Excellence in clinical performance is the hallmark of good healthcare and reflects aptitude, cognition, affect and skills. Over the years, attempts have been made to measure clinical performance of nursing staff and students in the patient care units. The preliminary tools developed for such purpose measured traits and tools developed after 1962, measured knowledge base, the amount of guidance required, time spent in teaching, dexterity and coordination. However, recent tools rate performance against patient care behaviors. Development of a valid tool to measure the clinical performance of nursing student in subsequent years of study in a graduate nursing programme had been the interest of the researcher. It was observed that though the curriculum was uniform throughout India, the assessment pattern varied between universities and institutions. This paper highlights the process as well as the challenges encountered in the process of development of the tool. These challenges might seem as opportunities for policy makers to reform the system of nursing education in India.