OET Writing for nurses: how to choose what goes into your letter from the case notes

As a nurse, you probably already write handovers and referrals at work. A part of OET Writing that often catches candidates out is not the letter itself but what comes before it: deciding which lines in the case notes belong in the letter and which do not. This guide walks through that decision, with an invented nursing example.

What the task asks you to do

For nurses, the Writing task is a profession-specific letter, such as a referral, a transfer or discharge letter, or a letter giving advice. On its Writing page, OET describes the skill being tested as selecting and organising relevant information and presenting it clearly and accurately for the intended reader. Choosing what to include is not a side issue; it is a large part of what is marked.

The sub-test lasts 45 minutes. The first five minutes are reading time, which OET presents as your chance to understand the task and notes and plan what the reader needs. That leaves 40 minutes to write and check your letter, and the task and case notes stay available to you for the whole of that time, not only during reading time.

Your letter is marked against six criteria: Purpose, Content, Conciseness & Clarity, Genre & Style, Organisation & Layout, and Language. Selection affects Content and Conciseness & Clarity most directly.

Start with the reader, not the notes

The instinct is to read the case notes from the top and pick out facts. It works better the other way round. Read the task instruction first and answer two questions:

1. Who is reading this letter, and what is their role?
2. What do you need them to do?

OET's own Writing guide suggests two further questions to shape your selection: whether the reader already knows the patient, and which part of the patient's care they will be involved with. A district nurse meeting a patient for the first time needs a fuller picture of how that person is managing day to day than a GP who has known them for years and only needs an update.

Once you know the reader and the request, every line in the notes can be tested against one question: does this person need it to continue the patient's care or to act on my request?

Sorting the case notes into three groups

As you read, decide which of three groups each note belongs to.

Must include

These are the facts the reader cannot do without: why you are writing, the patient's current situation and what has changed (including any medicines that were started, stopped or changed), anything the reader must act on, and safety information such as allergies. Safety information is worth repeating even when the reader may already know the patient, because it is easy to miss. The OET assessment criteria describe Content at the top band as including all the key information, with nothing important missing, and representing the case notes accurately.

Include briefly

Some background helps the reader but does not need detail. Repeated entries across several visits can often become one sentence. OET's Writing guide points out that information in earlier entries is often overtaken by later events, so you report where things stand now rather than retelling every visit.

Leave out

OET is clear that not everything in the case notes will be relevant. Typical examples are social details that do not affect care, history with no bearing on the request, or background a reader who knows the patient well already has. A quick test for a social detail: would the reader plan or do anything differently because of it? If not, leave it out. The Conciseness & Clarity criterion looks at whether unnecessary information has been included and how far it distracts the reader.

Leaving things out can feel risky when your day job trains you to record everything. But a letter is not a full record. It is a handover to one person for one purpose.

A worked example

This invented, simplified scenario is not based on any official task.

You are a ward nurse. Mr Ellis, aged 81, is going home after a hospital stay following a fall, and for now he cannot leave his flat on his own. The task asks you to write to the district nurse who will be visiting him at home, asking them to continue care of a wound on his lower leg and to check how he is managing.

The notes include, among other things:

• lives alone in a ground-floor flat
• retired postman
• daughter visits once a week
• day 1: needed two staff to help him stand
• day 6: walking on his own with a frame, slower than before admission
• wound on left lower leg, dressing plan recorded in the notes
• allergy to a particular type of adhesive dressing
• current medicines listed, none changed during this stay
• childhood appendix operation
• blood tests on admission, all within normal range
• enjoys crossword puzzles

Sorted against the reader and the request, it might look like this:

• Must include: the wound, its location and the dressing plan; the dressing allergy; how he is walking now; that he lives alone; the request for home visits.
• Include briefly: the fall that led to admission; his weekly family support; his current medicines, in one line, since nothing has changed.
• Leave out: his former job, his hobby, the childhood operation, the normal blood results.

Notice the two mobility entries. The day 1 note has been overtaken by day 6, so it goes in the leave-out group as a separate fact, and the letter reports only where he is now: walking independently with a frame, more slowly than before. And living alone is a must-include here because it affects how a visiting nurse will plan care, whereas the same detail might matter much less in a letter to a specialist clinic. Nothing in the leave-out group is wrong; it simply does not help this reader do this job.

Organising what you have kept

Decide the order before you write. OET's assessment criteria say the purpose should be immediately apparent: state it briefly in your opening lines, then give the details of what you are asking for later in the letter, often near the end. What you should avoid is a reader who only finds out why you wrote in the last paragraph.

For the body, the OET Writing guide describes organising chronologically, in time order, or thematically, grouping related information. For Mr Ellis, a sensible order would be:

1. Opening: he is being discharged home today after a fall, and you are asking for district nurse visits for his leg wound and to check how he is coping.
2. The wound, the dressing plan and the dressing allergy, plus one line saying his medicines are unchanged.
3. His mobility now, living alone and his family support.
4. Closing: the specific visits and checks you are asking for.

Grouping also stops you mentioning the same issue three times because it appeared on three dates in the notes. A useful check from the guide is to put yourself in the reader's place and ask what you would want to know first, second and third.

Length and time

The word range for the task is 180 to 200 words, and OET states on its Writing page that there is no automatic penalty for going over or under. OET's view is that every task fits within that range. A long letter is usually a sign that some leave-out material has slipped in or the letter is loosely organised. A short one often means something the reader needed has been missed. Neither is penalised by word count itself; the weakness shows up in how the letter is marked against the criteria.

So if your draft is running long, the fix is usually not to shorten every sentence but to check what has crept in from your leave-out group.

OET's guide suggests finishing with a few minutes to spare and reading the letter as the reader would: do they know what they need to do, do they have the information to act, and are the facts correct? This is where accuracy slips are caught. A changed tense is a common one: a note saying "smoker" becomes "he smoked" in the letter, which tells the reader he has stopped.

Practising the selection step

You can practise selection without writing a full letter. Take practice case notes, set a five-minute timer and, on paper, put every line into one of the three groups, then compare your choices with a model answer. When you do write full letters, feedback against the six criteria shows whether the problem is selection (Content, or Conciseness & Clarity) or something else. Clodia's Writing practice gives that criterion-by-criterion feedback on nursing letters, so you can see which criterion is holding you back.

Check the current rules. The details here describe the Writing sub-test at the time of writing. OET publishes the current format, the assessment criteria and official sample tests at occupationalenglishtest.org, and that is always the authority if anything you read elsewhere differs. Clodia is independent and not affiliated with OET or Cambridge Boxhill Language Assessment.