Everything international nurses need to know about passing the NMC Test of Competence — CBT and OSCE explained, preparation strategies, costs, and expert tips to pass first time.
Get NMC Exam PreparationThe Test of Competence (ToC) is the examination that all internationally educated nurses and midwives must pass to register with the Nursing and Midwifery Council (NMC) and practice as a registered nurse in the United Kingdom. The test ensures that all nurses, regardless of where they trained, meet the same high standards required for safe and effective practice in the UK.
The Test of Competence has been updated as of August 2021 (Test of Competence 2021). It consists of two parts that assess different aspects of nursing competence.
The Test of Competence applies to:
In August 2021, the NMC introduced a new Test of Competence that replaced the previous version. The new test reflects updated NMC standards and is designed to be more reflective of real-world nursing practice. If you took the old CBT before August 2021, you may need to take the new version. Always check the NMC website for the current test blueprint and ensure you're preparing for the right version.
The CBT is the first part of the Test of Competence. It is a multiple-choice exam that tests your theoretical nursing knowledge and decision-making abilities.
The 120 questions are divided into two parts:
Study the NMC Code and Standards of Proficiency thoroughly — many questions test your understanding of professional values. Practice medication calculations daily — these are high-yield questions. Familiarize yourself with UK-specific protocols (NEWS2, SBAR, 6 Cs of Nursing). Use the Pearson VUE practice tests to get comfortable with the computer interface. Join online study groups on Facebook for peer support. Book your CBT after at least 4-6 weeks of dedicated study.
The OSCE is a practical clinical examination that tests your nursing skills in simulated scenarios. It is taken in the UK after you have arrived and secured employment.
| Station Type | Number | Duration | What You Do |
|---|---|---|---|
| APIE Station | 4 stations | 17-20 min each | Complete a full nursing process: Assessment, Planning, Implementation, and Evaluation of care for a patient scenario |
| Skill Station | 4 stations | 13-17 min each | Demonstrate a specific clinical skill (e.g., vital signs, medication administration, wound dressing) |
| Professional Value Station | 2 stations | 13-17 min each | Demonstrate communication, teamworking, and professional behaviors |
These stations assess your communication and professional judgment in challenging scenarios.
Key skills: empathy, active listening, clear communication, ethical decision-making, knowing when and how to escalate
The OSCE can only be taken at approved NMC test centres. Most are located at universities across the UK.
| Test Centre | Location | Associated NHS Regions |
|---|---|---|
| Ulster University | Northern Ireland | Northern Ireland Trusts |
| Oxford Brookes University | Oxford, England | Oxford, Thames Valley |
| University of Northampton | Northampton, England | East Midlands, Midlands |
| Northumbria University | Newcastle, England | North East England |
| University of Sunderland (London Campus) | London, England | London NHS Trusts |
| Leeds Teaching Hospitals / University of Leeds | Leeds, England | Yorkshire and Humber |
| Edinburgh Napier University | Edinburgh, Scotland | NHS Scotland |
| University of Dundee | Dundee, Scotland | NHS Scotland (Tayside) |
| Coventry University | Coventry, England | West Midlands |
| University of Hertfordshire | Hatfield, England | East of England, London |
| Kingston University | London, England | South West London |
* Your NHS employer will book your OSCE at the nearest available test centre. Travel and accommodation for the OSCE are usually covered or subsidized by your employer.
Understanding the total cost helps you budget for your NMC registration process.
| Item | Cost (GBP) | Notes |
|---|---|---|
| NMC Application Fee | £183 | Paid when submitting your initial application |
| CBT Exam Fee | £83 | Paid when booking your CBT with Pearson VUE |
| OSCE Exam Fee (1st attempt) | £794 | Usually paid by your NHS employer |
| OSCE Exam Fee (2nd attempt) | £794 | May be covered by employer |
| OSCE Exam Fee (3rd attempt) | £794 | Rarely covered by employer |
| IELTS for NMC (if needed) | £175-£220 | Or OET at ~£350 |
| NMC Registration Fee (final) | £120 | Annual retention fee (first year prorated) |
| Minimum Total (if employer pays OSCE) | £461-£506 | Self-funded minimum |
| Maximum Total (if self-funding all OSCE attempts) | £2,943+ | Maximum potential cost |
The vast majority of NHS employers cover the OSCE exam fee (£794) for their recruited international nurses. Many also cover or contribute to CBT costs, provide paid OSCE training (typically 4-6 weeks), and pay for travel and accommodation to the OSCE centre. Always confirm what your employer covers before signing your contract. Private care homes may have different policies — clarify this during your recruitment process.
Passing the Test of Competence requires focused preparation. Follow these proven strategies to maximize your chances of passing first time.
Based on test centre data, the most common reasons for failing include: medication calculation errors (always double-check), failure to use aseptic non-touch technique properly, incomplete patient assessments (missing vital signs or observations), poor documentation (not writing everything down), failure to escalate concerns appropriately, not checking patient identity before procedures, and running out of time due to poor time management. Focus your preparation on these high-risk areas.
You have a maximum of 3 attempts at the CBT and 3 attempts at the OSCE within 2 years of each other. If you fail the CBT 3 times, you must wait 6 months before reapplying to the NMC. If you fail the OSCE 3 times, you must restart the entire NMC application process. Most nurses (over 85%) pass both parts within their first 2 attempts with proper preparation.
The complete process typically takes 4-8 months: Initial NMC application and eligibility assessment (2-4 weeks), CBT preparation and testing (2-4 weeks), job application and visa processing (4-8 weeks), arrival in UK and OSCE training (4-6 weeks), OSCE testing (1-2 weeks), and final NMC PIN issuance (1-2 weeks after passing OSCE).
Yes, most NHS trusts employ international nurses as pre-registration nurses or healthcare support workers while they prepare for and take their OSCE. You work under supervision and typically earn £18,000-£22,000 during this period. Once you pass the OSCE and receive your NMC PIN, you transition to a Band 5 registered nurse role (£28,407+).
If you fail your OSCE, you will receive detailed feedback on which stations you failed and why. Your employer will support you in preparing for your next attempt. You can rebook your OSCE (subject to availability) and typically need to pay the £794 fee again (some employers cover resit costs). Use the feedback to focus your preparation on weak areas. You have 3 attempts total within 2 years of passing your CBT.
The CBT contains questions relevant to your nursing field (adult, mental health, pediatric, or learning disability). The OSCE scenarios are also tailored to your specific nursing branch. Mental health nurses, for example, will encounter scenarios involving mental health assessments, de-escalation techniques, and therapeutic communication. Make sure the NMC has your correct nursing branch on record.
Yes, you should start preparing before arrival. Study the NMC Standards, practice clinical skills, learn UK nursing protocols, and watch OSCE preparation videos. However, much of the preparation happens during your employer's OSCE training program in the UK, which typically runs for 4-6 weeks before your exam. This training uses the same equipment and simulates the actual test conditions.
You need to pass the CBT before the NMC will issue you an Decision Letter (which confirms you're eligible for registration). Most NHS employers prefer candidates who have already passed their CBT, as this shortens the recruitment timeline. However, some employers will make a conditional offer while you're preparing for the CBT. We recommend passing the CBT as early as possible in your application process.
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