What is the NMC Test of Competence?
The Test of Competence (ToC) is how the Nursing and Midwifery Council checks that nurses and midwives trained outside the UK have the knowledge and skills to practise safely here. It is also used by some people returning to the register after a long break.
It has two parts:
- Part 1, the CBT: a computer-based, multiple-choice test of theory and numeracy.
- Part 2, the OSCE: an objective structured clinical examination, a practical test of clinical skills, values and behaviours.
There are separate versions for adult, mental health, learning disabilities and children's nursing, and for midwifery. You sit the version that matches the part of the register you are applying for.
Where do the CBT and OSCE fit in the NMC application?
- Check you are ready: Use the NMC's pre-application checklist to see what evidence you will need, including your qualification, registration history and English language evidence.
- Meet the English language requirement: You need to show you can communicate clearly and effectively in English. The NMC accepts certain English tests at set scores, and in some cases other evidence such as training or recent practice in English. Check the accepted tests and scores on the NMC website.
- Apply and have your eligibility confirmed: The NMC assesses your application and confirms whether you need to take the Test of Competence.
- Pass the CBT: Book through Pearson VUE once the NMC confirms you can. Many candidates sit the CBT in their home country before moving.
- Pass the OSCE: Book with an approved UK test centre. You can sit the CBT and OSCE in either order, but must pass both within two years of each other.
- Complete final checks: This includes an in-person ID check, health and character declarations and a professional indemnity arrangement, before you join the register.
If you are coming to the UK through an NHS or care employer under the Health and Care Worker visa, your employer will usually guide the order. NHS Employers guidance says that the first OSCE attempt is expected within 12 weeks of the employment start date on your certificate of sponsorship, and that candidates should pass within eight months of the start of their visa. Ask your employer to confirm what applies to you.
What is in the NMC CBT?
| Part | Questions | Time | Format |
|---|---|---|---|
| Part A: Numeracy | 15 | 30 minutes | You type a single numerical answer to each question |
| Part B: Clinical | 100 | 2 hours 30 minutes | Multiple choice, four options with one correct answer |
Both parts are taken in one sitting at a Pearson VUE test centre, but they are passed or failed separately. The NMC's test specification sets the numeracy pass mark at 13 out of 15. The clinical pass mark varies by field of practice and is generally in the range of 60 to 70%.
What does the clinical part cover?
Questions are based on the NMC's standards of proficiency for registered nurses and on the Code. Expect questions on safe and effective care, prioritising patients, recognising deterioration, medicines management, safeguarding, consent, mental capacity, confidentiality, communication, infection prevention and professional accountability. Many questions ask what you would do first, so UK priorities and escalation matter.
CBT resits
If you fail one part, you only resit that part. NMC guidance allows three attempts per application, at least 10 days apart and within one year. Check the current rules and fees on the NMC website when you book.
What is in the NMC OSCE?
The OSCE is taken in person at an approved UK test centre. It has ten stations and takes no more than about 2 hours 45 minutes in total.
| Station group | Number | What is tested |
|---|---|---|
| APIE stations | 4 | One linked patient scenario in four stages: Assessment, Planning, Implementation and Evaluation |
| Clinical skills stations | 4 | Two linked pairs of practical skills, such as medicines administration, wound care or basic life support, depending on your field |
| Professional values and behaviours, and critical appraisal | 2 | Written stations on professional issues and on appraising research evidence |
The APIE stations
APIE follows one patient through the nursing process. According to the NMC's test specification, the Assessment station lasts 20 minutes, Planning 14 minutes, Implementation 15 minutes and Evaluation 8 minutes.
- Assessment: introduce yourself, gain consent, take a structured history, record observations and complete a relevant assessment tool.
- Planning: write a person-centred care plan based on your assessment, with clear, measurable goals.
- Implementation: carry out a key part of the plan, often medicines administration, with safety checks.
- Evaluation: write a handover, often in SBAR format, summarising the patient's progress and plan.
What happens if you fail the OSCE?
Failing a station is common and does not end your application. According to NMC guidance:
- You can sit the OSCE up to three times within one application.
- You must wait at least 10 days between attempts.
- You only resit the stations you failed, and the test centre gives you feedback on which elements you missed.
- Resits must be at the same test centre as your first attempt.
- A reduced resit fee applies if you resit seven stations or fewer. At the time of writing (October 2026) the full OSCE fee is £794 and the reduced resit fee is £397. Fees change, so check the NMC website before you book.
- If you fail a third time, your application closes. You must wait at least six months and start a new application, resitting all ten stations.
If you are sponsored on a work visa, failing all permitted attempts can affect your sponsorship and leave to remain. Speak to your employer and, if needed, an immigration adviser early.
Worked example: preparing for an APIE assessment station
Maria had ten years of experience as a nurse in the Philippines and passed the CBT before moving to the UK. In her first mock OSCE she failed the Assessment station even though her clinical knowledge was strong. The feedback showed she had gone straight to taking observations without introducing herself fully, checking the patient's identity or asking for consent, and she had not asked about the patient's own concerns. In practice back home, much of this had been done by others or not spoken aloud.
Walks in, says hello, starts taking blood pressure, asks a few closed questions about pain, records observations and leaves.
Washes hands, introduces self by name and role, checks the patient's name and date of birth against the wristband, explains the purpose and gains consent. Takes a structured history using open questions, asks what matters to the patient, completes observations and calculates the NEWS2 score, completes the relevant assessment tool, documents accurately and escalates if needed.
Maria practised with a checklist, recorded herself, and asked a colleague to time her. At her real OSCE she passed every station. The lesson is that the OSCE rewards safe, visible, person-centred practice that follows UK standards, not just knowledge.
How to prepare for the CBT and OSCE
For the CBT
- Read the NMC Code carefully. Many questions test professional values, accountability and safeguarding.
- Use the NMC's test specification and blueprint to see what topics are covered.
- Take the free practice tests on the Pearson VUE website.
- Practise drug calculations daily without a calculator first, then with one, until you get 15 out of 15 reliably.
- Learn UK approaches such as NEWS2, the ABCDE assessment, SBAR and the Mental Capacity Act.
For the OSCE
- Use the official NMC and test centre candidate materials, including any marking criteria and mock videos they provide.
- Practise the APIE stations as a timed sequence, out loud, as if the examiner cannot read your mind.
- Learn the clinical skills stations for your field step by step, including infection control and safety checks.
- Practise writing care plans and SBAR handovers neatly and within time.
- Do at least one full timed mock several weeks before your exam. NHS Employers guidance encourages employers to plan this.
- Look after yourself: sleep, eat and plan your journey to the test centre.
After you pass
Once you have passed both parts and completed the NMC's remaining checks, you can join the register. The NMC says that once both parts are passed, the Test of Competence result is valid for five years, so you do not need to rush the final steps, though most employers will want you registered quickly.
Registration is the start of a new stage. You will need to keep up with the NMC Code, collect CPD and practice feedback, write reflective accounts, and revalidate every three years. Starting a simple portfolio from your first day makes this much easier.
Related courses
NMC Registration for Internationally Educated Nurses explains each stage of the application, from eligibility to the ID check. NMC CBT Preparation (Test of Competence Part 1) covers the numeracy and clinical content with practice questions. NMC OSCE Preparation: APIE Stations focuses on the assessment, planning, implementation and evaluation stations, with worked examples of care plans and SBAR handovers.
Frequently asked questions
What is the pass mark for the NMC CBT?
According to the NMC's test specification, the numeracy section (Part A) requires 13 out of 15 correct answers. The pass mark for the clinical section (Part B) varies by field of practice and is generally between 60 and 70%. Both parts must be passed, and if you fail one part you only need to resit that part.
Can I take the OSCE before the CBT?
Yes. The NMC allows the CBT and OSCE to be taken in either order, but you must pass both within two years of each other to continue your application. In practice most candidates take the CBT first, often in their home country, because employers sponsoring a visa usually require a CBT pass before issuing a certificate of sponsorship.
How many times can I resit the NMC OSCE?
You can sit the OSCE up to three times within one application, with at least 10 days between attempts. You only resit the stations you failed, at the same test centre. If you fail a third time, your application closes and you must wait at least six months before starting a new application and resitting all ten stations.
What does APIE stand for in the NMC OSCE?
APIE stands for Assessment, Planning, Implementation and Evaluation. These four linked stations follow one patient scenario through the nursing process. You assess the patient, write a person-centred care plan, carry out part of that plan such as giving medication, and then evaluate care, often by writing an SBAR handover.
Where can I take the NMC CBT?
The CBT is delivered by Pearson VUE at its test centres, including many outside the UK, so most candidates can sit it in or near their home country. You book once the NMC has confirmed you need the Test of Competence. You must bring a valid passport that matches the details in your NMC account.
How long is the NMC Test of Competence valid?
According to the NMC, once you have passed both the CBT and the OSCE, your Test of Competence result is valid for five years. You must pass both parts within two years of each other. Check the NMC website for the latest rules, as they can change.
Related courses
NMC Registration for Internationally Educated Nurses
This course walks internationally educated nurses and midwives through each stage of joining the NMC register, from checking you are ready to…
NMC CBT Preparation (Test of Competence Part 1)
This course prepares internationally educated nurses for Part 1 of the NMC Test of Competence, the computer-based test. It explains the structure of…
NMC OSCE Preparation: APIE Stations
This course prepares internationally educated nurses for the four linked APIE stations of the NMC OSCE: assessment, planning, implementation and…
Sources and further reading
- Test of Competence for nurses and midwives. Nursing and Midwifery Council.
- Test of Competence 2021: test specification (nursing). Nursing and Midwifery Council.
- Registering as a nurse or midwife trained outside the UK. Nursing and Midwifery Council.
- English language requirements. Nursing and Midwifery Council.
- OSCE information for employers of overseas nurses and midwives. NHS Employers.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
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