Background: Objective structured clinical examinations (OSCE) are commonly used to assess the clinical competence of undergraduate nursing students. There are, however, concerns about the stresses involved in such examinations and the perceived validity of such exams from a student perspective. Without student engagement the authenticity of such assessment may be compromised. Therefore, the aim of this integrative review was to explore and evaluate literature around undergraduate nursing students’ perceptions of OCSEs and summarise key themes emerging from this literature to establish current knowledge and understanding. This exploration of the literature aims to identify areas lacking quality research and make recommendations for future research. Methods: To undertake this review, we searched four databases from 1988-2015 using a range of keyword combinations relating to student perception and OSCEs. We also undertook reference chaining. Inclusion/exclusion criteria were applied to abstracts and then full papers. Quality was assessed by consensus between two authors using the National Health and Medical Research Council (NH&MRC) quality assessment framework and the mixed-methods assessment tool. Results: Thirteen studies met the inclusion criteria, and three primary domains emerged from data analysis: These domains, identified from the thematic analysis of these studies in relation to students perceptions of OSCEs include preparation for OSCE, process of the OSCE and performance following the OSCE. Conclusions: From this review we can conclude that academics/faculties must carefully consider OCSE preparation, process and follow-up when planning OCSEs for assessments including associated resource implications. OSCEs are used internationally and yet there is no validated, reliable tool for student perception that could be applied across facilities. Student engagement in the OSCE is essential for successful OCSEs and yet this consideration appeared rarely in the literature. A number of recommendations emerged from the review including the need for an evidence-based form of assessment that has a strong underpinning pedagogy.