OET Writing for Nurses — How to Pass
OET Writing is where most nurses lose marks they shouldn't. The task is predictable, the format is fixed, and the marking criteria are public. Here is exactly how to reach Grade B.
In this guide
What the OET Writing task involves
The OET Writing sub-test lasts 45 minutes. You are given a set of case notes — a patient's clinical record, typically covering admission history, assessment findings, investigations, and management — and asked to write a letter based on them.
For nurses, the letter is almost always a referral letter — from a ward nurse or community nurse to another clinician or service. The recipient varies: a GP, a specialist, a community care team, a social services department, or a discharge coordinator.
Time allowed
45 min
Word count
180–200
words recommended
Task type
Referral or transfer letter from case notes
Key fact
You are not writing from memory or general knowledge — you are transforming case notes into a clinical letter. All the information you need is provided. The skill being tested is selecting the right information, presenting it correctly, and writing it in appropriate clinical language.
Letter format and structure
OET Writing uses a standard clinical letter format. Follow this structure every time — it satisfies the Organisation and Layout criterion automatically when done well.
What to include — and what to leave out
Include
- — Clinically relevant history
- — Current diagnosis or working diagnosis
- — Relevant investigation results
- — Current management and medications
- — The specific request or action needed
Omit
- — Irrelevant social history
- — Test results not relevant to the referral
- — Repetition of information already stated
- — Invented details not in the case notes
- — Personal opinions or subjective commentary
The six marking criteria explained
OET Writing is marked against six criteria. Each is scored 0–6, and the scores are combined to give an overall band. Grade B requires a strong performance across all six — not just the two highest-weighted ones.
Purpose
Low weightDoes the letter achieve its communicative purpose? Is it clear from the opening why you are writing and what you need the recipient to do?
Tip: State the reason for writing in your first sentence. Don't make the reader guess why they received this letter.
Content
High weightHave you included all the relevant information from the case notes? Are irrelevant details omitted? Is the information accurate — no invented details or distorted facts?
Tip: This is the highest-weighted criterion. Read the case notes carefully and extract every piece of clinically relevant information. Include nothing you cannot justify from the notes.
Conciseness and Clarity
Medium weightIs the information presented clearly and without unnecessary repetition? Are long phrases cut to their essential meaning?
Tip: Clinical letters are efficient. 'The patient is currently experiencing pain in the chest area' → 'The patient reports chest pain.' Be clinical, not conversational.
Genre and Text
Medium weightDoes the letter read as a professional clinical letter? Is the tone appropriate — formal, objective, and impersonal?
Tip: Avoid first person ('I think', 'I believe'). Write in clinical register: 'The patient reports…', 'On examination…', 'It would be appreciated if…'.
Organisation and Layout
Medium weightIs the letter logically structured? Does information flow from background → current presentation → management → request? Are paragraphs well-organised?
Tip: Follow a consistent structure for every letter. Once you have practised a reliable structure, apply it automatically — don't reinvent it in the exam.
Language
High weightGrammar, vocabulary, spelling, and punctuation. Are clinical and professional terms used correctly? Is there a variety of sentence structures?
Tip: Accuracy matters more than complexity. A grammatically correct simple sentence is better than an ambiguous complex one. Aim for accuracy first, range second.
What Grade B looks like
Grade B in OET Writing is the standard required for NMC registration. It represents competent, professional clinical writing — not perfect writing.
All relevant information is included and accurately represented. A few minor omissions may be acceptable, but no significant clinical information is missing and no information is distorted or invented.
The letter follows a clear, logical structure. The recipient can understand the patient's situation, the current clinical context, and what action is being requested without effort.
Grammar, vocabulary, and spelling are generally accurate. There may be occasional errors but they do not cause ambiguity or impede understanding. Clinical vocabulary is used correctly.
The letter reads as a professional clinical document — objective, formal, and impersonal. No colloquialisms, no hedging language, no first-person opinion.
The mistakes that fail candidates
Copying case notes verbatim
The task is to transform case notes into a letter — not transcribe them. You must paraphrase, select, and restructure. Copied phrases score poorly on Language and Genre criteria.
Including irrelevant information
More is not better. Including information that isn't relevant to the referral wastes word count and lowers your Conciseness score. Ask: does the recipient need this to act on my request?
Inventing clinical details
Never add clinical information that is not in the case notes — this scores zero or below on Content. Stick to what is written, even if you think something should be there.
Not stating the request clearly
The letter must end with a clear, explicit request. 'I would be grateful if you could review this patient at your earliest convenience' is not enough. Be specific: 'I am writing to request an urgent cardiology review for...'
Writing in first person throughout
Clinical letters use impersonal constructions: 'The patient reports…', 'On examination, findings included…', 'It is requested that…'. Reserve 'I' for the opening and closing lines.
Going significantly over or under 180–200 words
There is no automatic penalty for length, but very short letters typically miss content and very long letters typically include irrelevant information. Aim for 180–200 words as a guide.
Neglecting the re: line
The Re: line is part of the letter and part of your score. Always include patient name, DOB, and a brief reason for referral on the re: line — it orients the reader before they start reading.
How to prepare effectively
OET Writing rewards structured practice — not just writing lots of letters. The quality of your review matters more than the volume of practice.
Understand the criteria before you write
Read the OET marking criteria carefully. Understand what each criterion is asking before you write a single practice letter. You cannot improve what you do not understand.
Learn the letter structure until it is automatic
You should not be deciding on your structure in the exam — it should be automatic. Practise the header, salutation, re: line, and paragraph structure until you produce it without thinking.
Practise case note analysis
Spend time reading case notes and underlining what is relevant before you write. This selection skill is where many marks are won and lost. Practise annotating notes: circle what to include, cross out what to leave.
Write under timed conditions
45 minutes feels generous but it goes quickly. Allocate 5 minutes reading and planning, 35 minutes writing, and 5 minutes reviewing. Practise this split from the start.
Get feedback on every practice letter
Self-review is limited because you know what you intended to write. OET Writing practice is most valuable when you receive feedback from a trained reviewer or against the official criteria. NMCPrep's OET Writing practice includes AI-powered feedback scoring your letter against all six criteria.
Case notes walkthrough
Before writing, spend 5 minutes reading the case notes and categorising the information. This prevents you from either missing important details or padding the letter with irrelevant ones.
Identify the recipient and purpose
Read the task instruction first. Who is the letter going to? What does the task ask you to write — a referral, a discharge summary, a transfer letter? This determines which information is relevant.
Scan the notes for relevant content
Go through the case notes section by section. Mark what is directly relevant to the referral. Be ruthless: social history, minor past medical history, and routine observations are often irrelevant.
Identify the clinical request
What do you need the recipient to do? This should be explicit in the task instruction. If the task says 'write a referral letter requesting physiotherapy assessment', your final paragraph must clearly request a physiotherapy assessment.
Plan your paragraphs
A 30-second plan — introduction, background, current status, request — prevents you from writing in circles and helps you hit the word count efficiently.