Research approaches to better engage student learning regarding the determinants of health are somewhat limited. The present study highlights the evolution of an authentic fieldwork assessment and the strategies nursing students used as they navigated the assessment for learning activity outside the classroom, and how these impacted student's performance. A cross-sectional study examined learning strategies, assessment challenges and concept understanding according to academic performance among students over a 2-year period. Among the 282 (19.7% response rate) students, success encapsulated making time, planning, good organisation, checking in and making time. Being less successful centred on being busy with other courses or employment. Poorer performing students were less likely to understand the assessment requirements or just ran out of time. Performance-based assessments remain relevant to nursing student learning. However, students must explicitly understand their benefits, be motivated to engage, have the capacity to persevere and seek clarification if understanding is not achieved.