OET Writing for Nurses: Discharge & Transfer Letters That Score B

Nurses sit a profession-specific OET Writing task. The case notes and recipient will always reflect real nursing practice. In the official OET, nurses are most commonly asked to write one of three letter types:

Letter type	Typical recipient	When you use it
Discharge letter	Community nurse, GP, residential care facility nurse	Patient is leaving hospital and requires follow-up care or monitoring at home or in a facility.
Transfer letter	Nurse at receiving ward or facility	Patient is moving between wards, hospitals, or care settings and the receiving team needs a full handover.
Referral letter	Specialist nurse, allied health professional, GP	Patient needs a service or assessment the current team cannot provide — e.g. wound care specialist, diabetes educator.

The discharge letter is by far the most common in nursing OET tasks. If you prepare one letter type thoroughly, make it the discharge letter.

The OET Writing sub-test is marked against six criteria. Purpose is scored 0–3; the other five are scored 0–7 each. Understanding each criterion tells you exactly where nursing candidates lose marks.

Criterion	Common nursing failure
Purpose	Opening sentence is vague — "I am writing regarding Mr Jones" says nothing. State the patient, the reason, and the request in one sentence.
Content	Missing key clinical information — omitting current medications, discharge instructions, wound care details, or follow-up dates.
Conciseness & Clarity	Copying case notes word-for-word, or including background that the recipient does not need (e.g., the full admission history in a discharge letter).
Genre & Style	Using note-form language ("BP: 130/80, stable") instead of prose; or an overly casual tone.
Organisation & Layout	Presenting information in the order it appears in the case notes rather than grouping it logically by theme.
Language	Grammatical errors, incorrect tense use, misspelled drug names, missing articles ("the patient" vs "patient").

The single most important insight: Half the marks are for selecting, organising, and presenting information — not for grammar. Nurses who plateau at a C+ are usually making content and organisation errors, not language errors.

A discharge letter for the OET follows a predictable structure that you should memorise and practise until it is automatic.

Opening paragraph — Purpose

State in one sentence: who the patient is, where they are being discharged from, where they are going, and your key request. For example:

"I am writing to arrange community nursing support for Mr George Nambiar (DOB 14/03/1963), who was discharged from Riverside Hospital on 26 July 2026 following treatment for community-acquired pneumonia."

Notice: patient name, date of birth, facility, discharge date, diagnosis, and purpose — all in one sentence.

Second paragraph — Relevant medical history

Include only the background relevant to the community nurse's care. For a pneumonia discharge, this might be: comorbidities that affect recovery (COPD, diabetes), current medications that the nurse needs to administer or monitor, and any allergies.

Do not include surgical history from ten years ago unless it directly affects current care.

Third paragraph — Hospital course and treatment

Briefly summarise what happened during the admission: the presenting symptoms, the diagnosis, the key interventions (IV antibiotics, oxygen therapy, physiotherapy), and the patient's condition at discharge.

Fourth paragraph — Discharge instructions and follow-up needs

This is the most important paragraph for a community nurse. Include:

• Current medications and dosages (especially new prescriptions and any changes)
• Wound care or procedure-specific instructions
• Monitoring requirements (vital signs frequency, oxygen saturation targets)
• Red flag symptoms that should trigger re-referral to hospital
• Scheduled follow-up appointments

Closing paragraph — Request

State clearly what you need the recipient to do. "I would be grateful if you could arrange twice-weekly wound dressing changes and monitor Mr Nambiar's respiratory status until his GP review on 5 August."

The case notes you receive in the OET Writing task are deliberately longer than what you need. Part of the test is deciding what to include and what to leave out. Markers penalise both omission of essential information and inclusion of irrelevant detail.

Always include

• Patient identification (name, age or date of birth, gender)
• Primary diagnosis and any relevant comorbidities
• Current medications, especially new or changed prescriptions
• Known allergies — always
• What the recipient needs to do (the core request)
• Follow-up appointments and review dates
• Any specific warnings or red flags

Usually leave out

• Old surgical history unrelated to the current problem
• Detailed admission vitals (unless they show a significant trend)
• Test results that are now resolved and irrelevant to ongoing care
• Medications that were stopped during admission (mention only if the stopping is clinically relevant)

A good test: Would the community nurse need this information to care safely for the patient? If yes, include it. If no, leave it out.

These are the errors that most reliably push nursing candidates below a B grade:

1. Copying case notes instead of transforming them

The case notes use abbreviations, bullet points, and clinical shorthand: "SOB++, SpO₂ 88% on air". Your letter must convert this to prose: "Mr Nambiar presented with marked shortness of breath and an oxygen saturation of 88% on room air." Markers deduct marks for note-form language in the letter body.

2. A weak or absent purpose statement

Many nurses write "I am writing regarding Mr Jones who was admitted on 14 July." This tells the reader almost nothing. The purpose must name the patient, the situation, and the request — all in the opening sentence.

3. Listing medications without context

Writing "Medications: metformin 500mg BD, lisinopril 10mg OD, aspirin 75mg OD" is note-form. Convert to: "Mr Nambiar's current medications include metformin 500mg twice daily for type 2 diabetes, lisinopril 10mg once daily for hypertension, and aspirin 75mg once daily."

4. Missing the discharge care request

In a discharge letter to a community nurse, the primary purpose is to ask for specific ongoing care. Candidates who describe the hospital admission in full but only vaguely mention "please follow up" are losing marks on both Purpose and Content.

5. Word count errors

The target is 180–200 words in the letter body (excluding address block, salutation, reference line, and sign-off). Letters under 160 words almost always miss key points. Letters over 220 words almost always include irrelevant detail. Count your words.

The NMC (Nursing and Midwifery Council) in the UK has a unique provision: nurses may meet the Writing requirement with a score of C+ (300) rather than the standard B (350), provided all other sub-tests (Listening, Reading, Speaking) score 350 or higher.

This is specific to NMC and does not apply to AHPRA (Australia), NCNZ (New Zealand), or most other registration bodies, which require 350 in Writing.

What does this mean in practice? A C+ in Writing (300) is still a passing score for OET itself — it is not a fail. It means the gap between a borderline candidate and NMC eligibility is often smaller for the Writing sub-test than for the others.

However, do not use this as a reason to under-prepare for Writing. A B grade (350) is more comfortable as a buffer, and AHPRA, NCNZ, and NMBI (Ireland) all require 350. If you are applying to multiple countries, aim for 350 in all sub-tests.

For the full NMC scoring requirements, see our dedicated guide: OET Score for NMC Registration — What UK Nurses Need.

The most effective way to improve your OET Writing score is to write letters under timed conditions and receive specific feedback on what went wrong. Reading guides is useful; practising is essential.

Our AI Writing Practice tool gives you real nursing clinical case notes — discharge, transfer, and referral scenarios — and grades your letter against the four key OET Writing criteria:

• Purposeful Communication — Did you address the purpose and include all key points?
• Language — Grammar, vocabulary, spelling, and medical terminology accuracy
• Organisation — Logical structure, clear paragraphing, conventional letter layout
• Tone & Register — Appropriate formality and clinical professionalism

Each submission returns a grade (A–E) for each criterion, a list of missed key points, and specific inline corrections. This is the fastest way to identify whether your weakness is content selection, organisation, or language — and to fix it before your actual exam.

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