changes to UK registration for overseas nurses in 2021

Changes to UK registration for overseas nurses coming in August 2021

The tests of competence

Overseas nurses wishing to register with the Nursing and Midwifery Council (NMC) in the UK are required to pass two Tests of Competence (ToC). The first is the Computer Based Test (CBT) which is taken in the candidate’s home country at a testing center. The second is the Objective Structured Clinical Examination (OSCE) which you can only take in person in the UK.

The need for change

In March 2018, the NMC approved new standards of proficiency for registered nurses. Since then there have been major changes to academic programs throughout the country. This in turn necessitated changes to the tests of competence for overseas registration with the NMC so that they reflect the new standards.

These changes were intended to go live in the summer of 2020, but due to coronavirus, they were postponed until April 2021. The changes have again been postponed and are currently due to be implemented on August 2, 2021.

How this affects you

From August 2, 2021 (unless extended again), overseas nurses seeking UK registration will be on one of two possible paths. The determining factor of which path you will take will be the date you sit your CBT. For ease, I will differentiate between the two by calling one of them original, and the second new.

Taking the ORIGINAL CBT before August 2, 2021

If you schedule your CBT before August you will take the original CBT. If you pass, you will then be required to sit the original OSCE.

Taking the NEW CBT starting on August 2, 2021

The original CBT will be discontinued in August and replaced with the new CBT. If you take the new CBT you will take the new OSCE.

What are the Changes?

The new CBT

The new CBT will consist of two sections. Part A: Numeracy and Part B: Theory. The pass mark for the CBT has not yet been publicized. Because each candidate receives a slightly different set of questions, the pass mark may vary. I expect the NMC to divulge more information about this after the test has been delivered and analyzed. If you fail one part you will only be required to pay for and re-sit the section you failed, not both.

Part A: Numeracy

• 15 questions
• 30 minutes
• Number answers, some will require units (a separate box for units will appear if this is the case)
• Most candidates complete this section with plenty of time to spare

Part B: Theory

• 100 questions
• 2 hours 30 minutes
• Entirely multiple choice with 1 correct answer and 3 incorrect answers (you will not be required to choose “the most correct answer”)

The new OSCE

The new OSCE structure will still consist of an APIE section and a Skills section, but there will be a total of 10 stations instead of 6. If you fail any 1 of the 10 stations, you will only need to pay for and re-sit the 1 station that you failed. For the re-sit you will be given the exact same scenario and/or skill.

APIE (Assessment, Planning, Implementation, Evaluation)

The APIE model will remain the same, though the scenarios and the skills you will be required to demonstrate may change to reflect the new nursing standards set out by the NMC. The two biggest changes are seen in the assessment station and the evaluation station.

In the assessment, alongside obtaining a full set of observations (vital signs), you will need to complete an A-E assessment.

In the evaluation, you will have 5 minutes to write notes on your patient using the SBAR tool (Situation, Background, Assessment, Recommendation) and 5 minutes to verbally hand over the patient (give report) to the examiner.

The timings will shift slightly from the original and will be as follows:

• Assessment – 20 minutes
• Planning – 14 minutes
• Implementation – 16 minutes
• Evaluation – 10 minutes (the timings for evaluation have not been finalized)

Skills

The skills portion of the OSCE will move from 2 clinical skills stations to a total of 6 stations made up of 4 clinical and 2 written skills.  

Simulation based skills stations

The other four skills will be separated into two scenarios consisting of two skills. Each pair of skills will need to be completed within 16 minutes.

Some examples of paired skills are:

• take a urine specimen from a catheter and complete a urinalysis dipstick
• complete a peak flow assessment and administer inhaled medications
• do a wound assessment and an aseptic non touch technique (ANTT) wound dressing change

Written skills stations

The two newest stations are titled “professional values” and “critical appraisal” which will both be written stations lasting 8 minutes. You will be asked to provide your response in bullet points.

Professional Values

For the professional values station you will read through a scenario which could resemble a previous interview question such as “What would you do if you observed a nurse taking a codeine tablet from the medicine cupboard and proceeding to swallow it? When you ask if she’s ok, she says she needs it for a headache.” For your response you will have to explain how you would manage the situation in line with the professional values outlined by the NMC.

Critical Appraisal

For the critical appraisal station you will be given a scenario and a summary of current research. In your response you will need to explain (in bullet points) the relevance of the research, how you would apply it, and what advice you would give the patient.

Things to consider

You may not have much of a choice when it comes to which tests of competence you will have to take. I am not convinced one path is better than the other, but there are some considerations which need to be made before scheduling your CBT.

Are you able to take the CBT now?

Are you prepared to take the CBT and are there any available spots at the testing centers before August? With the pandemic and the potential for unpredictable lockdowns, even having a test date booked doesn’t make anything certain.

What is your timeline?

Are you going to be able to move or travel to the UK in order to sit the original OSCE? At present the testing centers are planning to administer the original OSCE alongside the new OSCE for a period of time, though the details of the transition are still being finalized. Previously the plan was to run the tests concurrently for 6 months before fully transitioning. If that plan remains roughly the same, you would need to travel to the UK to take the exam before February 2, 2022.

Do you plan to take part in an OSCE program?

Many Trusts and independent companies in the UK offer OSCE programs for overseas candidates. Any changes take a little bit of time to implement and that will be true for anyone preparing overseas candidates for the new exam.

While the testing centers will be releasing support materials before the test goes live, they also plan to provide a Chief Examiner Report after an undefined period of live testing in order to address any issues with the delivery of the exam. At this point, they will amend the test one last time. With that in mind, it may be wise wait until the process has been ironed out and everyone has their head wrapped around the new tests of competence.

There are always hurdles when moving abroad, but if you decide to be in the first group of nurses taking the new exams, be prepared for a few extra bumps (more in the OSCE than the CBT).

Further Resources

The NMC have provided a series of webinars to help explain the changes to the CBT and OSCE. I highly recommend watching them to gain familiarity with the new process.

Keep an eye out for more support materials which the NMC will publicize before the new tests go live.

If you are only just beginning this journey use this site to learn what you need to do.

And if you’re still deciding whether you want to become an American nurse in the UK read through these lists of pros and cons.

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