Nurses and midwives who wish to work in the UK but trained overseas must gain professional registration with the Nursing and Midwifery Council (NMC).

Applicants are tested for competence through a two-part process to gain registration: the Test of Competence (ToC).

• Part one - computer-based test (CBT) multiple-choice examination which is accessible around the world for applicants to access in their home countries.
• Part two - practical objective structured clinical examination (OSCE), held in the UK in one of the five test centres.

To pass the ToC and join the register, applicants will also have to pass an English language exam. The tests can be taken in any order. 

The OSCE is based on UK pre-registration standards. Candidates are required to act out scenarios that nurses or midwives are likely to encounter when assessing, planning, delivering and evaluating care. An individual entering the UK to take a nursing role has up to three months (12 weeks) from the employment start date noted on the certificate of sponsorship to sit their first attempt at an OSCE exam. During this period they can be legally employed as a pre-registration candidate. Applicants must complete the OSCE in the UK at an approved test centre.

The OSCE (as part of the new ToC) is made up of ten stations separated into four skills-based, four stations designed to test the candidate’s knowledge and understanding of assessment, planning, implementation and evaluation of care (APIE), and two silent skills. The NHS constitutional values and the 6Cs of nursing are assessed throughout the OSCE at all stations.  

Applicants should refer to page four of the CBT information booklet for nurses and midwives which includes detailed booking instructions and course/module information. If an incorrect CBT has been sat, applicants will be required to re-sit and pass the correct CBT.

The Nursing and Midwifery Council (NMC) has launched a website hub which contains all the information candidates, recruiters and employers prepare for the new ToC. The hub includes:

• candidate handbooks
• test specifications
• blueprints
• practice tests for the new CBTs
• an OSCE prep resource pack.

The NMC is making changes to the English language requirements from 2023. You can find out more about the changes on the NMC website.

There are five locations that are approved OSCE test centres, providing a choice of six locations to sit the OSCE. Please visit the links below for more information:

• University of Northampton
• Oxford Brookes University (Oxford campus and Swindon campus)
• Ulster University (Northern Ireland)
• Leeds Teaching University Hospitals NHS Trust
• Northumbria University.

We are aware that capacity remains limited at OSCE test centres, so in order to release test centre capacity across the system, the NMC is asking that trusts:

• be flexible around dates for booking tests and book the first availability. If this is outside of the 12-week period from arrival, speak with your NHS England IR lead
• look to all test centres when booking
• book tests in advance (ie when the CoS has been issued or the flights have been booked, well before candidates begin their training), but avoid overbooking block tests and keep track of what has been booked
• don’t cancel bookings at existing test centres to rebook at new ones
• confirm candidate details with test centres at least eight weeks before the test; these include the candidate’s name, personal registration number, application type, and confirmation of which exam they will be sitting, especially if booking tests before candidates arrive
• take time to ensure candidates who have failed their first attempt are fully ready to re-sit the test of competence.

To ensure candidates have adequate time to prepare for the OSCE, they are given up to 12 weeks from the start date on their certificate of sponsorship (CoS) to complete the first attempt of their exam. In the run-up to the exam, candidates should be given support and the opportunity to practice and prepare for the OSCE. 

The experience a candidate has in the first few weeks is vital to their success in the OSCE. The NMC's registration process no longer requires applicants to complete a period of supervised practice, therefore the importance of establishing a quality and well-structured induction and socialisation period is critical. Many trusts also provide specific OSCE preparation support for their international recruits. 

In preparation for the OSCE, it is important that candidates are familiar with the NMC nursing blueprints. The exam blueprints set out the scope and content of the OSCE in terms of the topics, skills and procedures that a newly registered nurse would need to know and be able to demonstrate. Find out more on the NMC website.

The following top tips were provided by Cambridge University Hospitals NHS Foundation Trust and Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – both trusts have support programmes in place. 

• Empower candidates with practice and experience, and stress the importance of being able to verbalise and demonstrate their knowledge.
• Build up their resilience and confidence to speak up in front of others, as this can be something which overseas nurses are not always comfortable with. 
• Set up practice rooms in the same way as the OSCE, with simulated patients in a clinical setting, so that the setting is familiar to them.
• Create a dedicated support group - for example, a Facebook group.
• Consider sending a representative to complete a train-the-trainer course. This is run by both the University of Northampton and Ulster University, and allows information to be cascaded within the trust.
• Make sure candidates have plenty of time to practice their skills prior to taking the OSCE.
• Plan a mock, timed practice at least three weeks before the OSCE date to help identify if the candidate is ready (any later than this may then cause a delay in getting a new test date within the 12 week limit).
• If your candidates are not ready for their test, make sure you give them the choice to change the date.
• Although there is always time pressure linked to a candidate sitting the OSCE and to move staff through this process quickly, low pass rates suggest speed initially may cause more difficulties in the long term.

NMC have produced a PDF for candidates on preparing for the OSCE which includes information about what to expect common mistakes and errors and general tips and advice.