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Station 30 of 33 · Free

Asked to do a procedure you are not trained for.

  • Professional values
  • Written stations: values and evidence
  • Acute medical ward, night shift, 02:00
  • Written station (silent)
  • 10 minutes

Station timer

Station timer: 10 minutes [S5], a written station.

The paper on the desk

Setting: Acute medical ward, night shift, 02:00. Format: Written station (silent).

You are a registered nurse on a night shift. The ward is two registered nurses short tonight.

Mr Peter Lowe, 61, had a tracheostomy formed after surgery and moved to your ward this evening. His care plan says his inner cannula is due to be changed at 02:30.

You have never been trained or assessed in tracheostomy care. The nurse in charge is busy with an unwell patient in another bay. She says: 'It's easy. Just change it and I'll talk you through it from the other bay if you get stuck.'

Answer the questions in writing. You work alone and in silence.

In 10 minutes:

  1. What do you say to the nurse in charge, and what do you do next?
  2. Which sections of the Code guide your decision? Give a reason for each.
  3. Who else do you contact, and how do you keep Mr Lowe safe until a competent nurse is with him?
  4. What do you document and report afterwards?

On the desk: Question sheet, lined answer paper and a black pen.

More on the paper: the details you are given

Read these as part of the paper.

  • Mr Lowe is comfortable at the moment, with quiet breathing, and his call bell is in reach.
  • A fictional extract from your employer's policy, written for this practice station: 'Inner cannula changes are carried out only by staff who have completed tracheostomy training and been assessed as competent. If no competent nurse is on the ward, contact the critical care outreach team or the night site manager.'
  • Your other patients are stable. One healthcare assistant is working with you in your bay.

The checklist

Tick what you really did. 10 points, 3 safety-critical, each mapped to a platform of the standards of proficiency [S10] and to sections of the Code [S9]. Our own practice checklist, not the NMC marking criteria.

Did you do these?
  • Why it matters

    Doing a procedure you are not competent in puts the patient's airway at risk. Saying so is the safe and professional answer, not a refusal to help.

  • Why it matters

    Remote advice is not the training and assessment the policy asks for. If something goes wrong with an airway, there is no time to fetch help.

  • Why it matters

    Declining the task does not end your duty to the patient. The change still has to happen safely, and on time.

  • Why it matters

    A risk to a patient's airway cannot wait until the morning. Escalating up the line is how the organisation finds the right person.

  • Why it matters

    Working with the team, not against it, shows you are helping within your limits. It also frees the nurse who can do the task.

  • Why it matters

    The written station tests whether you can link your actions to the Code, not just what you would do.

  • Why it matters

    Professional behaviour under pressure keeps the team working together and keeps the focus on the patient.

  • Why it matters

    A clear record shows the next shift and any later review how the risk was handled.

  • Why it matters

    Reporting lets the organisation fix the gap so the next nurse is not put in the same position.

  • Why it matters

    Working within your competence also means building it through proper training before you take on a new task.

Model walkthrough

Show it, minute by minute (try the station first)
  1. 0:00

    Read all four questions first. Underline the risk (an airway procedure you are not trained for) and the time (02:30). Plan one short paragraph per question.

  2. 1:15

    Question 1: what you say and do. Lead with the decision, then the patient's safety.

    Write I would tell the nurse in charge politely that I have not been trained or assessed in tracheostomy care, so I cannot safely change Mr Lowe's inner cannula, even with advice from another bay.

  3. 2:45

    Keep the patient in the answer: who will do the change, and by when.

    Write I would ask her to find a trained nurse from another ward. If no one is available, I would contact the critical care outreach team or the night site manager straight away, as our policy says, so the change happens safely and on time.

  4. 4:15

    Question 2: name the Code sections and give one reason each.

    Write Code section 13: I must recognise and work within the limits of my competence. Code section 16: I must act without delay if there is a risk to patient safety, and an untrained airway procedure is that risk.

  5. 5:45

    Question 3: how you keep him safe meanwhile and help the team.

    Write Until a competent nurse arrives, I would stay close to Mr Lowe, watch his breathing and keep his call bell in reach, and take on other tasks so a trained colleague can come to him.

  6. 7:00

    Question 4: documentation and reporting.

    Write I would record the time, what I was asked, who I contacted and who changed the cannula. I would report the staffing and competence gap through the incident reporting system, and ask for tracheostomy training.

  7. 8:45

    Read your answers through. Check every question is answered, the writing is legible, and nothing sounds like blaming your colleague.

Common mistakes

  • Agreeing to 'have a go' because the ward is busy and the nurse in charge asked.

    Say clearly that you are not trained or assessed, and that you will find someone who is.

  • Refusing, then stopping there, so the patient's cannula change is left to chance.

    Declining the task means you now own finding a competent person: nurse in charge, outreach team, night site manager.

  • Listing Code sections without saying how they apply.

    One line each: section 13 for your limits, section 16 for acting without delay on a safety risk.

  • Writing a complaint about the nurse in charge.

    Report the staffing and competence gap as a safety issue through the incident system. Keep it factual.

  • Forgetting documentation, or running out of time on the first question.

    Give each question about two minutes, and keep the last minute to read your answers through.

From the official NMC materials

  • The two written (silent) stations, professional values and evidence-based practice, are 10 minutes each. [S5]
  • One station assesses professional accountability and the related communication skills, and one assesses critical appraisal of research and evidence. Both are written stations. [S3]
  • In each OSCE, one written station assesses the professional behaviours and values of Platform 1, Being an accountable professional. [S6]
  • The Code has four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. [S9]
  • The Code has 25 sections: 1 Treat people as individuals and uphold their dignity; 2 Listen to people and respond to their preferences and concerns; 3 Make sure that people's physical, social and psychological needs are assessed and responded to; 4 Act in the best interests of people at all times; 5 Respect people's right to privacy and confidentiality; 6 Always practise in line with the best available evidence; 7 Communicate clearly; 8 Work co-operatively; 9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues; 10 Keep clear and accurate records relevant to your practice; 11 Be accountable for your decisions to delegate tasks and duties to other people; 12 Have in place an indemnity arrangement which provides appropriate cover for any practice you take on as a nurse, midwife or nursing associate in the United Kingdom; 13 Recognise and work within the limits of your competence; 14 Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place; 15 Always offer help if an emergency arises in your practice setting or anywhere else; 16 Act without delay if you believe that there is a risk to patient safety or public protection; 17 Raise concerns immediately if you believe a person is vulnerable or at risk and needs extra support and protection; 18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations; 19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice; 20 Uphold the reputation of your profession at all times; 21 Uphold your position as a registered nurse, midwife or nursing associate; 22 Fulfil all registration requirements; 23 Cooperate with all investigations and audits; 24 Respond to any complaints made against you professionally; 25 Provide leadership to make sure people's wellbeing is protected and to improve their experiences of the health and care system. [S9]
  • Unsafe practice raises a red flag, and an agreed red flag always means the station is failed. [S3]
  • Saying what you would have done will not overturn a critical fail, and anything you do after the time is up is not assessed. [S5]

Open my report · Study plan · All stations

Independent practice. Not affiliated with, endorsed by or approved by the NMC, the test centres or any exam body. Original practice material, no real exam content. No guarantee of a pass. Our checklists are our own, not the NMC marking criteria. Written with AI from the official NMC materials, and checked word for word against them. Practice material, not advice for real patient care: follow your employer's policy and the NMC Code.