to register and practise safely in the UK.
The assessment station forms one part of the APIE structure. The APIE stations are four scenario-based stations that relate to the four stages of the nursing care process:1
- Assessment
- Planning
- Implementation
- Evaluation
Assessing patient needs is a core component emphasised in Future Nurse: Standards of Proficiency for Registered Nurses by the NMC.2
Assessment is the first and foundational step in delivering individualised nursing care. It provides essential information for planning interventions and ensures ongoing effective patient care.
Continual assessment is vital for the success and safety of patient management.3 The assessment station should not be seen merely as a checklist. Instead, nurses are evaluated across a range of professional competencies, including:
- Communication
- Listening
- Observation
- Critical thinking and decision-making
- Time management and prioritisation
- Problem-solving
- Documentation
- Applying accurate, evidence-based interventions
Assessment scenarios
In the adult NMC ToC OSCE exam, candidates are presented with one of ten possible patient conditions. They are required to safely approach and conduct a comprehensive physical and holistic assessment, followed by accurate documentation.
Scenarios may be based in either hospital or community nursing settings. It is recommended that candidates preparing for the OSCE become familiar with these clinical conditions to enhance their knowledge and enable safe, evidence-based decision-making.
Each scenario includes relevant clinical details such as the presenting complaint, past medical and social history, medications, and allergy status. Candidates should carefully read and prioritise key information at the beginning of the station.
Current scenarios
Current ToC assessment scenarios include:
- Alzheimer’s disease
- Chronic heart failure
- Community assessment
- Ectopic pregnancy
- End of life
- Fall and fracture
- Hernia
- Homelessness
- Pneumonia
- Subdural haematoma
These scenarios are subject to change and candidates are advised to regularly check the NMC ToC website for updates.
Station structure
This station must be completed in 20 minutes and will normally have a patient actor. Time management is essential, and candidates should adopt a clear, structured approach:
- Key principles which include key patient safety requirements
- Completing the ABCDE assessment
- Documenting NEWS2, GCS or additional assessment tools
- Completing a holistic assessment
- Ending the station professionally
Key principles
The assessment station specifically assesses nurses’ ability to ensure patient safety, and nurses are required to demonstrate specific practices to pass this element of the exam:
- Checking the scene for safety before approaching
- Maintaining the patient’s privacy and dignity
- Hand hygiene using the WHO’s 7-step technique
- Introducing themselves (“Hello, my name is…”)
- Confirming patient identity and allergy status against the wristband and documentation
- Explaining the assessment and gaining informed consent
ABCDE assessment
The ABCDE assessment is a structured approach recommended by the Resuscitation Council UK.4 It is used to identify and respond to life-threatening conditions in order of clinical priority.
Candidates are expected to:
- Complete the full ABCDE assessment
- Perform and verbalise all vital signs
- Identify abnormal findings and suggest necessary interventions or escalation
ABCDE assessment
The assessment should include:
- Airway: confirm the airway is clear and unobstructed
- Breathing: measure respiratory rate, assess rhythm, depth, and bilateral air entry; look for signs of respiratory distress (e.g. accessory muscle use, cyanosis, see-saw breathing); identify abnormal sounds (e.g. wheeze, stridor, rattle) and measure oxygen saturation (SpO2)
- Circulation: measure manual pulse rate, rhythm, and strength; record blood pressure, check capillary refill time, and assess for signs of pallor and peripheral perfusion
- Disability: assess consciousness using the ACVPU scale (or GCS for subdural scenarios); assess pain level, urine output, and blood glucose level
- Exposure: record temperature, check for injuries, rashes, or bruises; take a full medical history
NEWS2 and documentation
Accurate and complete documentation is a critically assessed part of the assessment station. Any incorrect or incomplete documentation is an automatic fail as it compromises patient safety.
In the assessment station, all scenarios except the subdural will have a National Early Warning Score (NEWS2) observation chart to complete.5 Candidates must document and verbalise:
- Respiratory rate
- Oxygen saturation
- Blood pressure
- Pulse rate
- Level of consciousness
- Temperature
Candidates must:
- Accurately calculate the total NEWS2 score
- Identify the appropriate frequency of monitoring
- Escalate concerns according to the escalation policy
- Ensure the observation chart has the date, time and nurse’s initials
Additional assessment tools
Candidates should be aware of additional assessment tools in the following scenarios:
- Subdural haematoma: candidates should use the GCS observation chart instead of NEWS2. Candidates must document all vital signs and GCS on the NMC GCS observation chart, and verbalise the required GCS monitoring frequency in line with NICE guidelines for head injury management.6
- Alzheimer’s disease: requires candidates to complete the 6-item cognitive impairment test (6CIT), a cognitive screening tool used to identify early signs of dementia or cognitive impairment, particularly in older adults. It asks a series of memory-based questions, and each question is scored for the number of incorrect responses. The higher the overall score, the more significant the memory impairment.
- Community assessment: requires candidates to complete a malnutrition universal screening tool (MUST)
The 6CIT and MUST assessments are normally partially completed in the station, and the candidate needs to:
- Finalise the assessment and document the total score
- Interpret the results
- Suggest appropriate nursing actions and referrals
Candidates must still complete all the requirements of the assessment station, including the key principles, ABCDE, and holistic assessment.
Holistic assessment
Holistic assessment is the cornerstone of nursing practice. While the ABCDE assessment and the NEWS2 assess a nurse’s ability to recognise and manage physical complaints, the holistic assessment assesses nurses’ ability to perform a patient-centred assessment.
It involves evaluating the patient’s full well-being, including physical, psychological, spiritual, and sexual health.
Due to time constraints, candidates must prioritise based on the scenario and the patient’s cues. Candidates should also consider key assessed areas, which include:
- Health promotion, including smoking and alcohol cessation
- Emotional well-being and low mood
- Safeguarding or environmental risks
- Recent bereavement
Candidates are expected to use active listening, ask open-ended questions, and make appropriate referrals (with consent).
Ending the station
It is important to leave time to end the station professionally, which involves summarising your nursing plan to the patient, asking if they have any questions and completing your final hand hygiene.
It is also recommended that, if you have any time remaining, you double-check all documentation, as this is a common cause of failure in this station.
Summary
The NMC OSCE assessment station is the most comprehensive component of the exam, assessing multiple areas of competence. Success requires more than performing tasks. It demands evidence-based decision-making, clinical safety, and compassionate communication.
Candidates must demonstrate confident, competent practice grounded in nursing knowledge and patient-centred care.
Editor
Dr Jamie Scriven
References
- NMC. Test of competence 2021: Nursing; Test specification for candidates. 2021. Available from: [LINK].
- NMC. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. Available from: [LINK].
- Lister S, Hofland J, Grafton H. The Royal Marsden Manual of Clinical Nursing Procedures. 10th ed. Oxford: Wiley-Blackwell. 2020.
- Resuscitation Council (UK). ABCDE Approach. Available from: [LINK].
- Royal College of Physicians. National Early Warning Score (NEWS). 2017. Available from: [LINK].
- NICE. Head injury: assessment and early management. 2023. Available from: [LINK].
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