Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Overseas Aptitude Test - information for applicants

Faculty of Nursing & Midwifery, RCSI December 2015

Please note that the contents of the Overseas Aptitude Test Information for Applicants is copyright of RCSI Faculty of Nursing & Midwifery. It is for the use of applicants only and cannot otherwise be copied or used without the written permission of the Executive Director of the Faculty.

1. Overview of the Aptitude Test

Last updated (06/02/19)

1.1. Working as a General Nurse (RGN) in the Republic of Ireland

In order to work as a nurse in the Republic of Ireland a person must be on the Active Register of the Nursing and Midwifery Board of Ireland (NMBI).

A person who trained outside the Republic of Ireland must undergo a regulatory assessment by the NMBI. When the assessment by the NMBI is complete, the outcome may be:

To register as an applicant

OR

To refuse the applicant registration

OR 

As a pre-requisite to registration, the applicant must successfully complete either:
(a): The RCSI Aptitude Test
or
(b): A period of adaptation and assessment

For details of the registration process with the NMBI click here.

1.2. Options available

Until December 2015, the only compensation measure available was the adaptation and assessment programme and the places available did not meet the demand. In 2015, led by Professor Thomas Kearns, the Faculty of Nursing & Midwifery (FNM) at the Royal College of Surgeons in Ireland (RCSI) developed the RCSI FNM Aptitude Test for Overseas Nurses (hereafter referred to as the Aptitude Test) as an alternative to the adaptation and assessment model for assessing the competence of overseas educated and trained nurses. It was developed following an extensive review of the national and international literature, and following a national survey and consultation with stakeholders in the Republic of Ireland. It gained approval by the NMBI. Since December 2015, the FNM coordinates and manages the Aptitude Test for overseas nurses applying to register as a general nurse (RGN) with the NMBI.

1.3. Principles Underpinning the Aptitude Test

In the Republic of Ireland, registered nurses and midwives are accountable healthcare professional practitioners working within a scope of practice. Fundamental to safe patient care is competent registered nurses and midwives. The principles and values underpinning the Aptitude Test include:

  • The priority to ensure patient and public protection
  • The Aptitude Test must assure the NMBI that the assessment methodology determines whether applicants meet the standards for safe, effective and competent practice in order to be eligible to register with the NMBI
  • Providing a robust, fair, objective, valid and reliable assessment methodology
  • Providing a responsive efficient, effective, economical and equitable assessment for all applicants
  • The competencies for entry to the NMBI Register inform this assessment
  • The assessment structure and process support the applicants to demonstrate the knowledge, skills and competencies that are determined by the NMBI in terms of the Registration Standards and Requirements.

1.4 Parts of the Aptitude Test

The Aptitude Test comprises two parts:

Part 1: Theory or Knowledge or MCQ Test

Part 2: Practical or OSCE Test

Part 1 must be successfully completed before part 2 can be attempted.

Both parts of the Aptitude Test, effective from January 2019, are based on the NMBI (2016) Nurse Registration Programmes Standards and Requirements. 4th edition. Refer pp 11-72 (hereafter referred to as NMBI Standards and Requirements) and are what a newly qualified general nurse in the Republic of Ireland must be able to achieve.

The Aptitude Test examines your potential suitability for registration as a general nurse with the NMBI and not just the suitability to work in one specific environment (for example where you may have an offer of a job).

1.5 Attempts

Two attempts (that is, one repeat) are allowed at each of the two parts of the Aptitude Test. The Theory part must be repeated in full. An applicant who fails at the first attempt of the Practical Part/OSCEs is required to re-sit the OSCE station/s failed. At a number of the stations, there are more than one situation or scenario used. The situation or scenario for the second attempt may be different to that of the first attempt. Therefore, an applicant is required to repeat the station/s failed but the situation or scenario may be different between the first and second attempt. 

1.6 Venue

Both parts of the Aptitude Test are held in the RCSI Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9. The Centre is the modern, white building beside the Accident and Emergency building at Beaumont Hospital (click here to see a photograph of the building). Once on the Beaumont Hospital grounds, please follow the signs for the Accident and Emergency department, which are marked in red.

Regarding the Aptitude Test venue, please consider the following:

  • This is the only venue for both parts of the Aptitude Test
  • Paid public parking should be available near the venue
  • Child-minding facilities are not available
  • Space is limited and there is no room for family members or friends
  • There is no facility for securing personal belongings and RCSI accepts no liability for damage or loss
  • There are no facilities available for refreshments. Refreshments may be brought by the applicant but there are no facilities to warm or cool food and drinks 
  • Latecomers cannot be admitted
  • If an applicant leaves the test venue at any point during the day of the test, re-admittance to the building is not allowed
  • In line with current legislation, smoking or vaping is prohibited in all areas of Beaumont Hospital

1.7 Test infringement

Any documentation currently on the RCSI FNM website pertaining to the Aptitude Test is available but must be appropriately referenced if used. All other RCSI FNM documentation pertaining to both parts of the Aptitude Test is strictly confidential and is for use only by RCSI FNM and must not be copied or recorded in any format or by any method. Only the handouts given by RCSI during the tutorials can be brought to the Aptitude Test centre. Communication with fellow applicants during any part of the Aptitude Test is not permitted.

Any electronic device such as mobile phones, iPods/iPads, MP3/4 players or any product with an electronic communication/storage device or digital facility, must be switched off and put in the bottom of your bag before entering the Smurfit Building. Your bag will be put in storage until you are ready to leave and cannot be accessed before that point. All such devices cannot be switched back on until you actually leave the Smurfit Building.

Possession of unauthorised items is an infringement of the regulations and could result in disqualification from the Aptitude Test. Any sign of misappropriation or false information or any attempt to cheat at any part of the Aptitude Test may result in the NMBI being informed and your test being cancelled.

1.8 Unfit to continue during the Aptitude Test

If, after commencing but before completing either attempt at either part of the Aptitude Test, an applicant considers that she/he is unfit to continue, then the following must be adhered to:

  • The applicant contacts the coordinator on site and declares that she/he is unfit to continue.
  • The applicant leaves the test centre.
  • The applicant goes to a medical practitioner and gets a medical certificate stating that she/he was unfit to continue with the test and submits to the Aptitude Test coordinator before 5pm on the Tuesday following the test (or before 5pm on the Wednesday following the test if the Monday is a public holiday).
  • The attempt for the day that the applicant declared her/himself unable to continue is then discounted. Any part of the test taken on the day is not considered and the applicant will have to retake the full test for that day.
  • If the applicant decides to complete the test on the day that she/he states that she/he is unwell, then the attempt is considered and the results stand.

1.9 Issues arising

Any issues arising during any part of the Aptitude Test must be addressed with the coordinator before leaving the test centre.

1.10 What to wear

Theory Test/MCQ

There is no specific dress code for this part of the test but you are advised to dress comfortable and warm as the temperature in the computer lab is generally cooler than in other parts of the building.

Practical Test/OSCEs

As the practical part is a simulated setting, you are required to present as if you are working in the clinical environment, taking into account all aspects pertaining to comfort, clothes (uniform) footwear, hair style, make-up and jewellery. You will need a watch for checking pulse and respiration rate.

Climate and Weather

You are advised to check out the climate in Ireland. Refer: http://www.met.ie/climate/climate-of-ireland.asp

You are advised to check the current weather in advance of your journey. Refer: www.met.ie 

1.11 Quality matters 

The Aptitude Test is not an education programme but it is a test based on two assessment methods:

a): Theory Test or Knowledge Test or MCQ
b): Practical Test or Objective Structured Clinical Examination (OSCEs)
Quality matters have been effectively addressed, and continue to be addressed, through a number of ways, including:

  • The MCQs were developed and framed against the syllabus/indicative content published by the NMBI (Refer: NMBI Standards and Requirements.
  • Subject experts develop the MCQs
  • The MCQs are subjected to testing and analysis
  • The MCQs are tested with a cohort of newly qualified Irish degree educated nurses
  • The Aptitude Test was subject to an audit/inspection by an NMBI site visit team on two separate occasions
  • The assessment content in terms of the bank of MCQ items and the OSCE scenarios and assessment proforma were submitted to NMBI as part of the site visit process
  • The assessment was subjected to approval and monitoring via education and training committee and Board of NMBI
  • A multi-stakeholder evaluation was completed during the first six months (pilot) as a condition of regulatory approval; the findings of this evaluation were submitted to NMBI and contributed to the on-going approval by the NMBI as the professional regulatory and competent authority for nurses and midwives in the Republic of Ireland
  • The assessment has been subjected to external validation by a subject expert in the CGFNS, the largest international credentialing body for nurses and other health professions in the world
  • OSCEs are frequently developed and reviewed by experts in the particular area
  • There is a bank of OSCEs maintained
  • The OSCE assessors are experienced nurses, from a wide range of healthcare facilities, who hold a post-graduate qualification and have been trained by RCSI as OSCE assessors (over 200 have attended training
  • Each applicant is assessed by 28 assessors in 14 independent groups of two
  • The Aptitude Test has been audited by the RCSI Quality Enhancement Office.

 

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2. Theory Test

(Last updated 02/01/19)

The Theory Test consists of a supervised online assessment of professional knowledge and understanding. A method of assessment known as multiple-choice questions (MCQs) is used. For a photograph of the Integrated Theory Lab where the Theory Test takes place click here

  • You will be required to answer 150 questions over a three-hour period.
  • Each question will have four possible answers and you are required to give only one answer to each question.
  • A minimum pass mark of 50% must be achieved in the Theory Test.
  • You will not be permitted to leave the test until 60 minutes has passed.

On the day of the Theory Test

  • Arrive promptly at the start time and you are shown to the reception room where you sign-in and your documentation is checked with you.
  • When all applicants have been checked in, an RCSI representative gives a presentation regarding the theory part and addresses any queries.
  • Following the presentation, you are shown to the restroom where you can leave your belongings and any refreshments you have brought. Please note, no security is provided.
  • You are then brought to the Integrated Theory Lab where the Theory Test is undertaken.
  • Following the test, you return to the restroom, have the refreshments you brought with you and collect your belongings.
  • An RCSI representative gives a presentation on the next steps in the process.
  • Brief tutorials on equipment and documentation may be given.

Sample MCQs - These may or may not appear in a test.

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3. Practical Test

(Last updated 06/02/19)

3.1 OSCE stations

A methodology known as Objective Structured Clinical Examination (OSCE) is used. OSCE is acknowledged internationally as an assessment methodology that enables the applicant to demonstrate competence in a simulated practice setting, known as a station.

Assessment of competence for practice through a range of OSCEs includes a number of different simulated stations. A station is set up as a clinical setting and has all the necessary equipment.

You are required to complete up to 20 stations, with a minimum of 14 stations. Each station assesses different competencies pertaining to general nursing.

Each station has a Descriptor Sheet and this is displayed both outside and inside the station and is available for you to refer to as you need. You spend ten minutes at each station carrying out the care as per the Station Descriptor. There are a number of aims and competencies that you are expected to achieve at each station. When the time is up then the assessment ends, regardless of whether or not you have finished.

There are two trained assessors at each station. The OSCE assessors are experienced nurses who hold a post-graduate qualification and have been trained by RCSI as OSCE assessors. Some stations may have a mannequin. Stations may have one of the assessors acting as a patient or a relative or a staff member. Both assessors observe the applicant's performance and mark as competent (pass) or incompetent (fail). In order to pass the practical part, the applicant must be deemed competent in each competency at each station


3.2. Scenarios for OSCEs

Each station has a station descriptor sheet containing the scenario/situation for the station.

The station descriptors may change from one Aptitude Test to the next.

When you commence at each station, one of the assessors will read the station descriptor with you before you commence your care. The station descriptor is available for you to refer to as you need.

Sample scenarios

Please note: These samples may or may not form part of a particular Aptitude Test.

3.3 Housekeeping matters

  • Arrive promptly at the start time; you will be shown to the reception room where you sign in and you are checked against your passport page and photograph that you uploaded with your application. Unless requested to do so, there is no need to bring any documentation with you.
  • When all applicants have been checked in, an RCSI representative gives a presentation regarding the practical part and addresses any queries.
  • The applicants are divided into two groups: half the applicants are brought to the ground floor and the other half are brought to the first floor. Members from one group must not meet with members of the other group until all stations have been complete.
  • There is a restroom where you can put your belongings and any refreshments that you brought with you. Please remember no security is provided.
  • Half the stations are on the ground floor and the other half of the stations are on the first floor.
  • Half the applicants complete the stations on the ground floor and the other half of the applicants complete the stations on the first floor.
  • There is then a break of approximately 30 minutes during which you may wish to have refreshments you brought with you.
  • Following the break, you switch floors: if you completed the stations on the ground floor before the break then you are brought to the first floor to complete the remaining stations and vice versa.
  • Following the practical part, an RCSI representative gives a presentation on the next steps in the process.

3.4 Possible contributing factors why applicants are failing OSCEs

 

The failure rate needs to be viewed against the backdrop that the OSCEs are based on the NMBI Standards and Requirements for Irish-trained general student nurses. Therefore the OSCEs reflect what an RGN working as first year staff nurse in a general hospital (or comparable) would be expected to know and do in a safe and competent manner.

As the applicants are already trained as general nurses in their own country, an exploration as to why some are failing might be useful for prospective employers, recruitment agencies and future applicants. Notwithstanding that a certain level of examination anxiety is normal, the following observations are offered as mere suggestions as to possible factors that may be contributing to some applicants failing.  

  • Relevant experience: It would appear that some applicants, although qualified for a number of years, may not have had recent relevant experience in a general hospital. Obviously, this is not the business of RCSI, but might be something prospective employers/recruitment agencies may wish to explore.
  • Lack of preparation: Applicants are strongly advised to be fully aware of the most recent information on the RCSI website including all the links. It would appear that some applicants are working off a printed copy of older versions of the information.
  • Rote learning: Preparation for any examination is vital. However, nursing is not just about knowledge but it is also about the application of that knowledge to ensure safe delivery of patient care. It would appear that some applicants are rote-learning different aspects but not able to apply the knowledge. Applicants must be prepared for changes in scenarios and for safe application of knowledge that may not be required in the linear fashion in which a topic was rote-learnt.
  • Differences between countries: There will always be some differences between countries in regard to equipment and documentation. Images of equipment and documentation are clearly shown on the website. It would appear as if some applicants do not take care when studying the images of the equipment or practise filling in the documentation, both of which are crucial.
  • Not heeding: Short tutorials on equipment and documentation are given. It would appear as if some applicants do not fully pay heed at these tutorials. Again, in an effort to help the applicants, the possible scenario/s pertaining to an OSCE station are displayed outside the station. But again it appears as if some applicants do not take sufficient care in reading these. On the day of the OSCEs we advise applicants to avoid getting easily distracted but it would seem as if this happens to some applicants.
In conclusion, the majority of applicants prepare well; are able to apply knowledge in a safe way and give full care and attention throughout the Aptitude Test. However, the above observations may assist others.

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4. Application process and documentation required

(Last updated 21/03/19)

You should consider if you are: a) Eligible to take the Aptitude Test; b) Ready/Prepared to take the Aptitude Test; and c) Interested in taking the Aptitude Test. To assist with your considerations, the following map might help you on your journey.

Step 1: You submit/arrange submission of various documents to the NMBI for a full regulatory assessment. Upon completion of the NMBI regulatory assessment, a Decision Letter (which has an expiry date) is issued. One of the outcomes of the regulatory assessment may be that you have to undergo one of two compensation measures. One of the compensation measures is the RCSI FNM Aptitude Test for Overseas Nurses (Aptitude Test). RCSI cannot answer any queries in relation to the regulatory assessment. Refer to the NMBI 

Step 2: Decide what is best for you. Before you decide which compensation measure to pursue, fully inform yourself. Details of where to get further information are contained in the NMBI Decision Letter. Regarding the Aptitude Test you are strongly encouraged to fully familiarise yourself with Information for Applicants PLUS all the links contained in this document. Refer to this webpage

Step 3: If you decide that the compensation measure you wish to pursue is the Aptitude Test, then an on-line application is made & 4 documents are uploaded: NMBI Decision Letter; Biog page of passport/ID; Recent photograph; and Proof of Payment. If satisfactory, an invitation is sent for the Aptitude Test that is open. To allow for the following steps to be met & to allow for travel and other arrangements, each Aptitude Test opens approximately 15 weeks in advance. Only one test is open at a time & as soon as one test closes the next one opens.

Step 4 A:If you require it, application is made (without delay) for an Atypical Working Scheme (AWS) Letter of Approval. RCSI cannot answer any queries in relation to immigration requirements. Refer to Immigration  

Step 4 B: You apply to the NMBI for a Candidate Registration Certificate (CRC). An invitation (the email sent by the RCSI with the invitation) to the Aptitude Test must be submitted with the application for the CRC to the NMBI. Details are included in your NMBI Decision Letter. RCSI cannot answer any queries in relation to the CRC.

Step 5: Application is made (without delay) for an Entry Visa. Supporting documents include your NMBI CRC (which has an expiry date) & your AWS Letter of Approval. RCSI cannot answer any queries in relation to immigration requirements, including employment needs. Refer to Immigration

Step 6: The week prior to the Aptitude Test for which you are scheduled (usually 10 days in advance) a REMINDER email is sent to you. In order to secure your place on this test date, you must reply before 8am (Irish time) on the Wednesday prior to the test. You must be sure that you will attend before replying 'YES', for example, you must NOT reply 'YES' unless the VISA/other requirements have been issued. If a 'YES' reply is not received by the due date and time, the place will be immediately offered to the applicant at the top of the waiting list for the test. If a 'YES' reply is received after the closing date and time, then you will be placed at the bottom of the waiting list and whereas every effort will be made to accommodate you, a place is not guaranteed.

Step 7: Theory/MCQ/Knowledge Test: Your NMBI Decision Letter must be in-date on the date of the Theory Test. Your NMBI CRC must reference the RCSI Aptitude Test and must be in date for the duration of the Aptitude Test (both MCQ & OSCEs). The onus is on you to ensure that all details on the CRC are accurate. The CRC must be in paper format: either original or a clear photocopy (colour or black & white). An electronic version of the CRC is not acceptable. The onus is on you, the applicant, to ensure compliance with the NMBI requirements regarding documentation. Failure to comply may cause issues/delays in finalising your application for registration. All queries regarding the Decision Letter & the CRC to the NMBI only (not RCSI). In order to gain entry to the Theory Test you must have only the following two documents: Passport/ID & NMBI CRC.

Results of Theory Test are issued via email by 2pm on the Tuesday following the test & if you pass then this email contains details of your OSCE/Practical Test.

Step 8: OSCEs/Practical Test: If you are successful in the Theory Test, then you are invited to the OSCEs/Practical Test the following week. Unless specifically requested, you do not need to bring any documentation with you. Results of OSCEs/Practical Test are issued via email by 2pm on the Tuesday following the test & if you pass then your results are sent to the NMBI.

Step 9: What next? If the Aptitude Test (both parts) is passed, then the results are issued to the NMBI. You must now pay the NMBI registration fee.

If either part is failed on the first attempt, then a proposed date for the repeat is offered.

If an applicant fails either part of the Aptitude Test on the second attempt, then the NMBI is informed.

Full details on the documentation required can be found here. 

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5. Revision and preparation

(Last updated 28/01/19)

Please note: RCSI does not endorse or approve any training or preparation course for the Aptitude Test.

5.1 Overview

In preparation for the tests from January 2019 until further notice, it is essential that you base your revision on the NMBI publication: NMBI (2016) Nurse Registration Programmes Standards and Requirements. 4th edition. Refer pp 11-72 

The Aptitude Test is designed to reflect the nature of the syllabus and knowledge required for the general nurse pre-registration programme in the Republic of Ireland as per the NMBI Standards and Requirements. It addresses the NMBI Domains of Competency for the pre-registration general nurse programme in an attempt to ensure patient safety and public protection. The Domains of Competency and Indicative Content of the NMBI Standards and Requirements must be fully and carefully considered in order to help guide your revision for the Aptitude Test. RCSI does not recommend specific reading. Multiple sources might be considered including your notes and textbooks from your own training. It is essential that the most up-to-date research-based sources are used.

Please note: This website must be checked on a regular basis for additions and updates regarding revision and preparation.

5.2 Essential minimum background reading

As well as your revision that is based on the NMBI Standards and Requirements, the following is the essential minimum background reading. However the below is only meant as an overview of a given topic and not all topics arising in the OSCE's may be covered below. Further study in regard to a topic must be undertaken by studying your up-to-date textbook and other research-based sources.

Diagnostic tests

Diseases and conditions

Infection prevention and control, and waste management

IVI

Medical preparations

News

Nursing process, example references

Professional issues

Sepsis

5.3 Charts

Before presenting for the Aptitude Test, an applicant must be fully familiar with the following charts and must know how to complete and interpret/analyse each chart.

General Reading

Hinkle JL. Ceever KH (2014) Brunner & Suddarth's Textbook of Medical - Surgical Nursing 13th ed) Lippincott Williams & Wilkins Wolkers Kluwer Health

Dougherty L. Lister S (2015) The Royal Marsden Clinical Nursing Procedures (9th ed) Wiley Blackwell.

5.4 Equipment

Each station has specific equipment, which must be used as part of the care at that station. If something is not at the station, then it does not need to be used as part of the care at that station.

Sample equipment and photographs of OSCE stations

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6. Further information

Queries regarding the application process including payment should be made to pamelapeppard@rcsi.ie.

For all other queries pertaining to the RCSI Aptitude Test contact marianeary@rcsi.ie

Ongoing updates will be placed on the RCSI website. 

We at RCSI will continue to be responsive and aim to address all queries in a timely manner.

On behalf of the FNM at RCSI, may I wish you every success in whatever course of action you decide to follow.

Prof. Thomas Kearns, Executive Director, Faculty of Nursing & Midwifery, RCSI

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