NMC OSCE Marking Criteria v2.4 (2025) – What is new?

The NMC OSCE marking criteria v2.4 (2025) emphasises clinical reasoning, person-centred communication, and systems-based thinking over procedural accuracy alone. The updated criteria allocate 40% of marks to clinical reasoning and escalation decisions, 35% to communication and patient engagement, 20% to technical skill, and 5% to professional behaviour. These changes reflect the NHS’s shift toward compassionate, evidence-based practice and require candidates to articulate their clinical decisions-not just perform tasks silently.

Why the NMC Updated Marking Criteria in 2025

If you’ve been preparing for the NMC OSCE and noticed the marking seems different, you’re right. In July 2025, the NMC released an updated marking rubric-version 2.4-that fundamentally shifts what examiners are looking for.

This isn’t just a minor tweak. The new criteria represent a philosophical shift in UK nursing assessment. For decades, OSCE stations prioritised procedural perfection: perform the right steps in the right order, document correctly, follow protocol. But the real world of nursing isn’t about executing isolated tasks. It’s about clinical reasoning, communication under pressure, and adapting to patient needs.

The 2025 update recognises this reality.

Why does this matter to you? If you’re preparing using old materials, practice techniques, or mindsets, you could be optimising for outdated criteria. Understanding what’s actually being assessed in 2026 is the difference between passing and failing.

In this guide, we’ll break down exactly what changed in v2.4, how examiners now score each station, and the strategic shifts you need to make in your preparation.

What Changed: The Core Shift in v2.4 (2025)

The previous marking criteria (v2.3, used through 2024) weighted marks differently:

• Technical Skill: 45%
• Communication: 30%
• Safety/Infection Control: 15%
• Professional Behaviour: 10%

The new criteria (v2.4, effective July 2025):

• Clinical Reasoning & Escalation: 40%
• Communication & Patient Engagement: 35%
• Technical Skill: 20%
• Safety & Professional Behaviour: 5%

What This Means in Practice

Old mindset: “If I do the procedure correctly and quickly, I’ll pass.”

New mindset: “I must explain my thinking, respond to the patient, and justify my clinical decisions.”

The Rise of Clinical Reasoning (40% of Marks)

Under v2.4, clinical reasoning is now the dominant assessed competency. This includes:

• Interpreting findings – Can you read a blood pressure and recognise what it means clinically?
• Escalation decisions – Do you know when a reading is abnormal and what to do about it?
• Patient context – Are you tailoring your approach to the individual patient (age, comorbidities, medication history)?
• Verbalisation of thought process – Can you articulate WHY you’re doing something, not just WHAT you’re doing?

This is the biggest change. Examiners now want to hear your reasoning aloud.

Real example (Blood Glucose Station):

Old criteria (v2.3): Perform fingerstick → Get reading → Document. Silent, efficient, 90 seconds. PASS.

New criteria (v2.4): Perform fingerstick → Get reading → Interpret result (is it normal? abnormal?) → Decide on escalation (“This is 3.2 mmol/L-below the normal range of 4-7. This indicates hypoglycaemia. I would immediately alert the nurse in charge.”) → Document. PASS with higher marks.

Notice the shift: the examiner now cares less about your speed and more about your thought process.

The Five Marking Domains (v2.4 Framework)

To understand how examiners score you in 2026, familiarise yourself with these five domains:

Domain 1: Clinical Reasoning & Escalation (40%)

What examiners assess:

• Do you understand normal vs. abnormal findings?
• Can you interpret clinical data (blood pressure, glucose, temperature, respiratory rate, etc.)?
• Do you escalate appropriately when findings are abnormal?
• Can you prioritise-which findings are most urgent?
• Can you justify your decisions using clinical knowledge?

Example: Pressure Area Assessment Station- It is a silent station

Examiners want to hear:

“The patient has a stage 2 pressure ulcer on the sacrum with signs of infection (erythema, warmth, exudate). According to the European Pressure Ulcer Advisory Panel, this requires immediate escalation to the wound care team. I would also initiate isolation precautions and contact infection control.”

Not just: “Patient has a pressure ulcer. I’ll document it.”

How to score high on this domain:

• Always verbalise your interpretation of findings
• Use clinical language (describe findings using pathophysiology, not just observation)
• Link findings to management decisions
• Articulate when and why you escalate
• Show awareness of guidelines (NICE, NMC, nursing standards)

Domain 2: Communication & Patient Engagement (35%)

Communication is now the second-most-weighted domain, signalling the NHS’s emphasis on patient-centred care.

What examiners assess:

• Do you explain procedures to the patient beforehand?
• Do you check patient understanding?
• Do you respond to patient concerns or anxiety?
• Is your language clear, jargon-free, and respectful?
• Do you maintain eye contact and show empathy?
• Do you involve the patient in decisions about their care?

Example: Blood Glucose Station

Poor communication (v2.3 mentality):

Nurse: “I’m checking your blood sugar.” (Performs fingerstick without explanation. Reads result silently. Documents and leaves.)

Strong communication (v2.4 expectation):

Nurse: “Good morning. I’m going to check your blood sugar with a small finger prick. Have you had this done before?” (Patient responds.) “It may feel like a small pinch. Is that okay?” (Gains consent.) (Performs procedure.) “Your result is 6.8 mmol/L, which is in the normal range of 4-7. That’s good news. Are you experiencing any symptoms like shakiness or sweating?” (Offers reassurance.) “I’ll make sure your nurse knows the result. Do you have any questions?”

Notice: The second approach is slower but hits the 35% communication weight.

How to score high on this domain:

• Explain every procedure before doing it
• Use simple, patient-friendly language
• Ask open questions and listen actively
• Acknowledge patient concerns (never dismiss anxiety as unjustified)
• Show respect and dignity-address patient by preferred name
• Document with the patient present when possible

Domain 3: Technical Skill (20%)

Technical skill has dropped from 45% to 20%-a significant reduction. This doesn’t mean accuracy doesn’t matter; it means procedural perfection alone won’t carry you.

What examiners assess:

• Is your technique safe and hygienic?
• Are you confident and competent with equipment?
• Do you follow aseptic principles where required?
• Is your documentation accurate?
• Do you manage equipment properly (sharps disposal, waste)?

Example: Blood Glucose Station

Examiners still mark these technical elements:

• Proper hand hygiene before and after
• Use of appropriate personal protective equipment
• Safe fingerstick technique (side of finger, not pad)
• Correct application of blood to test strip
• Safe disposal of lancet and sharps
• Accurate documentation of time and reading

But a technically perfect procedure without explanation or escalation decision loses marks in the 40% clinical reasoning domain.

How to score high on this domain:

• Practice procedures until they’re automatic (muscle memory)
• Know where equipment is and how to use it safely
• Always prioritise infection control and patient safety
• Double-check your documentation for accuracy
• Never skip steps to save time-quality over speed

Domain 4: Safety & Professional Behaviour (5%)

This is a small percentage but critical. Failures here are deal-breakers.

What examiners assess:

• Do you maintain infection control standards (hand hygiene, glove use, sharps safety)?
• Do you respect patient dignity and privacy?
• Do you communicate respectfully with the team?
• Do you follow professional boundaries?
• Do you act in the patient’s best interest?

How to score high on this domain:

• Hand hygiene is non-negotiable-do it at start and end of every interaction
• Never expose a patient unnecessarily
• Always ask permission before touching
• Speak respectfully to all-examiners, actors, and colleagues
• If unsure, ask for help rather than guess
• Report concerns (never ignore potential safety issues)

How the 2025 Marking Criteria Affects Each Station Type

A-E Assessment Stations (Clinical Observations)

What’s tested: Vital signs, observations, clinical assessment (e.g., blood glucose, urine, blood pressure, temperature, respiratory rate, SpO2, blood glucose, neurological assessment).

v2.4 Focus: Interpretation of findings + escalation decision.

Marks allocation:

• Clinical Reasoning (40%): Can you interpret the result and recognise abnormality? Blood glucose 3.2 = hypoglycaemia → escalate. Temperature 39.5°C = fever → investigate cause → escalate.
• Communication (35%): Explain the test, gain consent, discuss findings with patient, reassure.
• Technical Skill (20%): Accurate measurement, safe technique, correct equipment use.
• Safety (5%): Hand hygiene, sharps disposal, documentation.

Strategic implication: Spend 30% of practice time on procedure, 40% on interpretation and escalation, 30% on communication skills.

APIE (Assessment, Planning, Implementation, Evaluation) Stations

What’s tested: Scenario-based nursing problem-solving.

v2.4 Focus: Your reasoning process and communication of the plan.

Marks allocation:

• Clinical Reasoning (40%): Can you assess the scenario, identify key problems, prioritise, and propose evidence-based solutions?
• Communication (35%): Can you explain your plan to the patient/family and gain buy-in?
• Technical Skill (20%): If implementation is required (e.g., applying a dressing), is it technically sound?
• Safety (5%): Are your suggestions safe and ethical?

Strategic implication: For APIE stations, practice articulating your thought process: “This patient presents with X. This suggests Y. I would prioritise Z because…”

MSU (Midstream Urine) Station

Marks allocation:

• Clinical Reasoning (40%): Can you collect a proper MSU? Do you know why MSU technique matters (contamination prevention)? Can you interpret findings (protein, nitrites, glucose, cells)?
• Communication (35%): Can you explain the procedure to a potentially embarrassed patient with sensitivity and clarity?
• Technical Skill (20%): Aseptic technique, proper collection method, labelling.
• Safety (5%): Privacy, dignity, infection control.

Strategic implication: Practice your explanation of MSU collection with empathy-many patients find this procedure uncomfortable.

Silent Stations (No Actor Communication)

Even silent stations are affected by v2.4. While patient communication isn’t possible, clinical reasoning and technical skill are heavily marked.

Marks allocation:

• Clinical Reasoning (40%): Interpret findings, make decisions, escalate if needed.
• Communication (20%): Ability to document findings clearly and communicate with the examiner if needed.
• Technical Skill (25%): Accurate procedure execution.
• Safety (15%): Strict adherence to protocol.

Common Mistakes Under the NEW Criteria (v2.4)

Many nurses fail OSCE under the 2025 criteria because they’re optimising for the old rubric. Here are the most common pitfalls:

Common Mistake	Why It Fails Under v2.4	How to Fix It
Performing procedures silently	v2.4 weights clinical reasoning at 40%. Silent task execution ignores this entirely. Examiners want to hear your thinking.	Verbalise everything: “I’m checking your glucose because you mentioned feeling faint. This helps me rule out hypoglycaemia.”
Rushing through to finish quickly	Speed suggests you haven’t thought about the patient’s individual needs. v2.4 emphasises person-centred care.	Slow down. Explain. Listen to patient responses. Quality over speed.
Getting the “right answer” but not explaining how you know	Under v2.3, results mattered. Under v2.4, your reasoning matters more. A nurse who says “Glucose is 6 mmol/L-that’s normal” scores higher than one who just records 6 without interpretation.	Always explain findings: “This is normal because the fasting range is 4-7 mmol/L.”
Ignoring patient anxiety or questions	Communication jumped from 30% to 35%. Dismissing a worried patient loses marks.	Respond with empathy: “I can see you’re worried. Let me explain what I’m doing.”
Not escalating abnormal findings	Escalation is now core to clinical reasoning (40%). Detecting abnormality but not acting on it is a critical failure.	Know escalation pathways. Always alert a senior nurse if findings are abnormal. Articulate why: “This is outside normal range-immediate escalation required.”
Using vague or non-clinical language	v2.4 expects nurses to articulate clinical reasoning. Vague language (e.g., “The patient seems off”) isn’t clinical.	Use precise language: “Blood pressure 160/100 suggests hypertension. I would check previous readings and consider cardiovascular risk.”
Documentation without clinical interpretation	Just writing numbers misses the 40% clinical reasoning weight.	Document findings AND your interpretation: “Glucose 3.2 mmol/L (ABNORMAL-hypoglycaemic). Escalated to nurse in charge. Patient given fast-acting carbohydrates.”
Forgetting that communication now matters more	Many nurses trained under old OSCE see communication as secondary. It’s now 35%.	Invest in communication training: explain, listen, reassure. Practice with actors or colleagues.

The 2026 NMC Competency Standards Context

The v2.4 marking criteria aren’t random. They align with the updated NMC Code (2018, refreshed in 2024) and the NMC’s emphasis on:

• Person-centred care: Understanding the individual patient’s needs, values, and preferences
• Evidence-based practice: Making decisions grounded in research and clinical guidelines
• Clinical reasoning: Moving beyond task completion to genuine problem-solving
• Systems thinking: Understanding how your action affects the broader healthcare system

By reweighting marks toward clinical reasoning and communication, the NMC is assessing whether you embody these values-not just whether you remember procedural steps.

How to Prepare Under v2.4: A Strategic Approach

1. Shift Your Mental Model

Old mindset: “How do I do this task correctly?”

New mindset: “Why am I doing this? What am I looking for? How does the finding change my management?”

Before every station, ask:

• What clinical problem am I assessing for?
• What findings would be normal vs. abnormal?
• If I find an abnormality, what would I do?

2. Practice Verbalisation (Not Just Procedure)

Don’t just drill procedural steps. Drill your explanation of what you’re doing and why.

Example (Blood Glucose Station):

Wrong approach: Perform the procedure 50 times in silence.

Right approach: Perform the procedure 10 times in silence, then 40 times while explaining aloud: “I’m cleaning the site because this reduces contamination. I’m using the side of the finger because it’s less painful and easier to get a drop of blood. I’m reading the result immediately because test strips are time-sensitive. A reading of 6.8 is normal because the fasting range is 4-7 mmol/L. A reading below 4 would indicate hypoglycaemia, requiring immediate escalation.”

3. Link Findings to Management

For every finding you identify, know what it means and what you’d do about it.

Example:

• Finding: Blood pressure 160/100
• Interpretation: Stage 2 hypertension
• Action: Report to senior nurse, consider escalation, may require antihypertensive medication
• Patient communication: “Your blood pressure is higher than ideal. I’m going to let your nurse know so we can manage this safely.”

4. Build Communication Skills Deliberately

Communication is now 35% of marks. This requires practice with real people (or good actors).

Strategies:

• Record yourself explaining procedures and listen critically
• Practice with a partner or mentor
• Take a communication skills course if available
• Study transcripts of high-scoring OSCE interactions
• Role-play difficult scenarios (e.g., anxious patient, non-compliant patient)

5. Use the Updated Marking Rubric in Practice

When you practice with mentors or simulate exams, ask them to score you using the v2.4 rubric-not the old one.

What this means:

• Ask for feedback on your clinical reasoning (Did I interpret findings correctly? Did I escalate appropriately?)
• Ask for feedback on communication (Was my explanation clear? Did I respond to patient concerns?)
• De-emphasise feedback on pure speed (finishing in 5 minutes vs. 10 minutes matters less now)

6. Study Real Case Scenarios

The v2.4 criteria emphasise clinical reasoning in context. Study scenarios where findings vary:

• Patient with glucose 6.8 mmol/L (normal) vs. 3.2 mmol/L (abnormal) – How does your management differ?
• Patient with blood pressure 120/80 (normal) vs. 170/110 (abnormal) – What’s your escalation pathway?
• Patient with fever 38.5°C – Is it concerning? When do you escalate? What’s your questioning?

Connecting to the Broader OSCE Preparation Landscape

The v2.4 marking criteria update doesn’t exist in isolation. It’s part of a larger shift in how OSCE is assessed.

Understanding Your Overall OSCE Journey

The NMC OSCE consists of 4 stations × 15 minutes each. The 2025 update affects all stations equally.

Related preparation areas:

• Why Reading the NMC OSCE Scenario Is Crucial for Exam Success – Understanding the scenario is the first step in clinical reasoning
• Red Flags in the NMC OSCE: What Every Candidate Must Know – Recognising abnormal findings is core to the 40% clinical reasoning weight
• Common Errors in the NMC OSCE Silent Clinical Skills – Even silent stations require strong clinical reasoning interpretation
• APIE Stations Explained: How to Structure Your Assessment and Plan – APIE stations directly test clinical reasoning and communication

Silent vs. Interactive Stations

Not all stations are the same. Silent stations have no patient actor; you’re just demonstrating procedure and explaining to the examiner. Interactive stations have a patient actor; communication is more critical.

Under v2.4:

• Silent stations emphasise technical skill + clinical reasoning (communication with examiner)
• Interactive stations emphasise communication with patient + clinical reasoning + technical skill

Both require strong clinical reasoning (40%), but interactive stations emphasise patient communication more.

The Role of Exam Anxiety in 2026

With the new emphasis on verbalisation and communication, exam anxiety becomes more relevant.

Why? Anxiety often silences nurses-they freeze up, become task-focused, and forget to explain. Under v2.4, this silence costs you 35% (communication) + 40% (clinical reasoning) = 75% of marks.

Consider: Overcome Exam Anxiety: NMC CBT Stress-Relief Techniques That Work in 2026 – Anxiety management directly impacts your ability to verbalise and communicate under v2.4 criteria.

Frequently Asked Questions About v2.4

Q: Does v2.4 mean I don’t need to be technically skilled anymore?

A: No. Technical skill is still 20% of marks, and poor technique can lead to patient safety failures. But technical perfection without clinical reasoning is no longer enough. You need both-with more emphasis on reasoning.

Q: I’ve been preparing using old materials. Is my preparation wasted?

A: Not wasted, but incomplete. Procedural knowledge is still necessary but not sufficient. You now need to add clinical reasoning and communication practice to your preparation.

Q: How much time should I spend on each domain?

A: Given the weighting, allocate your study time roughly as:

• Clinical reasoning: 40%
• Communication skills: 35%
• Technical skill: 20%
• Safety/professional behaviour: 5%

Q: Does v2.4 apply to all four stations?

A: Yes, all four OSCE stations are marked using v2.4 criteria, though the weight of communication varies (more in interactive stations, less in silent stations).

Q: What if I’m already booked for an OSCE exam? Will I be marked on v2.4?

A: Yes. v2.4 became effective July 2025. Any exam after that date uses the new criteria.

Q: Are there different criteria for different nursing fields (Adult, Child, Mental Health)?

A: The overall framework is the same, but clinical content differs. A child nurse’s blood glucose station differs from an adult nurse’s. The 40/35/20/5 weighting applies to all fields.

What Happens in Your OSCE Exam Room (v2.4 Reality)

To make this concrete, here’s what a 2026 OSCE looks like:

Station 1: Blood Glucose Monitoring (Interactive)

The setup: You’re given a patient actor (woman, 62, Type 2 diabetes). You have 15 minutes.

Under v2.3 (old criteria):

• Perform fingerstick
• Get result
• Document
• Score: If technical = correct, you might pass

Under v2.4 (new criteria):

• Introduce yourself and explain the procedure (communication: 35%)
• Perform fingerstick (technical: 20%)
• Interpret the result aloud (“This is 7.1 mmol/L, which is slightly elevated but not concerning in a non-fasting state”) (reasoning: 40%)
• Ask if patient has symptoms (“Are you experiencing unusual thirst, fatigue, or frequent urination?”) (communication: 35%)
• Explain the interpretation to the patient (“Your glucose is well-controlled with your current medication, but we’ll monitor it”) (reasoning: 40%)
• Document and summarise your plan (reasoning: 40%)
• Score: If you hit all domains, you pass comfortably

The new OSCE is slower, more conversational, and more focused on thinking aloud.

Station 2: Pressure Area Assessment (Silent)

The setup: Manikin or photo. You’re assessing a pressure ulcer and documenting.

Under v2.4:

• Examine the wound carefully (technical: 20%)
• Describe findings using clinical language (“Stage 2 pressure ulcer, 3×4 cm, with erythema and exudate, indicating infection risk”) (reasoning: 40%)
• Explain to the examiner your interpretation (“This requires escalation to wound care and infection control”) (reasoning: 40%)
• Document with clinical detail (reasoning: 40%)

Silent doesn’t mean silent in your head-it means silent with the patient, but vocal with the examiner.

Key Takeaways: What You Must Remember About v2.4

1. Clinical reasoning is now dominant (40%): Examiners want to hear your thinking, not just see your actions.
2. Communication jumped to 35%: Explain procedures, listen to patients, show empathy. This is no longer secondary.
3. Technical skill dropped to 20%: Still important, but perfection here won’t carry you. Balance it with reasoning and communication.
4. You must verbalise your thought process: Silent task completion, no matter how accurate, will score poorly under v2.4.
5. Abnormal findings require escalation: Detecting something unusual and not acting on it is a critical failure.
6. Context matters: Generic “correct technique” is less valued than technique tailored to the individual patient.
7. The shift reflects real nursing: v2.4 aligns with modern nursing practice-it’s not just a marking change; it’s a values change toward patient-centred, evidence-based care.

Ready to Master OSCE Under the 2026 Criteria?

The good news: if you understand v2.4, you can prepare strategically. The bad news: winging it won’t work anymore.

The nurses who excel under v2.4 are those who invest in three areas: clinical knowledge (to interpret findings), communication skills (to explain your thinking), and authentic practice with feedback (to refine both).

If you’re feeling unprepared or uncertain, professional OSCE training tailored to the 2025 criteria can accelerate your progress significantly. Mentors experienced with v2.4 can identify gaps in your clinical reasoning and communication that generic resources miss.

NMC OSCE For nurses Everything You Need to Know in 2026👉 Click Here

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