Nursing courses in Australia are preparing graduates for comprehensive practice within Universities. The evaluation of safe and effective comprehensive nursing performance requires the consideration of a much broader range of practice competencies than has previously been the case. In particular there is a need to explore integrated assessment approaches that closely resemble the realities of the health care setting. Part 1 of this paper provides an overview of the Objective Structured Clinical Assessment (OSCA) which it is suggested is an effective way of assessing student comprehensive nursing performance. Some theoretical considerations in OSCA development are discussed and then an outline of the processes involved in designing and implementing an OSCA provided. Part 2 describes an evaluation project supported by the NSW Nurses' Registration Board. The aim of the study was to determine the validity and reliability of the use of the OSCA as an integrated assessment tool as a measurement of the extent to which a student nurse can plan and deliver safe and effective comprehensive nursing care.