Informed Consent in the NMC OSCE: How to Check Capacity, Gain Consent and Document It

You can perform every step of a procedure correctly and still fail on informed consent in the OSCE. A candidate who measures, cleans and administers flawlessly, but never checks that the patient understands, or never records the decision, has missed exactly what examiners are told to look for. This post sets out what the NMC marking criteria expect on informed consent in the OSCE: the mental capacity check, the words to say aloud, and what to do when a patient refuses.

Quick answer: consent is valid only when it is voluntary and informed and given by someone with capacity. Check mental capacity, explain in plain words, confirm the choice is free, name the type of consent and document it before you act. Missing consent is a red flag in the NMC criteria. If you are preparing now, read this alongside the new OSCE stations from 26 October 2026.

Why informed consent in the OSCE is marked so strictly  

Consent is assessed in its own right. The NMC marking criteria include a gaining informed consent domain, and failing to gain it is listed as a red flag. Consent also appears as a step inside your APIE and most of your clinical skills. The NMC Code reinforces this: clause 4.2 tells nurses to gain properly informed consent and document it before carrying out any action. In short, consent is treated as a patient safety step that runs across the exam, not a single box on one station. For the wider standard, see our guide to the NMC Code for OSCE candidates and the essential clinical skills for the OSCE.

The mental capacity check in plain language  

Start from the presumption of capacity. Under the Mental Capacity Act 2005, a person is assumed to have capacity for a decision unless it is shown otherwise, and an unwise decision does not, on its own, mean a person lacks capacity. Take practicable steps to help them decide, for example using simple language or visual aids.

A person lacks capacity for a specific decision only if they are unable to do one of the following:

• understand the information relevant to the decision

• retain that information

• use or weigh it as part of making the decision

• communicate the decision, by any means

Capacity is decision specific and time specific. Note that the Mental Capacity Act 2005 applies in England and Wales; Scotland and Northern Ireland have their own mental capacity frameworks, and the Code expects you to follow the law of the country where you practise.

Voluntary, informed and documented: what to say  

Three short tests turn the theory into something an examiner can hear.

Informed: explain what you plan to do, why, the main risks and any alternatives, then check understanding with teach-back. For example: “I would like to check your blood pressure to see how your body is responding. It involves a cuff on your arm that tightens for a few seconds. Can you tell me, in your own words, what we are about to do?”

Voluntary: make sure the decision is free of pressure from family or staff. For example: “This is your choice, and you can say no or ask me to stop at any point.”

Documented: record the consent in the notes before you act. Saying “I would document that consent was gained before starting” shows the examiner the step.

Consent that is both voluntary and informed is only complete once you name the type of consent you are relying on. In the OSCE you will usually rely on verbal consent (the patient clearly agrees after your explanation) or implied consent (the patient cooperates, for example by offering their arm for a blood-pressure cuff). Written consent is rarely required for the procedures tested in the exam, but you should still document the consent you obtained.

For the structure of a well-run exchange, see opening, explaining and closing a station.

When the patient refuses or may lack capacity   

A competent adult can refuse, even when the refusal seems unwise. Respect it, and document it. The NMC Code (clause 2.5) expects you to respect and record a person’s right to accept or refuse care.

If you are not sure the patient has capacity, do not simply carry on. In an OSCE this usually means saying that you would stop, raise your concern with the nurse in charge or a senior colleague, and act in line with the Mental Capacity Act 2005 and local policy. Best interests decisions and the least restrictive option only come into play once a lack of capacity has actually been established, and much of that process sits beyond what a candidate nurse decides alone. Keep your answer to the nursing action: pause, escalate, document. For more on the values being assessed here, see why the Professional Values station matters.

Frequently asked questions  

Do I need to check capacity in every station? Gaining informed consent is part of the marking criteria, and the capacity check sits within that consent domain. So you should always gain and document consent before acting. Treat capacity as part of gaining consent, rather than assuming every station scores it as a separate item.

What if the patient refuses? Respect the refusal, confirm you have explained the options clearly and document the decision. You do not persuade and you do not proceed. Showing that you would record the refusal, and inform the nurse in charge if needed, demonstrates safe practice.

Where do I document consent? In the patient’s notes, before you carry out the action. In the OSCE, state aloud that you would record that consent was gained, so the examiner can credit the step.

Conclusion  

Informed consent in the OSCE is a safety step, not a formality. The candidates who pass treat it as part of the clinical skill itself: check mental capacity, explain in plain words, confirm the choice is voluntary and informed, and document it before acting. Avoid the common slips set out in our top OSCE mistakes to avoid.

Practise consent on a mock OSCE circuit with Envertiz Academy, with an examiner who marks it. Book a place on UK OSCE training for nurses.  Disclaimer

This page is for general guidance only and does not replace the official NMC OSCE marking criteria or the law. Always refer to the current NMC documentation and the Mental Capacity Act 2005 (or the relevant capacity legislation where you practise).