NMC Test of Competence Preparation
The OSCE is designed to assess your ability to competently apply your professional nursing or midwifery skills and knowledge in the UK. It is set at the level expected of nurses and midwives as they enter the profession (at the point of registration). This means you must show that you are capable of applying knowledge to the care of patients at the level expected of a newly registered nurse or midwife.
The examination tests your ability to apply knowledge to the care of patients rather than how well you can remember and recite facts. All of the test scenarios and any questions relate to current best practice and you should answer them in relation to published evidence and not according to local arrangements.
The OSCE is made up of six stations, each lasting 15 minutes with an additional five minutes preparation time. Four stations will be scenario-based and relate to the holistic patient-centred assessment, planning, implementation and evaluation stages of nursing and midwifery care. Two stations will be testing practical clinical skills. Please remember that you will have done these nursing or midwifery competencies many times before. Make sure that you read the station instructions carefully. Do not be afraid to look at them again if you are unsure. You will not be penalised for this.
Typical skills that will be tested either on their own or within a nursing/midwifery scenario include:
- vital signs
- calculating drug dosages
- intramuscular and subcutaneous injections
- basic life support – cardio-pulmonary resuscitation (adult, child, baby)
- safe disposal of sharps
- medication administration
- peak flows
- wound care
- urinary catheterisation
- hand hygiene
- palpation (midwifery)
- auscultation of foetal heart (midwifery)
- new born check (midwifery)
Communication is central to nursing and midwifery practice and will always be assessed during the OSCE’s.
We assess the full range of communication skills (verbal, nonverbal and written) by observing the interaction between the candidate and a simulated patient (this may be an actor or a nursing manikin) and also by assessing your nursing or midwifery documentation.
The examiner will assess your approach to the simulated patient all through the examination, and they will award marks for communication skills such as:
- clearly explaining care, diagnosis, investigations and or treatments
- involving the patient in decision-making
- communicating with relatives and health care professionals and obtaining informed consent
- active listening
- dealing appropriately with an anxious patient or relatives
- giving clear instructions on discharge
- giving advice on lifestyle, health promotion or risk factors
- demonstrating compassion and care during communication
- clear documentation which meets current NMC guidelines
- professional behaviour
You should speak to the simulated patient as you would any patient you are meeting for the first time. If you are being assessed using a nursing manikin please remember to verbalise you actions and reasons for them in the same way that you would with a real patient.
Approach to the patient
- introduce yourself and explain or clarify the purpose of the nursing or midwifery encounter.
- check what the patient wants you to call them
- be polite, respectful, non-judgemental and maintain the patient’s dignity
- be empathetic and acknowledge the patient’s emotions or concerns and show sensitivity to any discomfort
- be sensitive to personal space – sit at an appropriate distance from the actor and be aware of their body language. If you move too close and the role player moves back, you are too close
- treat a nursing manikin as you would a real patient.
Explaining and advising
- establish what the patient already knows and wants to know
- explain clearly what you are going to do and why, so the patient can understand
- remember to always check if the patient has any questions
- offer appropriate reassurance
- do not alarm the patient but you must be able to explain the need for urgent action if it is required
- always check the patient has understood
- do not routinely over-simplify names for parts of the body. It is reasonable to expect most people will know common body name such as ‘bladder’, ‘ovary’, ‘womb’ and ‘vein’. If you doubt a patient’s understanding, check and alter your approach to meet the patient’s individual needs. This is an important skill.
- treat a nursing manikin as you would a real patient
Involving patient in management
- respect patient autonomy and help the patient to make a decision based on available information and advice. This includes competent explaining skills as above
- explain information and its implications so the patient can make an informed choice about any nursing or midwifery actions
- check the patient’s understanding and feelings about the proposed nursing or midwifery interventions. They may not always agree with your proposed plan of care
- treat a nursing manikin as you would a real patient
Nursing or Midwifery Assessment
You should be able to undertake an accurate nursing or midwifery assessment and make a reasoned plan of care if required. You should be able to:
- assess the patient’s nursing or midwifery problems accurately
- listen attentively to the patient’s problems and concerns
- use clear language and question at a comfortable pace
- clarify and check information and summarise understanding
- be able to plan holistic safe and effective care based on your nursing or midwifery assessment and best practice
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