Nurse · Discharge to community nurse · 3 bands compared
OET Nurse: Grade A vs B vs C Letters Compared (Discharge to community nurse)
Three discharge letters written for the same UK nursing case notes, shown at Grade A, B and C. Each letter demonstrates typical band differences in content, clarity and language for a nurse-to-community-nurse handover.
In short
- →Grade A: complete, clinical, concise instructions with specific monitoring and escalation.
- →Grade B: mostly complete but a few missing details and minor language issues.
- →Grade C: important omissions, unclear instructions and organisational weaknesses.
The shared case notes
Mr John Smith, 78, was admitted for a 3‑day stay with left lower‑leg cellulitis. He received IV antibiotics initially and was switched to oral therapy when afebrile and clinically improved. He uses a walking frame and lives alone with a weekly carer. No known drug allergies. Wound is 3 cm × 2 cm on the lateral calf with minimal serous exudate; pain controlled with regular paracetamol. Observations stable; temperature normal for 24 hours. Discharged home today with community nursing required for ongoing wound care, medication support and safety checks.
The three letters at a glance
The three letters — same case, different bands
Grade A
450/500Dear Community Nurse,
Re: Mr John Smith, DOB 12/03/1948; NHS 123456789. Discharged home today following a 3‑day admission for left lower‑leg cellulitis. He received IV flucloxacillin then converted to oral flucloxacillin 500 mg four times daily; continue oral antibiotics for five further days (finish date: 5 days from discharge). No known drug allergies.
Wound: 3 cm × 2 cm lateral calf, minimal serous exudate. Please perform dressing change and wound assessment on Day 1, Day 3 and Day 5 post‑discharge. Use sterile technique; apply non‑adherent dressing and protective secondary dressing. Measure wound and photograph if possible. Monitor for increasing erythema, spreading cellulitis, purulent discharge, increased pain or temperature >38.0°C — escalate to ED or on‑call surgical team if any of these occur.
Medications: paracetamol 1 g up to four times daily PRN for pain. Mobility: uses walking frame; assist with stair negotiation. Please liaise with GP for review within 48–72 hours and refer to community physiotherapy for strength and falls assessment. Contact me on 020 7123 4567 for clarification.
Verdict: This letter meets Grade A because it fulfils the task fully: clear purpose, precise clinical details, specific wound care and escalation criteria, appropriate requests for visits and referrals, and fluent, accurate language.
Grade B
360/500Dear Community Nurse,
Re: Mr John Smith, DOB 12/03/1948. Discharged today after treatment for left leg cellulitis. He received IV antibiotics and was changed to oral flucloxacillin 500 mg three times daily; continue for five days. No known allergies recorded.
The wound is on the lateral calf, about 3 cm by 2 cm with small amount of clear fluid. Please change dressing on Day 1 and then every two days until healed. Use sterile dressings and check for redness, increased pain or pus. Measure wound size and update patient notes. If he develops fever or spreading redness contact the GP or ED.
Medications: paracetamol for pain as required. He mobilises with a walking frame and needs support with stairs. Please arrange community physiotherapy and GP follow‑up in 48–72 hours. If you need further information phone the ward on 020 7123 4567.
Verdict: This letter is Grade B because it conveys most necessary information and reasonable instructions, but dosing was inconsistent with usual regimen and some instruction specificity and phrasing could be improved; language is generally clear with minor inaccuracies.
Grade C
290/500Dear Community Nurse,
Re Mr John Smith, discharged today after leg infection. He had IV antibiotics and now is on oral antibiotics; no allergies noted. Wound on left calf (about 3 cm). Please look after dressing and change it regularly.
Watch for worse infection signs and send to hospital if needed. He uses a walking frame and has pain which he takes paracetamol for. Please check his medications and help with stairs if needed. Ask GP to see him in a few days.
Contact the ward for any problems. Thanks and regards, Ward staff 020 7123 4567 for follow up details if required but ensure checks done soon after discharge please and document outcomes in notes when you visit him at home soon after discharge.
Verdict: This letter is Grade C due to omissions and vagueness: no clear antibiotic dose or duration, dressing frequency unspecified, weak escalation details and repetitive, imprecise language. Organisation and clarity are limited, requiring improvement.
Criterion-by-criterion: Grade A vs B vs C
| Criterion | Grade A | Grade B | Grade C |
|---|---|---|---|
| Purpose | Purpose explicit and immediately clear; clinical handover focal point. | Purpose mostly clear but opening less direct or slightly wordy. | Purpose vague or buried; reader must infer main action required. |
| Content | Complete clinical details, specific requests and escalation criteria included. | Covers most key information; some specifics or timings missing. | Important clinical details or instructions omitted or unclear. |
| Conciseness & Clarity | Concise, unambiguous instructions; clinical language used efficiently. | Generally clear but occasionally wordy or slightly ambiguous. | Repetitive and imprecise; reader may be uncertain what to do. |
| Genre & Style | Professional, clinical tone; appropriate register for community nurse. | Mostly professional but occasional colloquial or informal phrasing. | Inconsistent tone; overly informal or unclear phrasing. |
| Organisation & Layout | Logical order: ID, summary, instructions, meds, escalation, contacts. | Reasonable order but some detail placement could be improved. | Poor sequencing; items repeated and important info scattered. |
| Language | Accurate grammar, precise clinical vocabulary and correct spelling. | Generally accurate with a few grammatical or lexical slips. | Frequent errors, imprecise terminology; hampers comprehension. |
How to lift this letter one band
To move a Grade C letter into Grade B: add missing clinical specifics and structure. Clearly state drug name, dose, frequency and exact duration. Specify dressing type and an explicit schedule for visits (for example Day 1, Day 3). Give measurable escalation signs (temperature threshold, increasing erythema, purulent discharge). Remove repetition and improve sequencing: ID, brief summary, wound care, meds, mobility, referrals, contacts. Correct basic grammar and replace vague words with precise clinical terms.
To move a Grade B to Grade A: tighten clinical accuracy and concision. Ensure all timings and doses align with current clinical practice, and include quantifiable wound measurements and photographs if available. Add a clear request for which team should action GP review and community physiotherapy referral. Provide precise escalation instructions (exact temperature, specific signs) and a direct contact name and number. Use professional, confident phrasing and check for minor language slips to present a flawless handover.
2026 update
What changed in 2026 for Nurse band scoring
The 2018 OET writing criteria remain the basis for marking, but the 2026 scoring regime is stricter in task fulfilment and clinical accuracy. Examiners now expect explicit, measurable clinical instructions and clear escalation thresholds rather than vague cautions. Concision and precise medical language carry greater weight; small factual or dosing inaccuracies are less easily overlooked. For nurses, this means more emphasis on exact drug doses, timings, wound measurements and specific follow‑up actions.
Frequently asked questions
How long should an OET discharge letter be?
Aim for 160–200 words distributed logically across short paragraphs to include all required clinical details.
What details are essential for nurse‑to‑community‑nurse letters?
Patient ID, diagnosis, current treatment including drug names/doses/duration, wound details, dressing plan, escalation signs, mobility needs and contact info.
How specific must escalation criteria be?
Be measurable: give temperature thresholds, signs to look for (increased erythema, purulent discharge, rising pain) and clear next steps.
Can I use abbreviations in OET letters?
Use common, unambiguous abbreviations (e.g. PRN, QDS) sparingly; when in doubt, write terms in full to avoid confusion.
How do I improve language accuracy quickly?
Practice phrases for common situations, focus on collocations (e.g. 'wound assessment', 'change dressing'), and review grammar patterns for conditionals and imperative forms.
What is the biggest reason candidates drop from B to C?
Omissions of critical clinical information or unclear instructions that affect patient safety and require the reader to infer next steps.
Keep learning
Scoring criteria
See if your nurse letter is at Grade C, B, or A.
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