The OET (Occupational English Test) writing sub-test for nurses asks you to write a letter, usually a referral or discharge letter, from case notes in 45 minutes. Most regulators, including the UK NMC, require at least a grade B in writing (some accept C+ for writing). The writing sub-test is where many nurses struggle. Here’s a practice case, a model letter and the techniques behind it.
This is an original practice task, not an official OET task. Check oet.com for official samples and assessment criteria.
How OET writing works
- Time: 5 minutes reading time (no writing), then 40 minutes to write.
- Length: the body of the letter should be about 180–200 words.
- Task: usually a referral, transfer or discharge letter to a health professional, or sometimes a letter to a carer.
- Criteria: purpose, content, conciseness and clarity, genre and style, organisation and layout, and language.
Practice task: case notes
Setting: Medical ward, City General Hospital
Patient: Mrs Grace Okafor, 74, widow, lives alone in a ground-floor flat. Daughter visits weekly.
Admission: 28/10/2026. Diagnosis: left lower lobe pneumonia, type 2 diabetes mellitus (10 years), hypertension.
Treatment: IV co-amoxiclav for 4 days, now oral amoxicillin 500 mg three times daily until 07/11/2026. Oxygen weaned off on day 3. Insulin glargine started: 10 units at night (previously on metformin only, HbA1c 78 mmol/mol).
Progress: Chest clear on day 6. Mobile with a walking frame. Mild fatigue. Eating 50–75% of meals. Blood glucose 6–12 mmol/L.
Concerns: Anxious about injecting insulin; demonstrated technique twice, still hesitant. Poor eyesight (cataracts), difficulty reading meter. Fall at home 2 months ago (no injury). Daughter works full time.
Discharge plan: Discharge 04/11/2026. Community nurse visits to support insulin administration and monitoring. Request home safety assessment. Glucose meter with large display provided. GP review in 1 week.
Task: Using the information in the case notes, write a letter to Ms Helen Ward, Community Nurse, Riverside Community Health Centre, 12 Bridge Road, Riverside, outlining Mrs Okafor’s needs after discharge.
Model letter
Ms Helen Ward
Community Nurse
Riverside Community Health Centre
12 Bridge Road
Riverside04 November 2026
Re: Mrs Grace Okafor, aged 74
Dear Ms Ward,
I am writing to refer Mrs Okafor, who is being discharged home today following treatment for left lower lobe pneumonia, for support with newly started insulin therapy and a home safety assessment.
Mrs Okafor was admitted on 28 October and treated with intravenous antibiotics. Her chest is now clear, and she will continue oral amoxicillin 500 mg three times daily until 7 November. Due to poorly controlled type 2 diabetes (HbA1c 78 mmol/mol), insulin glargine 10 units at night was commenced in addition to metformin. Her blood glucose levels have ranged from 6 to 12 mmol/L.
Although Mrs Okafor has been shown how to self-administer insulin, she remains anxious and hesitant. Furthermore, her vision is impaired by cataracts, so she has been provided with a glucose meter with a large display. I would be grateful if you could visit to supervise her insulin administration and blood glucose monitoring until she is confident.
Mrs Okafor lives alone and mobilises with a walking frame. As she fell at home two months ago, a home safety assessment would also be appreciated. Her daughter visits weekly but works full time.
Her GP will review her in one week. Please do not hesitate to contact me if you require further information.
Yours sincerely,
Registered Nurse
Medical Ward
City General Hospital
Body word count: approximately 200 words.
Why this letter works
1. Purpose is clear early
The first paragraph tells the reader exactly why they’re receiving the letter: insulin support and a home safety assessment. OET assessors look for the purpose in the opening, and they want it to be specific, not just “for further management”.
2. Only relevant information is included
Details such as the exact admission course, the day oxygen was weaned and the percentage of meals eaten were left out because the community nurse doesn’t need them to act. Good OET letters select, they don’t copy.
3. Logical organisation
- Paragraph 1: purpose
- Paragraph 2: background and treatment
- Paragraph 3: the main concern (insulin and vision) and request
- Paragraph 4: social and safety issues and request
- Paragraph 5: follow-up and close
4. Professional tone
Phrases like “I would be grateful if you could” and “would also be appreciated” are polite and appropriate for a colleague.
5. Case notes transformed into full sentences
Notes such as “anxious about injecting insulin; demonstrated twice, still hesitant” became “Although Mrs Okafor has been shown how to self-administer insulin, she remains anxious and hesitant.”
Useful phrases for OET nursing letters
- I am writing to refer… who is being discharged today following…
- Mrs X was admitted on… with…
- She was commenced on… / Her medication was changed to…
- On examination… / Her observations are stable.
- Of particular concern is…
- I would be grateful if you could…
- It would be appreciated if you could arrange…
- Should you require any further information, please do not hesitate to contact me.
Common mistakes that cost marks
- Writing 300+ words by copying everything from the case notes.
- Leaving the purpose vague or hiding it in the last paragraph.
- Using note form (“Pt anxious re insulin”) or unexplained abbreviations.
- Getting dates, doses or names wrong.
- Informal language such as “Please sort out her insulin.”
- No paragraphs, or paragraphs in a confusing order.
A 45-minute strategy
- Reading time (5 min): identify the reader, the purpose and what they need to know.
- Planning (5 min): tick relevant notes, cross out irrelevant ones, group into paragraphs.
- Writing (30 min): write clearly. Don’t rush the opening.
- Checking (5 min): grammar, spelling, articles (a/the), tenses, dates and doses.