OET Writing for nurses: 4 referral patterns

Of the four OET sub-tests, Writing is the one our user inbox sees the most pre-test panic about. Speaking is intimidating but at least conversational. Listening and Reading have right and wrong answers. Writing is open-ended — you stare at a stack of case notes, 40 minutes on the clock, and have to compose a clinical letter from scratch.

The good news, and the thesis of this post: most OET nurse Writing tasks fit one of four structural patterns. Once you recognise which pattern the case notes call for, the architecture of the letter is mostly decided. The actual prose is small variations around a fixed scaffold. Candidates who recognise the pattern in the first 90 seconds of reading the case notes write substantially stronger letters than candidates who try to compose from scratch every time.

This post identifies the four patterns, shows the structural scaffold for each, and gives you the diagnostic questions that pick which one fits a given case. If you have never read the 9-criteria rubric for OET Writing, do that first — this post assumes the rubric vocabulary.

Why patterns matter more than perfect grammar

OET Writing is scored on six criteria: purpose, content, conciseness, clarity, genre and style, language. Most candidates assume the make-or-break criterion is "language" — that is, grammar and vocabulary. It is not.

The two criteria that separate Band C from Band B for almost every nurse re-sit case we look at are purpose and genre and style. Purpose asks: did the letter make clear, in the first paragraph, why this letter is being sent and what action the recipient is being asked to take? Genre and style asks: does this letter read like a clinical handover, a GP referral, a discharge note — or like a general essay on the patient's case?

Both of those criteria are determined by the pattern of the letter, not by the sentence-level prose. A letter with five grammar slips that nails purpose + genre routinely scores higher than a grammatically perfect letter that fumbles either. This is why pattern recognition is the highest-leverage skill in OET Writing prep for nurses, full stop.

The diagnostic: pick the pattern from case notes in 90 seconds

Every OET Writing task gives you 5 minutes of reading time at the start. Spend the first 60 to 90 seconds of that not reading the case notes line by line, but reading the task instructions at the bottom (which name the recipient and the purpose) and skimming the case notes to identify what kind of clinical situation this is.

Three questions tell you which of the four patterns to use:

1. Where is the patient going?

   • Staying in your care, being handed to another nurse / different shift → Handover
   • Going home with a follow-up appointment booked → Discharge home
   • Going to a GP for routine follow-up of a chronic condition → GP follow-up
   • Going to a specialist for a new concern that needs expert assessment → Specialist referral

2. What does the recipient need to do?

   • Continue ongoing care → handover or follow-up shape
   • Schedule something specific → discharge or referral shape

3. What is the urgency timeline?

   • Hours (next shift) → handover
   • Days to weeks → discharge or referral
   • Routine chronic → GP follow-up

If you have answered these three questions in 60 seconds, you know which of the four patterns you are writing. The remaining 4 minutes of reading time go into pulling the specific clinical details you need to fill the pattern.

Pattern 1: handover

When you write it: the patient is staying in your care setting (ward, residential aged care, community team) and the recipient is the nurse who takes over the next shift, or a nurse on a different team in the same facility.

What the recipient needs to know is: who is this patient right now, what changed during my shift, what is critical for the next 8–12 hours.

Structural scaffold:

1. Opening (1 sentence): Patient name, age, current location, primary reason for admission / care. "This is a handover for Mrs. Eleanor Hayes, 78, on Ward 4 East, admitted three days ago with community-acquired pneumonia."

2. Status this shift (2–3 sentences): Vitals trend, level of consciousness, pain score, any clinical events. Concrete numbers, not adjectives. "She has been afebrile since 0800, oxygen saturation 94 to 96 per cent on 2 L nasal cannulae, pain controlled with paracetamol regular at 6/24 intervals."

3. What changed on my shift (2–3 sentences): New investigations, results that came in, medication adjustments, communications with the medical team. "Dr. Cheng reviewed at 1600 and reduced her IV antibiotic dose; the order is now ceftriaxone 1g daily. Sputum culture results returned this afternoon — sensitive to current treatment."

4. For your shift (3–4 sentences): Specific tasks the next nurse must do, with windows. "Please monitor oxygen saturation hourly overnight. The 2200 dose of ceftriaxone is due. A follow-up chest X-ray is booked for 0800 tomorrow — she will need to be ready to go down to imaging by 0745. Family are visiting after dinner; her son has asked to be paged if there is any deterioration."

5. Closing (1 sentence): Standard handover sign-off. "Please contact me on extension 4421 if anything is unclear."

What makes a handover letter score Band B: the verb tenses are present and past, not future hypothetical. Every clinical detail has a number or a time. The next-shift tasks are bulleted in your head even if presented as prose, so the recipient can mentally checklist them.

What sinks a handover to Band C: speculation about the patient's prognosis, paragraphs of background history that should have been compressed to one line, vague language like "she has been a little uncomfortable" instead of "her pain score has ranged from 4 to 6 over 24 hours". Save the speculation; ship the facts.

Pattern 2: discharge home

When you write it: the patient is leaving the hospital and going home, with some combination of medications to take, follow-up appointments to attend, and warning signs to watch for. The recipient is usually a community nurse, the patient's GP, or a domiciliary care team.

What the recipient needs to know is: this patient is now in the community — what do I need to know to support them safely.

Structural scaffold:

1. Opening (1–2 sentences): Admission summary in one breath. "Mr. Anil Sharma, 64, was admitted on 12 March with an acute exacerbation of chronic obstructive pulmonary disease and discharged home on 19 March."

2. What was treated (3–4 sentences): The diagnosis, the treatment, the patient's response, the discharge clinical state. "He received seven days of oral prednisolone, doxycycline, and bronchodilators. By day five he was afebrile with peak expiratory flow returned to his baseline of 280 L/min. He is discharged on his regular tiotropium 18 mcg once daily, salbutamol 100 mcg as needed, and a five-day prednisolone taper to complete at home."

3. Functional state at discharge (2 sentences): How is the patient able to manage. Eats, washes, walks, sleeps, manages medications. "He is independent with all activities of daily living, mobilising without assistance, and his wife is at home to support medication management."

4. What you (recipient) need to do (3–4 sentences): Specific community-care tasks. "Please monitor his respiratory status at the home visit scheduled for 22 March. The prednisolone taper finishes 24 March — please confirm he has taken the full course. He has a follow-up appointment with his respiratory consultant on 4 April; please support him in keeping this."

5. Red flags for re-admission (1–2 sentences): Signs that should prompt urgent contact. "If he develops a temperature above 38°C, increased sputum production with colour change, or peak flows below 200 L/min, please advise re-attendance at the emergency department."

6. Closing: Standard sign-off. "He has been provided with a written discharge summary and contact numbers for the respiratory team."

What makes a discharge letter score Band B: the boundary between hospital-care and community-care is clearly drawn — what was done in hospital is past tense, what needs to happen in the community is future imperative. Medication doses are specific. Red flags are concrete and actionable.

What sinks a discharge letter to Band C: laundry lists of investigations that don't change community care decisions, missing red flags, "the patient should continue taking his medications as prescribed" (which says nothing).

Pattern 3: GP follow-up

When you write it: the patient has been seen in a hospital outpatient department, a specialist clinic, or by a community nursing team, and you need to communicate something to their primary-care GP for ongoing management of a chronic condition.

What the recipient (the GP) needs to know is: what changed, what they should do, what they should keep doing.

Structural scaffold:

1. Opening (1 sentence): One-line summary. "This is a follow-up letter regarding Mrs. Patricia Wong, your patient with type 2 diabetes, whom I reviewed at the diabetes clinic on 8 March."

2. Current status (2–3 sentences): HbA1c, current medications, complications, anything that has changed. "Her HbA1c has improved from 8.4 per cent in December to 7.6 per cent now. She remains on metformin 1g twice daily and gliclazide MR 60mg daily. Her blood pressure today was 138/84."

3. What changed at this review (2 sentences): New issues, new findings, new investigations. "I have requested fasting lipids and a urine albumin-creatinine ratio, results to follow. Her foot examination showed reduced sensation in the right great toe — she has been booked for a podiatry assessment."

4. What I would like you to do (2–3 sentences): Specific actions for the GP. "Please review her blood pressure at her next attendance; if it remains above 135/80, consider adding ramipril given her diabetic status. Please also follow up the podiatry assessment outcome."

5. What I will do (1 sentence): Your team's continued role. "I will see her again in six months, or sooner if her HbA1c does not continue to improve."

6. Closing: Standard sign-off.

What makes a GP follow-up letter score Band B: the division of labour between the specialist team and the GP is explicit. The GP knows what is theirs to do and what is the specialist's. Specific numbers replace adjectives throughout.

What sinks it to Band C: copying the entire clinical history into the letter (the GP already has it — they referred the patient), recommending things the GP would have already done, omitting the closing-loop statement of when you will see the patient next.

Pattern 4: specialist referral

When you write it: the patient has a new concern that exceeds the scope of primary or community-nursing care and needs to be assessed by a specialist. The recipient is the consultant or specialist team.

What the recipient needs to know is: why are you sending this patient, what have you already done, what specifically are you asking for.

Structural scaffold:

1. Opening (1 sentence) — explicit purpose statement: "I am referring Mr. James O'Connor, 52, for assessment of a six-week history of intermittent chest pain on exertion."

2. History of the presenting complaint (3–4 sentences): The patient's symptoms, timeline, exacerbating and relieving factors. Specific. "The pain is described as central, retrosternal, with no radiation. It occurs after approximately 200 metres of brisk walking, is relieved by rest within two minutes, and has been progressive over six weeks. He denies associated breathlessness, syncope, or nocturnal symptoms."

3. Relevant background (2–3 sentences): Medications, comorbidities, family history if relevant. "He has well-controlled hypertension on amlodipine 10mg, no diabetes, and a strong family history — his father had an inferior myocardial infarction at 56."

4. What I have done so far (2–3 sentences): Investigations already complete, results, treatment trialled. "His resting ECG is unremarkable. I have started him on aspirin 75mg daily and short-acting GTN as required, and counselled him on lifestyle modification."

5. What I am asking for (1–2 sentences) — explicit request: "I would be grateful for your assessment with a view to exercise tolerance testing and consideration of further investigation as you see fit. Given the family history and progressive pattern, I would appreciate prioritised review if possible."

6. Closing: Standard sign-off.

What makes a specialist referral score Band B: the specificity of the request. The recipient knows exactly what is being asked for, and the rest of the letter supports that ask. Negative findings are included where they are clinically relevant (the absence of nocturnal symptoms in suspected cardiac chest pain matters).

What sinks it to Band C: vague requests ("please review"), missing the family-history line in cardiac cases, including investigations the specialist already knows would be standard (the consultant does not need to be told what an ECG is).

How the patterns fit together — the meta-skill

In real OET Writing case notes you sometimes get cases that genuinely don't fit cleanly into one pattern. The patient is being discharged home, but to community nursing care, and there is a new red flag that warrants a specialist referral on top. In those cases, you pick the pattern that matches the primary recipient of the letter, then borrow one section from another pattern as needed.

The task instructions at the bottom of the case-notes packet name the recipient explicitly. If they say "Write a letter to Dr Patel, the patient's GP" — that is pattern 2 (discharge to community) or pattern 3 (ongoing GP follow-up), depending on whether the patient is leaving hospital or already in the community. If they say "Write a letter to the on-call nurse for the night shift" — pattern 1. If they say "Write a referral letter to the cardiology team" — pattern 4.

The fastest way to learn this is to take five practice OET Writing tasks back-to-back and, before writing each one, write at the top of your draft which of the four patterns you are using. Within five practice attempts you will be able to identify the pattern within 60 seconds of reading the task instructions. That is the meta-skill that separates Band B from Band C in OET Writing for nurses.

Common pitfalls across all four patterns

Three recurring issues we see in nurse OET Writing samples regardless of pattern:

The opening sentence buries the purpose. The first sentence of every OET Writing letter should state, in one breath, why the letter is being sent. "I am writing to inform you" + the action you want is the standard scaffold. Candidates who open with the patient's age and history before stating the purpose lose points on the "purpose" criterion every time. The patient's age and history go in sentence two.

Future tense for past clinical actions. Once a treatment has been started, it is "started" or "commenced" — not "will be commenced". Mixing tenses in the same letter is a fluency hit on the language criterion. Past tense for done, present tense for ongoing, future tense for the recipient's actions only.

Salutation and sign-off drift. "Dear Doctor" if you do not know the doctor's name; "Dear Dr Patel" if you do (no first name). Sign off with "Yours sincerely" if you used the doctor's name; "Yours faithfully" if you used the generic title. This is genre-and-style criterion scoring — small but consistent across every letter. Get this right.

The next step

The fastest way to internalise the patterns is comparative. Pick three OET Writing case-note sets — the official samples in the OET preparation pack work. For each, write at the top of your draft which pattern you are using and why, then write the letter following that pattern's scaffold. After three letters you will have a clear sense of how the four patterns differ in practice.

If you want a per-criterion score against the OET rubric on each draft, the OET Live Writing scorer gives you that. Most candidates who follow a pattern-first approach for four weeks see their Writing band lift by one full level. The patterns are the lift; the per-attempt scoring is the calibration.