Background Maintaining the quality and integrity of student assessments, especially in professional fields like nursing, is critical. Managing moderation processes across large teams poses social and logistical challenges, further complicated by varying quality and clarity of institutional guidelines. Systematic reviews on moderation practices in higher education are scarce. Objectives This integrative review critically analyses moderation practices in the literature and evaluates the quality of published institutional guidelines to support faculty in enhancing moderation practice. Method An integrative review, guided by research questions, was used to facilitate data extraction. Searches in ERIC, Web of Science, and A Plus Education Informit databases focused on higher education papers published in English between 2008 and 2023. Of 552 studies screened, 19 were included in the final review. The quality of the included studies was appraised using the appropriate Critical Appraisal Skills Programme (CASP) checklists, tailored to the specific research designs. Institutional guidelines were identified via web searches and evaluated using a tool based on elements of a recognised clinical practice guideline assessment tool. Results The review included 19 peer-reviewed studies and 27 institutional guidelines. Of the studies, 14 were qualitative, 2 quantitative, 2 mixed-methods, and 1 a guideline review, with most focused on Australian higher education. Key findings indicate the importance of collaborative moderation processes, in establishing shared standards. The studies highlighted the need for clear marking guides, ongoing training, pre-teaching discussions and adequate resourcing. The guideline evaluation revealed variability in quality, with frequent deficiencies in stakeholder involvement and development rigour. Some guidelines offered practical implementation tools. Conclusions Moderation practices in higher education are complex and resource-intensive, particularly for large teams. Effective moderation is crucial for maintaining assessment quality and integrity. Consensus moderation, through collaboration among markers, tutors, and assessors, supports shared standards via dialogue, calibration, and consensus building. Improving moderation practices requires evidence-based guidelines, a focus on consensus-building, sufficient resources, and ongoing professional development.