NMC ToC OSCE: Evaluation (APIE) Station

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 evaluation station forms the final 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

This station is a verbal handover station, where nurses have 8 minutes to plan and hand over their patient using the SBAR communication tool.

Candidates will use the same patient scenario from the previous three APIE stations and are expected to hand over using information from those stations and provide appropriate recommendations.

Candidates will have access to all their paperwork from the other three APIE stations and may read and refer to it. It is very important not to alter or write on any paperwork from the other APIE stations, as this is considered malpractice and will result in an automatic fail across all 10 stations.

What is SBAR?

SBAR (Situation, Background, Assessment, Recommendation) is a widely adopted communication tool used in healthcare settings. It is a structured method of communicating clinical information between health professionals.²

Inadequate communication is considered the most common cause of serious errors in clinical practice.² Benefits of using SBAR include:

Helps prevent breakdowns in communication by creating a shared mental model for all patient handovers
Levels the traditional hierarchy between doctors and other caregivers by establishing a common language for communication
Easy to remember and encourages staff to think and prepare before communicating ²

Communication skills are central to nursing and safe patient care and form Annexe A of Future Nurse: Standards of Proficiency for Registered Nurses by the NMC.³ Therefore, communication skills are critically assessed in the NMC OSCE exam.

Planning the SBAR

In the exam, candidates have 8 minutes to plan and verbally hand over using SBAR. It is good practice to spend 2–3 minutes planning before starting the verbal handover.

During the planning stage, nurses should:

Read the evaluation briefing carefully
Identify if anything has changed for the patient
Review the new patient observations and note any significant changes
Identify who they are handing over to and the reason
Organise APIE paperwork and refresh their memory on the information from each station
Plan appropriate recommendations

Candidates are normally asked to complete a nurse-to-nurse handover, which could involve:

Handover at the end of a shift to the oncoming staff
Handover to a specialist nurse (e.g. tissue viability nurse, Alzheimer’s specialist nurse)
Transfer of a patient to another clinical area (e.g. from the emergency department to a ward)

Sometimes the patient has clinically deteriorated, and the nurse is expected to hand over to a doctor, recognising the need for urgent assessment. Candidates must read the briefing carefully to identify who they are handing over to and why.

Only the verbal part of the handover is assessed. So, avoid spending too long planning at the expense of delivering the handover.

SBAR structure

Situation

The situation section should include a brief introduction that informs the person being handed over to the current situation and the reason for the handover.² In the exam, this information is normally available in the evaluation station briefing.

You should include:

Your name and clinical setting
Patient’s name, hospital number and/or date of birth, and location
The reason for the handover

Example

“Hello, my name is ………, and I am the registered nurse on the medical assessment unit. I am contacting you about my patient, Ryan Dylan, date of birth 14/02/1940, hospital number F156959, who is an inpatient on the medical assessment unit. He was admitted with pneumonia and is now ready for transfer to the respiratory ward, so I am handing over his ongoing nursing care.”

Background

This section should give an overview of the patient’s history. In the OSCE exam, this draws on information from the assessment station. The assessment briefing will contain this information, and candidates can read it without needing to remember it.

You should include:

Date of admission/visit, reason for admission/referral, and diagnosis
Relevant medical, medication, and social history
Allergies
Findings from the assessment (observations, NEWS2/GCS, holistic assessment details)

Example

“Ryan was admitted to the medical assessment unit today with increased shortness of breath and a two-week history of cough and chest infection. He was diagnosed with community-acquired pneumonia. His past medical history includes chronic obstructive pulmonary disease, hypertension since 2010, osteoarthritis, and urinary frequency. His normal medications are amlodipine 10 mg OD, oxybutynin hydrochloride 5 mg OD, Trelegy Ellipta 92/55/22 1 dose OD, and paracetamol 1 g as required. He lives alone with no social support, smokes 20 cigarettes a day, and has been unsuccessful in previous attempts to quit. His daughter visits twice weekly. He is allergic to penicillin, which causes rash and swelling.”

“On admission, his observations were: respiratory rate 25/min, SpO₂ 97% breathing air, pulse 90 bpm, blood pressure 110/75 mmHg, temperature 37.8°C, alert, blood glucose 5 mmol/L, NEWS2 score 4. He also reported reduced mobility at home and difficulty managing activities of daily living.”

Assessment

This section summarises the current situation using information and paperwork from the evaluation briefing, planning station, and implementation station.

You should include:

The most recent observations provided in the evaluation briefing
If any changes have occurred from the observations in the assessment station
The main nursing needs, including the problems identified in the planning station and key holistic assessment needs
The nursing and medical interventions that have been completed, including key interventions from the planning station, the medication given during the implementation station and any due medication which was omitted and why
Any other referrals made or interventions during the assessment station

Example

“Ryan’s most recent observations are: respiratory rate 22/min (slightly reduced but still >20), SpO₂ 94% breathing air (decreased), pulse 100 bpm (increased), BP 145/75 mmHg (increased), temperature 38°C (increased), alert, NEWS2 score 3.

His main nursing needs have been the management of shortness of breath, including upright positioning, hourly NEWS2 monitoring, and respiratory assessment. Prescribed antibiotics and oxygen have been administered. Due to reduced mobility, he has been referred to physiotherapy for assessment and walking aid review. He has been encouraged to change position regularly to prevent pressure damage. Smoking cessation advice has been provided, and an occupational therapy referral has been made for home assessment.”

“The medications given at 08:00 include clarithromycin, oxybutynin hydrochloride, and amlodipine. Amoxicillin was omitted and escalated due to a penicillin allergy.”

“I remain concerned about his respiratory rate being >20 and his NEWS2 score of 3.”

Recommendation

The recommendation section of SBAR should include the actions required of the person taking the handover. It should include a realistic and appropriate plan of action.²

Nurses should consider who they are handing over to and the ongoing nursing care required for the patient.

If the patient is deteriorating and being handed over to a doctor, state the need for immediate review and set a time frame.

Example

“Please can you:

Continue NEWS2 monitoring 4–6 hourly, assessing respiratory rate, rhythm, depth, oxygen saturation, and signs of distress, and escalate as per NEWS2 policy
Continue his prescribed medications, ensuring penicillin is not given and ask the prescriber to remove it from the chart
Encourage oral intake and monitor food/fluid balance
Support mobilisation with a walking aid, follow-up physiotherapy referral, and assess his pressure areas every two hours
Discuss home adaptations and follow up on the occupational therapy referral
Continue smoking cessation support
With consent, update the patient’s daughter on the plan of care”

Structure and safety

The NMC will assess nurses on using a systematic and structured approach to the handover. It is essential to follow the SBAR structure and be organised and clear in your communication. Examiners will also assess whether the information provided ensures patient safety and continuity of care.

It is important to ensure key safety aspects are included in the SBAR, such as:

Patient allergies
Omitted medications and the reason
Do not attempt resuscitation (DNAR) orders
Safeguarding concerns

Summary

The NMC OSCE evaluation station assesses a nurse’s ability to communicate clearly under time pressure, ensuring safe and effective patient care. Nurses should practice this station and ensure they can complete the requirements within the time allocated.

Candidates must be competent in using SBAR to systematically hand over patient information, maintaining safety and continuity of care.

Editor

Dr Jamie Scriven

References

NMC. Test of competence 2021: Nursing; Test Specification for Candidates. 2021. Available from: [LINK].
NHS. Safer Care: SBAR Implementation and Training Guide. 2010. Available from: [LINK].
NMC, Standards of proficiency for registered nurses. 2018. Available from: [LINK].