OET Writing Guide for Nurses

By SpeakOET Team · July 27, 2026

If you’ve sat OET Writing before and come away thinking “my English is fine, so why did I only get a C+?” — this guide is for you. Writing is the sub-test where strong spoken English stops being enough, because the examiner isn’t just reading your grammar. They’re reading whether you can take a page of messy case notes and turn it into a letter a stranger could safely act on in under a minute. That’s a specific, learnable skill, and most candidates have never been taught it directly. We have — this is everything we’d tell you in a one-to-one lesson.

What is OET Writing?

OET Writing is a 45-minute task where you read a set of case notes about a patient and write a letter based on them — almost always to another healthcare professional, but sometimes to a patient or their family. There’s no choice of topic and nothing to memorise in advance: the case notes are new to you on the day, and your letter has to be built from them, in your own words, under time pressure.

Think about what actually happens at handover on a busy ward. A colleague hands you a summary of a patient you’ve never met, and you need to understand, within seconds, what matters: what happened, what’s outstanding, what you need to watch for. A good handover note gives you exactly that. A bad one buries the important line (“still due a repeat potassium”) somewhere in the middle of three paragraphs about the patient’s admission four days ago. OET Writing is testing whether you can produce the good version, under exam conditions, for a reader who has never seen this patient before.

The format

Every nursing Writing task follows the same shape: case notes, a set of task instructions telling you who to write to and why, and a blank answer sheet (or text box, for OET@Home). Here’s how the 45 minutes are structured:

The letter types

The task rotates between a few letter types, and each one changes who your reader is and what tone you need:

You won’t know which one you’ll get until you open the case notes, which is why memorising one fixed letter (one opening sentence, one structure) is risky — it fits some tasks and visibly doesn’t fit others.

What examiners expect

Examiners are trained to read your letter the way your named reader would: someone who has never met this patient and needs to act on your letter safely. In practice, that means they’re checking for a clear reason for writing, accurate content taken from the case notes, appropriate tone for that reader, logical organisation, and clean-enough language that none of the above gets lost. All six of the official criteria below map directly onto that reader’s experience.

The 6 assessment criteria

OET scores your letter against six official criteria. Purpose is scored out of 3; the other five are each scored out of 7, for a raw total out of 38, which converts to your letter grade and 0–500 score. Knowing these six by name — and what an examiner is actually looking for in each — is the single biggest lever you have, because it turns “write a good letter” into six concrete, practisable checks.

1. Purpose (Overall Task Fulfilment)

Does your letter make clear, immediately, why you’re writing — and does it restate that purpose as a specific request near the end? Examiners can tell within one sentence whether an opening is tailored to this patient or lifted from a template you rehearsed at home. A generic opening that would fit any letter caps this criterion at 2 out of 3, no matter how well the rest is written.

How to improve: build your opening from two things pulled from the actual case notes — the patient’s name and the specific clinical reason — and close with a specific ask (“please review and advise on further management”), not a vague sign-off.

2. Content

Everything the reader needs to safely continue care, accurately represented, with nothing important left out. This is judged directly against the case notes in front of the examiner, so any change of meaning when you paraphrase counts against you — even a small one.

How to improve: before you write a single sentence, list every “must include” fact from the case notes on scrap paper or in your head — diagnosis, medications, allergies, relevant social context, and what happens next. Tick each one off as you draft so nothing gets dropped under time pressure.

3. Conciseness & Clarity

The right length for this case and this reader, with no irrelevant information, and everything summarised rather than copied wholesale from the notes. This is the criterion that punishes candidates who panic and include everything “just in case.”

How to improve: for every sentence you write, ask “does the person reading this need it to do their job?” If the honest answer is no, cut it — even if it’s interesting, even if it’s true.

4. Genre & Style

Formal, factual, and appropriate to whoever you’re writing to. Clinical language for a clinician, plain language for a patient or family member, and a neutral tone throughout — facts, not judgements, about the patient.

How to improve: write “did not,” never “didn’t”; describe behaviour in numbers and facts instead of labels; and only use an abbreviation if the specific reader named in your task would already know it.

5. Organisation & Layout

A logical order — chronological or thematic — with the most important information first, related ideas grouped into paragraphs, and a layout (salutation, body, closing) the reader can scan quickly. This is scored separately from Content, so accurate facts in the wrong order still lose marks here.

How to improve: before writing, sort your case-note facts into 3–4 themed groups rather than writing them in the order they’re printed on the page. The case notes are a source of facts, not an outline.

6. Language

Grammar, vocabulary, spelling, and punctuation, judged by whether an error causes the reader real strain or confusion — not by counting every minor slip. A missing article rarely costs you anything; an error that changes clinical meaning costs you a lot.

How to improve: spend your last few minutes proofreading specifically for negations, numbers, units, and dosages — the handful of words where an error is actually dangerous, not just untidy.

A minute-by-minute exam strategy

“Manage your time” is useless advice on its own. Here’s exactly what to do with each of the 45 minutes, based on how the highest-scoring candidates actually work through the task.

A full worked example

Here’s a realistic (invented) case-notes stimulus, followed by the thinking a strong candidate does before writing a single sentence of the letter itself.

What a strong candidate notices first: the steroid detail is easy to skim past because it reads like background, but it’s actually the reason the task explicitly asks about glucose monitoring. Missing that connection means missing the point of the letter — a Content error, not a language one. This is exactly the kind of detail the Content criterion is built to catch.

Paragraph plan: (1) reason for writing + admission summary, (2) relevant background — diabetes, hypertension, steroid course and its effect on glucose, (3) discharge medications and what’s needed next (X-ray, glucose monitoring), (4) closing request.

Notice what’s absent as much as what’s present: no description of the patient’s day-by-day observations chart, nothing about how he felt about being in hospital, no restating of information the GP doesn’t need. Every sentence earns its place against one of the six criteria — that’s the discipline the test is actually rewarding.

18 mistakes that quietly cap your score

Most of these won’t make your letter unreadable — which is exactly why they survive candidates’ own proofreading. They cap a score that otherwise looks fine.

Tips from experienced OET tutors

Always check the exact current task format, timing, and marking guide on the official OET website — those details are set and occasionally updated by OET, not by us.

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