Station 1 of 33 · Free
Assessment: new confusion, a fever and a urinary infection.
Station timer
Station timer: 20 minutes [S6] [S4] for the assessment station in adult nursing, with a prompt 5 minutes before the end [S5].
20 minutes. Read the brief, then perform out loud with your hands moving, as if you were in the room.
Perform now, out loud
Talk to the patient, move your hands as if the equipment were there, and say each check as you do it. Open the findings as you assess.
Station brief
Setting: Acute medical unit, 12:00. Patient: Simulated patient (actor) with her daughter.
You are the registered nurse on the acute medical unit. It is 12:00. Mrs Margaret Ellis, 79, came in from home at 08:00 with 2 days of burning when passing urine and passing urine more often. Her daughter, Claire, is with her and says her mother has not been herself since this morning.
History: type 2 diabetes (metformin), high blood pressure (amlodipine), osteoarthritis. Allergy on her wristband: codeine (vomiting). Hospital number 4471029. She lives alone, walks with a stick, and Claire visits every day.
Observations at 08:00: respiration rate 18, SpO2 96% on air, blood pressure 126/74, pulse 92, alert, temperature 38.2 °C. NEWS2 2.
In 20 minutes:
- Carry out a holistic A to E assessment of Mrs Ellis.
- Take a full set of observations, record them on the NEWS2 chart and total the score.
- Assess her activities of living, then tell the examiner your findings, your concern and what you are doing about it.
In the station: Vital signs monitor, tympanic thermometer, watch with a second hand, capillary blood glucose meter, blank NEWS2 chart, activities of living assessment form, pen, alcohol hand rub, call bell.
Findings: what the patient or assessor tells you
Open these as you assess, one at a time, the way an assessor or patient would give them.
- Airway: talking in full sentences, no noisy breathing.
- Breathing: you count a respiration rate of 22. SpO2 95% on air. Chest moves equally on both sides; no cough.
- Circulation: pulse 108, regular. Blood pressure 104/62. Capillary refill 3 seconds. Skin warm and flushed, mouth dry. She has passed about 150 mL of dark, strong-smelling urine since 08:00.
- Disability: knows her name, not sure where she is or why. Claire says she is normally fully orientated and does her own shopping. Capillary blood glucose 11.8 mmol/L. Pain low in her tummy, 4 out of 10.
- Exposure: temperature 38.4 °C. No rash, no wounds. Both heels slightly red; the redness fades under finger pressure.
- Activities of living: has eaten little and drunk only a few cups of tea for 2 days. Urgency, and one episode of incontinence this morning that embarrasses her. Unsteady when she stood up at 10:00. Worried about who will feed her cat.
The checklist
Tick what you really did. 11 points, 4 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.
Your result
NEWS2, worked out
Show the chart, band by band (total it yourself first)
| Parameter | Value | Score |
|---|---|---|
| Respiration rate | 18 | 0 |
| SpO2, Scale 1 | 96% | 0 |
| Air or oxygen | Air | 0 |
| Systolic blood pressure | 126 | 0 |
| Pulse | 92 | 1 |
| Consciousness (ACVPU) | Alert | 0 |
| Temperature | 38.2 °C | 1 |
| Parameter | Value | Score |
|---|---|---|
| Respiration rate | 22 | 2 |
| SpO2, Scale 1 | 95% | 1 |
| Air or oxygen | Air | 0 |
| Systolic blood pressure | 104 | 1 |
| Pulse | 108 | 1 |
| Consciousness (ACVPU) | New confusion | 3 |
| Temperature | 38.4 °C | 1 |
Bands from the RCP NEWS2 chart [S11]. The build recalculates every total.
Model walkthrough
Show it, minute by minute (try the station first)
- 0:00
Read the brief and the 08:00 observations. Note the baseline: NEWS2 2, pulse 92, blood pressure 126/74. Plan the A to E so the full set is charted well before the 5-minute prompt.
- 0:45
Hand rub. Introduce yourself, ask her preferred name, check identity against the wristband and chart, confirm the allergy, gain consent.
Say Hello, I'm (your name), one of the nurses. What would you like me to call you? Can you tell me your full name and date of birth? Thank you. I'd like to check your breathing, pulse, blood pressure and temperature and ask you some questions. Is that all right?
- 2:00
Airway and breathing: listen to her speech. Fingers on her wrist, count breathing for a full minute: 22. SpO2 95% on air. Watch the chest move.
- 3:30
Circulation: pulse 108 and regular, blood pressure 104/62, capillary refill 3 seconds, warm and flushed, dry mouth. Ask about urine: about 150 mL since 08:00, dark.
- 5:30
Disability: ask where she is. Ask Claire whether this is new. Score ACVPU as C. Capillary glucose 11.8 mmol/L. Pain 4 out of 10, low in her tummy.
Say Claire, is your mum usually this muddled, or is this new today?
- 7:00
Exposure: temperature 38.4. Check skin and heels: red, but the redness fades under finger pressure.
- 8:00
Chart every value and total it: 2, 1, 0, 1, 1, 3, 1 = NEWS2 9, with a red score of 3 for new confusion. Say it out loud.
Say Her NEWS2 is 9, up from 2 at 08:00, and the new confusion scores 3 on its own. With a urinary source, I'm treating this as suspected sepsis at high risk.
- 9:00
Escalate now, from the bedside: call bell, nurse in charge, emergency medical review with critical care outreach. SBAR with the numbers.
Say This is (your name), staff nurse on the acute medical unit, about Margaret Ellis, 79, hospital number 4471029. I'm worried she has sepsis. Her NEWS2 is 9, up from 2 at 08:00. Respirations 22, sats 95% on air, blood pressure 104/62, pulse 108, temperature 38.4, and she is newly confused. She has had 2 days of urinary symptoms and has passed about 150 mL since 08:00. Please come and see her now. I'm starting continuous monitoring and getting blood cultures, a lactate and a cannula ready so she can have antibiotics within the hour.
- 11:00
Activities of living with her and Claire: food, fluids, continence, mobility since the wobble at 10:00, sleep, home and the cat. Offer help with the incontinence privately.
- 15:00
5-minute prompt. Finish the chart and the activities of living form. Monitor attached, call bell in her hand, walking stick within reach.
- 17:00
Tell the examiner: findings, NEWS2 9, suspected sepsis at high risk, who you told and when, and what must happen in the next hour.
Say My priority is suspected sepsis from a urinary infection. I've escalated for an emergency review, and I'll stay with her on continuous monitoring until the team arrives.
Common mistakes
Adding up NEWS2 in your head and putting one value in the wrong band.
Write each score next to its value on the chart, then add them: 2, 1, 0, 1, 1, 3, 1 = 9.
Putting the confusion down to age or dementia because she is 79.
Ask someone who knows her. New confusion scores 3 on its own and is a red flag for sepsis.
Finishing the activities of living form before escalating.
Escalate the moment the total reaches 7 or more, then come back to the form.
Leaving her alone to phone from the desk.
Use the call bell or send a colleague. Stay with her: she is confused and unsteady.
Guessing the respiration rate.
Count for a full minute with your fingers still on her pulse.
From the official NMC materials
- In adult nursing the APIE stations last 20 minutes (assessment), 14 minutes (planning), 15 minutes (implementation) and 8 minutes (evaluation). [S6] [S4]
- You get a prompt 5 minutes before the end of an APIE station and 3 minutes before the end of a skills station. [S5]
- In the assessment station you take and record observations (for example on a NEWS chart) and, in adult nursing, carry out a holistic A to E assessment: airway, breathing, circulation, disability and exposure. [S5]
- Notes you write in the assessment station are not marked; they are for your own use in the written stations that follow. [S5]
- Communication is assessed throughout. With a manikin, say your actions and the reasons for them out loud, as you would with a real patient. [S3]
- Unsafe practice raises a red flag, and an agreed red flag always means the station is failed. [S3]
- The NMC's adult mock OSCE checks identity with the person's name plus either their date of birth or hospital number, verbally and against the wristband and paperwork. [S7]
- Common mistakes the NMC lists for every station: touching the patient before hand hygiene, not checking allergies, not checking identity, not gaining consent and not finishing in time. [S5]
- 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]
The clinical numbers in this station
- NEWS2 scores (RCP Chart 1). Respiration rate: 8 or less scores 3, 9-11 scores 1, 12-20 scores 0, 21-24 scores 2, 25 or more scores 3. SpO2 Scale 1: 91% or less 3, 92-93% 2, 94-95% 1, 96% or more 0. Air 0, oxygen 2. Systolic blood pressure: 90 or less 3, 91-100 2, 101-110 1, 111-219 0, 220 or more 3. Pulse: 40 or less 3, 41-50 1, 51-90 0, 91-110 1, 111-130 2, 131 or more 3. Consciousness: alert 0, new confusion, voice, pain or unresponsive (CVPU) 3. Temperature: 35.0 or less 3, 35.1-36.0 1, 36.1-38.0 0, 38.1-39.0 1, 39.1 or more 2. [S11]
- NEWS2 response (RCP Chart 4). Total 0: minimum 12-hourly observations. Total 1-4: minimum 4-6 hourly; the registered nurse assesses and decides on more frequent monitoring or escalation. 3 in a single parameter: minimum 1-hourly; inform the medical team. Total 5 or more: minimum 1-hourly; the registered nurse immediately informs the medical team and requests urgent assessment by a clinician with acute care competencies. Total 7 or more: continuous monitoring and emergency assessment by a team with critical care competencies. [S12]
- NICE: with suspected or confirmed infection, a NEWS2 score of 7 or more suggests high risk of severe illness or death from sepsis, 5 or 6 medium risk, and 1 to 4 low risk. [S13]
- NICE: for high risk of sepsis, a clinician at FY2 level or above urgently assesses, a venous blood test includes lactate and blood cultures, broad-spectrum IV antibiotics are given within 1 hour of calculating the NEWS2 score, and an IV fluid bolus is given within 1 hour unless contraindicated. [S13]
- NICE: use a validated scale (for example Braden) to support clinical judgement; encourage adults at risk of a pressure ulcer to change position at least every 6 hours, and those at high risk at least every 4 hours; check whether redness blanches using finger palpation or diascopy. [S15]
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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.