The OET Writing sub-test is one of the most challenging components for internationally trained nurses seeking registration in English-speaking countries. Unlike general English exams, OET Writing requires you to transform complex clinical case notes into a clear, concise, and professionally structured letter in just 45 minutes. This guide gives you everything you need to achieve a Grade B or higher.
At Anglotec AI Academy, we have spent four decades specialising in medical English communication. Our nursing-focused OET preparation has helped over 15,000 nurses from India, the Philippines, Nigeria, Pakistan, and across the globe achieve their dream of working in the UK, Australia, Ireland, and New Zealand. The strategies in this guide are the result of that deep expertise.
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1. Understanding the OET Writing Task for Nurses
The OET Writing sub-test for nurses consists of a single task: writing a formal letter based on a set of case notes. The letter type is most commonly a referral letter, but you may also be asked to write a transfer letter or discharge letter. Understanding exactly what each type requires is essential for success.
You are given case notes that simulate a real hospital or community health setting. These notes typically include patient demographics, medical history, presenting complaint, nursing assessments, interventions provided, current status, and the purpose of the letter. Your job is to select the relevant information and present it in a formal letter format appropriate for the recipient.
The Case Notes Challenge
The case notes present the biggest challenge for most nurses. They are deliberately dense, containing both relevant and irrelevant information. A typical set of case notes may contain 25-40 bullet points, but only 60-70% of this information belongs in your letter. The ability to discriminate between essential and non-essential information is a core skill that OET assesses.
Here are the typical sections you'll see in nursing case notes:
- Patient Demographics: Name, age, gender, date of admission — always include these.
- Medical History: Only include conditions relevant to the current situation.
- Social History: Include only if directly relevant (e.g., lives alone when arranging community care).
- Medications: Include current medications if relevant to the referral.
- Nursing Assessments: Include abnormal findings; normal findings can usually be omitted.
- Interventions: Include nursing care provided and patient response.
- Current Status: Essential for the receiving healthcare professional to understand the situation.
- Purpose of Letter: This tells you exactly what the recipient needs to do — it guides your entire letter.
Always read the "Purpose of Letter" section first. This tells you who you're writing to and what action they need to take. Everything in your letter should support this purpose. If a piece of information doesn't help the recipient do their job, leave it out.
2. The Six Marking Criteria Explained
OET Writing is assessed on six criteria, each scored from 0 to 7. To achieve a Grade B (the standard required by the NMC, AHPRA, and most nursing councils), you need a total of at least 350 out of 500 points. Understanding exactly what each criterion measures is the foundation of effective preparation.
1. Purpose
Is the purpose of the letter immediately apparent? Does it include the reason for writing and what you want the reader to do?
2. Content
Is all relevant information included? Is irrelevant information omitted? Does the recipient have everything needed?
3. Conciseness & Clarity
Is the letter concise without being telegraphic? Is the meaning clear on first reading?
4. Genre & Style
Is the tone appropriate? Is it formal but not cold? Are healthcare conventions followed?
5. Organisation & Layout
Is the letter logically structured? Are paragraphs well-organised? Is it easy to follow?
6. Language
Is grammar accurate? Is vocabulary precise and appropriate? Is spelling correct?
What Examiners Look For in Each Criterion
Purpose (Score 6-7): A high-scoring letter states the purpose clearly in the opening paragraph. The reader should know within the first two sentences why you're writing and what action you expect. For example: "I am writing to refer Mrs. Smith to your community nursing team for ongoing wound care following her discharge from hospital today."
Content (Score 6-7): Content is about selectivity. A Band 6-7 letter includes all clinically relevant information and excludes irrelevant details. This is where the "Purpose" section of the case notes becomes your guide. Ask yourself: "Does this information help the recipient do what I'm asking them to do?" If not, leave it out.
Conciseness & Clarity (Score 6-7): This criterion penalises both excessive wordiness and excessive brevity. Your letter should be 180-200 words. Under 150 words usually means you've missed important content. Over 220 words often means you've included unnecessary detail. Every sentence should carry essential information.
Genre & Style (Score 6-7): The letter must be formal but not cold. Use appropriate medical terminology but explain complex conditions if the recipient may not be a specialist. Address the recipient appropriately ("Dear Dr. Jones," "Dear Community Nurse,"). Sign off correctly ("Yours sincerely," if named; "Yours faithfully," if unnamed).
3. The Perfect OET Letter Structure
Every OET nursing letter follows a clear structure. Mastering this structure gives you a framework to work within, reducing cognitive load during the exam and ensuring you don't forget essential elements.
Standard Letter Layout
- Sender's Address: Write this at the top right of the letter (provided in the task).
- Date: Write the date from the case notes in the format: 15 January 2026.
- Recipient's Address: Write this on the left side, below the date.
- Re: Patient Name (DOB: date of birth) — Always include this reference line.
- Salutation: "Dear Dr. [Surname]," or "Dear Community Nurse," if unnamed.
Paragraph-by-Paragraph Guide
Paragraph 1 — Purpose: State who you are, who the patient is, and why you're writing. Include the action you want the recipient to take. Keep this to 2-3 sentences.
Paragraph 2 — Background: Provide relevant medical history and the reason for the current admission or visit. Include dates and key clinical details. Be selective — only include history relevant to the current situation.
Paragraph 3 — Current Situation & Interventions: Describe the patient's current status, nursing assessments, care provided, and response to treatment. This is typically the longest paragraph. Include abnormal findings and significant interventions.
Paragraph 4 — Request & Closing: Restate what you need the recipient to do. Provide your contact details for follow-up. Thank them appropriately.
Remember the acronym P-B-C-R: Purpose, Background, Current, Request. Every letter should follow this flow. Practice writing letters using only these four paragraphs until the structure becomes automatic.
4. Sample OET Referral Letter for Nurses
Below is a sample referral letter based on typical OET nursing case notes. Study this carefully — it demonstrates the structure, language, and level of detail expected at Grade B level.
SAMPLE REFERRAL LETTER — OET NURSING (Grade B Standard)
Based on: Community nurse referral for wound care
Dear Ms. Chen,
I am writing to refer Mrs. Okafor to your community nursing team for ongoing wound care and assessment following her discharge from hospital today.
Mrs. Okafor was admitted to Ward 4B on 10 January 2026 with a diabetic foot ulcer on her left heel. She has a five-year history of Type 2 diabetes mellitus, which has been poorly controlled with HbA1c levels consistently above 9%. She also has peripheral neuropathy and mild peripheral vascular disease.
During her admission, Mrs. Okafor received intravenous antibiotics for five days and underwent surgical debridement of the wound on 12 January. The wound has been dressed daily with saline and a hydrocolloid dressing. Tissue viability assessment indicates good granulation tissue with no signs of infection. However, the wound measures 3cm x 2cm and will require continued dressing changes every two days. Mrs. Okafor has been taught basic foot care and has been provided with a pressure-relieving heel protector. Her blood glucose levels have stabilised, and she has been restarted on her usual oral hypoglycaemic medication.
Given Mrs. Okafor's mobility limitations and the need for regular wound assessment, your support with home visits for wound dressing would be greatly appreciated. Please also reinforce diabetic foot care education. I can be contacted on extension 4521 if you require further information.
Yours sincerely,
Registered Nurse
This letter is exactly 186 words — the sweet spot for OET Writing. The purpose is clear in paragraph 1. Only relevant history is included (diabetes, neuropathy, vascular disease — all relevant to wound healing). Social details are omitted because they're not needed for this referral. The tone is professional and warm. The request is specific: dressing changes every two days and foot care education reinforcement.
5. Transforming Case Notes into Letter Content
The most critical skill in OET Writing is the ability to transform abbreviated, often disorganised case notes into flowing, grammatically correct prose. This is where many nurses struggle, especially if English is not their first language.
Step-by-Step Transformation Process
- Read the entire case notes once (2 minutes): Get the full picture before you start selecting information. Don't write yet.
- Identify the recipient and purpose: This determines what information is relevant.
- Highlight relevant information: Go through the notes and mark what must be included.
- Cross out irrelevant information: Be ruthless. Social history, normal findings, and resolved issues can usually be omitted.
- Group information by paragraph: Allocate highlighted information to your four paragraphs.
- Write the letter (25-30 minutes): Transform notes into connected prose.
- Review (5 minutes): Check word count, spelling, grammar, and that all key information is included.
Case Note Transformation Examples
Case note: "PMH: T2DM x 5yrs, HTN, OA knees"
Letter: "She has a five-year history of Type 2 diabetes mellitus and hypertension. She also has osteoarthritis affecting both knees."
Case note: "Wound: L heel, 3x2cm, sloughy, dressed BID"
Letter: "The wound on her left heel measures 3cm by 2cm and presents with sloughy tissue. It is being dressed twice daily."
Case note: "Tolerating diet, ambulating with frame, pain 3/10"
Letter: "She is tolerating a normal diet and is able to mobilise with a walking frame. Her pain is well controlled, currently rated at 3 out of 10."
6. Mastering Medical Language and Abbreviations
OET Writing expects you to use appropriate medical terminology correctly. You should use standard medical abbreviations where appropriate but always expand them on first use if the recipient might not be a specialist. For example, write "Type 2 diabetes mellitus (T2DM)" on first mention, then you can use T2DM subsequently.
Essential Nursing Abbreviations
| Abbreviation | Full Form | Usage in Letter |
|---|---|---|
| T2DM / T1DM | Type 2 / Type 1 Diabetes Mellitus | "Type 2 diabetes mellitus (T2DM)" |
| HTN | Hypertension | "hypertension (HTN)" |
| BID | Twice daily (Latin: bis in die) | "twice daily" (avoid Latin in letters) |
| BD | Twice daily | "twice daily" |
| TDS/TID | Three times daily | "three times daily" |
| QID | Four times daily | "four times daily" |
| PRN | As needed (Latin: pro re nata) | "as required" or "when needed" |
| IV | Intravenous | "intravenous (IV)" |
| PO / per os | By mouth | "orally" |
| IM | Intramuscular | "intramuscularly" |
| SC / Subcut | Subcutaneous | "subcutaneously" |
| BM / BGL | Blood glucose level | "blood glucose level" |
| RR | Respiratory rate | "respiratory rate" |
| HR | Heart rate | "heart rate" |
| BP | Blood pressure | "blood pressure" |
| SPO2 | Oxygen saturation | "oxygen saturation (SpO2)" |
| MOB | Mobilisation | "mobility" or "mobilisation" |
| OOB | Out of bed | "out of bed" |
| WBAT | Weight bearing as tolerated | "weight-bearing as tolerated" |
| NWB | Non-weight bearing | "non-weight-bearing" |
Useful OET Letter Phrases
Having a mental library of formal phrases helps you write faster and more accurately under exam conditions:
- Opening: "I am writing to refer / transfer / discharge / update you regarding..."
- Background: "Mrs. X was admitted to [ward] on [date] with / following / due to..."
- Current status: "At present, she is / her condition is / she is currently..."
- Medications: "Her current medications include... / She has been prescribed..."
- Request: "It would be appreciated if you could / Please would you / I would be grateful if..."
- Closing: "Please do not hesitate to contact me on [number] if you require further information."
7. Time Management: The 45-Minute Plan
Poor time management is one of the most common reasons nurses fail to achieve their target OET Writing score. Many candidates spend too long reading and planning, then rush the writing itself. Here's the proven time allocation our top-performing students use:
- 0-5 minutes: Strategic Reading — Read the case notes fully. Identify recipient, purpose, and key information. Don't start writing yet.
- 5-10 minutes: Planning — Highlight relevant notes. Cross out irrelevant ones. Allocate information to paragraphs. Write key vocabulary.
- 10-35 minutes: Writing — Write the letter following your P-B-C-R structure. Aim for 180-200 words. Don't stop to check spelling — keep writing.
- 35-42 minutes: Reviewing — Read the letter aloud in your head. Check: word count, spelling, grammar, all key information included, purpose clear.
- 42-45 minutes: Final Polish — Make quick corrections. Ensure the letter flows well. Check the salutation and sign-off.
Never spend more than 10 minutes on reading and planning combined. Some nurses spend 15-20 minutes planning and then have only 25 minutes to write and review. This leads to rushed, error-filled letters. Practice the 5-minute reading + 5-minute planning split until it becomes natural.
8. Common Mistakes Nurses Make in OET Writing
Having assessed thousands of OET Writing practice letters, our examiners at Anglotec have identified the most common mistakes that cost nurses valuable marks. Avoiding these can be the difference between a Grade C and a Grade B.
Many nurses include every detail from the case notes, thinking more information is better. It's not. Including irrelevant social history, resolved conditions, or normal findings shows poor clinical judgement and loses marks under Content and Conciseness.
OET penalises direct copying from case notes. You must transform the notes into connected, grammatical prose. "Pt c/o chest pain" must become "She complained of chest pain." This is non-negotiable.
The ideal word count is 180-200. Under 150 words usually means missing content. Over 220 words often means including irrelevant details and losing Conciseness marks. Count your words during practice.
A letter without a clear purpose statement in the first paragraph cannot score above 5 for Purpose. Always state why you're writing and what you want the reader to do.
Phrases like "the patient is doing okay," "she's got diabetes," or "please look after her" are too informal. Use formal medical English: "the patient's condition is stable," "she has been diagnosed with diabetes mellitus," "ongoing monitoring would be appreciated."
If you know the recipient's name, use "Dear Ms./Dr. [Surname]," and sign off "Yours sincerely." If you don't know the name, use "Dear Community Nurse," and sign off "Yours faithfully." Getting this wrong loses Genre & Style marks.
Your OET Writing Preparation Checklist
Pre-Exam Checklist for Grade B
- I can identify the purpose and recipient within 30 seconds of reading case notes
- I can distinguish relevant from irrelevant information accurately
- I can write a referral letter in 180-200 words in under 30 minutes
- I know 50+ medical abbreviations and their full forms
- I can transform abbreviated case notes into grammatical sentences
- I use formal letter conventions correctly (salutation, sign-off, reference line)
- I always include a clear purpose statement in paragraph 1
- I have practised at least 15 full letters under timed conditions
- I review my letters for spelling, grammar, and word count
- I have memorised useful phrases for openings, transitions, and closings
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