Language tests and tests of competence for registration purposes - a scoping review of the experiences of overseas nurses.

Background: The overseas applicant's capability of practising safely and effectively is proven through the tests of competence which consist of computer-based tests and the Objective Structured Clinical Examination (OSCE). All prospective applicants to the Nursing and Midwiferey Council (NMC) register must be able to demonstrate that their skills, knowledge and behaviours are at the level required to meet the NMC preregistration nursing or midwifery standards for the United Kingdom (UK).

Aim: The aim of this review is to explore the challenges faced whilst undertaking these tests of competence, the OSCE, by overseas educated nurses who aspire for Nursing and Midwifery Council (NMC) registration in the UK.

Methods: A scoping review using the Arksey and O'Malley (2005) framework was conducted to explore and produce a profile of the existing literature on the registration requirements of the NMC. A search of CINAHL, Medline and Scopus resulted in 150 records, which were then screened against the inclusion criteria - English Language, publication between 2015 onwards and discussed the language tests/competency tests required for gaining entry to the NMC register. A total of nine articles met the criteria and are included in this scoping review. The PRISMA-ScR framework is used to present the review.

Results: There was a paucity of studies that addressed the experience of overseas nurses who faced the OSCE. An interpretative stance was adopted to formulate the themes which were: competence/practice disparity, arbitrary issues for failing, failure to capture the digital health agenda, financial implications, and consequences of failing the OSCE. The results raise concern whether the nurses from overseas are held to higher standards than those trained in the UK and whether the assessment process is realistic and not pedantic.

Conclusions: This scoping review demonstrates there is a lack of robust research evaluating the effectiveness of tests of competencies. The review indicates there is no due acknowledgement of the previous skills and knowledge of the overseas nurses. Future research should focus on exploring the feasibility of tests of competence and its role in the integration of the nursing workforce.