Community or district nurse
Visits at home. Needs the tasks to carry out (dressings, injections, monitoring), the first visit date, the home situation and equipment supplied.
OET Writing
OET Nursing Discharge Letter: Writing the Final Request Paragraph
A nursing discharge letter hands care over to the person who will see the patient after hospital. This guide shows you how to choose what that reader needs and how to write the final paragraph, so they know what to do, what the patient has been taught and when to act.
What a nursing discharge letter has to do
Nurses often ask: "My letter covers the whole admission, so why is my Purpose weak?" Usually the letter summarises the stay well and then ends with "Thank you for your help". The reader knows what happened, but not what to do next.
What OET actually asks for
OET describes the Writing task as a profession-specific document, such as a referral, or a letter of transfer or discharge, written from case notes. You get 5 minutes of reading time, when you cannot write or mark anything, then 40 minutes to write. OET suggests planning in the first 2–3 minutes of writing time.
Length is a guide
OET gives 180–200 words as a guide for the body paragraphs and says assessors do not count your words. The greeting, closing sentence and sign-off are not part of it.
The reader must be able to continue care
OET says to select the case-note information the reader needs to continue care. Its Writing Guide on Purpose adds that the reason for writing should be immediately apparent and then expanded in the last paragraph: for example, how often the reader should see the patient and what to support them with.
Who reads a nursing discharge letter, and what they need
The reader decides which notes are essential, so identify them from the task before you read the notes in detail.
GP practice nurse
Sees the patient at the surgery. Needs what changed in hospital, what to check at the review (weight, blood pressure, a blood test), the education given and the date.
Care home or residential facility
Often a nurse manager or senior carer. Needs mobility and falls risk, medication and who gives it, diet, what staff should watch for and whom to call.
Does the reader know the patient?
OET warns that titles such as “community nurse” do not, on their own, mean the reader knows the patient. Without clear wording in the task, give brief relevant background.
The final request paragraph: four questions to answer
Before you write the last paragraph, answer these four questions from the case notes. Each answer becomes one sentence, and together they turn a summary into a handover.
| Question | What to write | Example from the practice case below |
|---|---|---|
| 1. What must the reader do, and when? | An action the reader can carry out, with a date or frequency | “At his review, please compare his weight with his discharge weight…” |
| 2. What follow-up is already arranged? | Appointments and calls, so the reader does not duplicate them and can remind the patient | “The heart failure nurse will telephone him within two weeks…” |
| 3. What has the patient been taught? | The key points and how well they were understood, so the reader reinforces rather than repeats | “…and reinforce his fluid restriction.” |
| 4. When should someone act? | The warning signs and what should happen next, including whom to contact | “He knows to contact the practice if his weight rises by more than 2 kg in three days…” |
Keep the request within the reader’s role
Lead with the main request, then follow-up and warning signs. Ask a practice nurse to check, measure, take blood or reinforce advice, not to change a dose. If a doctor may need to act, say so: “please arrange a GP review if…”.
Practice case: heart failure discharge to a practice nurse
This is an invented practice case written by OET with Dr Hesham to demonstrate the method. It is not an official OET task and does not describe a real patient.
Practice case: the task
You are the charge nurse on Ward 9 (Cardiology), Northfield General Hospital. Mr Graham Lowe is being discharged home today. Write a letter to Ms Amira Shah, Practice Nurse, Brookfield Medical Practice, 22 Station Road, Brookfield, who will review him next week. The body should be approximately 180–200 words.
Practice case: case notes (summary)
- Mr Graham Lowe, DOB 14/05/1952; retired bus driver; lives with wife
- PMH: chronic heart failure (2023); AF (2021); T2DM, diet-controlled; cataract surgery (2019); NKDA
- Meds: furosemide 40 mg mane; bisoprolol 2.5 mg OD; ramipril 2.5 mg OD; apixaban 5 mg BD
- 27/10: SOB on minimal exertion, ankle oedema to mid-shin; weight 92.4 kg; IV furosemide
- 28/10: stopped weighing himself 3 months ago (scales broken); drinking approx. 3 L/day
- 30/10: oedema reducing; oral furosemide 80 mg mane
- 31/10: creatinine 128 micromol/L (112 on admission); potassium normal
- 01/11: pt and wife taught daily weights, fluid restriction 1.5 L/day; diary given; both explained plan back; son bought new scales
- 02/11: weight 86.6 kg; BP 116/70; mobilising independently; complains about hospital food
- Plan: practice nurse review 09/11 (weight, BP, U&Es, diary, reinforce fluids); contact GP if weight up >2 kg in 3 days or more SOB/swelling; heart failure nurse phone call within 2/52; cardiology clinic 6/52
Keep, because the practice nurse needs it
- Furosemide increased: the one medication change
- Discharge weight 86.6 kg: the baseline for the review
- Creatinine rise: the reason for the blood test
- Stopped weighing, high fluid intake: why the education matters
- Education given, understanding confirmed, wife’s role
- Review tasks, warning signs and follow-up already arranged
Summarise or omit
- Summarise: admission symptoms in one clause; other medicines as “unchanged”
- Omit: former job, cataract surgery and diet-controlled diabetes, which do not affect this review
- Omit: normal potassium and blood pressure, the new scales and the complaint about food
Paragraph plan
- P1, purpose: discharge today after an exacerbation; please review on 9 November
- P2, what changed: furosemide increase, discharge weight, creatinine rise
- P3, education: the cause, what was taught, understanding confirmed
- P4, request: review tasks, warning signs, follow-up arranged
Model letter: discharge to the practice nurse
A model answer to the invented practice case above (body: 197 words). Strong letters can differ in wording, but they make the same selection decisions.
Model letter (invented practice case)
Ms Amira Shah
Practice Nurse
Brookfield Medical Practice
22 Station Road
Brookfield
2 November 2026
Dear Ms Shah,
Re: Mr Graham Lowe, DOB 14/05/1952
Mr Lowe, who has chronic heart failure, is being discharged home today after an exacerbation. I would be grateful if you could review him at the practice on 9 November.
He was admitted with breathlessness and ankle swelling, which improved with intravenous diuretics. His furosemide has been increased from 40 mg to 80 mg each morning; his other medications are unchanged. He now weighs 86.6 kg, nearly 6 kg less than on admission, but his creatinine has risen from 112 to 128 micromol/L.
He had stopped weighing himself and was drinking about three litres daily. He has been taught to weigh himself every morning, limit his fluids to 1.5 litres a day and record both in a diary with his wife’s help. They both explained the plan back correctly.
At his review, please compare his weight with his discharge weight, check his blood pressure, take blood for urea and electrolytes and reinforce his fluid restriction. He knows to contact the practice if his weight rises by more than 2 kg in three days or his breathlessness or swelling worsens. The heart failure nurse will telephone him within two weeks, and cardiology will see him in six weeks.
Should you require any further information, please do not hesitate to contact me.
Yours sincerely,
Charge Nurse
Ward 9, Northfield General Hospital
Why the final paragraph works
- It opens with actions the practice nurse can do, tied to the date in paragraph 1.
- “Compare his weight with his discharge weight” works because paragraph 2 gave the number, and the creatinine rise explains the blood test.
- “Reinforce” tells the reader the teaching is done; they do not need to start again.
- The warning signs come with an action and a contact, and arranged follow-up comes last.
Key takeaway
Read your final paragraph as the practice nurse on 9 November. If you could start the appointment without the hospital notes, the request is clear.
Five alternative closing-request sentences
Each sentence belongs to a different invented patient. Use them as patterns: an action, a time, and a reason or warning sign.
| Reader and situation | Closing-request sentence |
|---|---|
| District nurse, wound care | I would be grateful if you could visit Mrs Okafor on 4 November to change her dressing and assess the wound for signs of infection, such as increasing redness, heat or discharge. |
| Practice nurse, new inhaler | As Mr Diaz is still unsure about his new inhaler, could you please check his technique at his first appointment and reinforce the advice he has been given? |
| Care home, falls risk | I would appreciate it if your staff could supervise her evening medication and help her to walk with her frame, as she remains at risk of falls. |
| Care home, follow-up arranged | He has an appointment at the fracture clinic on 18 November, and it would be helpful if a member of staff could accompany him. |
| Community nurse, escalation | Please contact her GP if her blood glucose readings stay above the targets in her care plan for more than two days, or if she becomes drowsy or confused. |
Common mistakes in the final paragraph
These patterns are common in practice letters, and each is easy to fix once you can see it.
Ending with thanks and nothing else
“Thank you for your continued care” is a courtesy, not a request. Without an action, the Purpose is not expanded.
“Please monitor him”
Monitor what, against which value? Name the measurement and the baseline: weight against 86.6 kg, the wound for redness.
Re-teaching the education session
Listing every leaflet uses words the reader does not need. Give the key points and how well they were understood.
Warning signs without an action
“Watch for breathlessness” leaves the reader guessing. Say what should happen and who should be contacted.
Note-form medication lists
“Furosemide 80 mg mane, bisoprolol 2.5 mg OD…” copies the notes. Report the change in full sentences and summarise the rest as unchanged.
Official sources
The test facts on this page were checked against these official OET pages on 2 November 2026.
Nursing discharge letter FAQ
Short answers to the questions nurses ask about the end of an OET discharge letter.
What should the last paragraph of an OET discharge letter include?
State what the reader should do and when, mention any follow-up that is already arranged, refer to the education the patient received if the reader needs to reinforce it, and say when the reader or patient should seek help. Then add a short courtesy sentence offering further information.
Should the request go at the start or the end of a discharge letter?
Both. OET's guidance on Purpose says the reason for writing should be immediately apparent and then expanded later in the letter. State the purpose and the main request in the opening paragraph, then give the detailed actions in the final paragraph.
Do I need to include warning signs in a nursing discharge letter?
Include warning signs when the case notes give them and the reader or patient needs to act on them. Say what the sign is and what should happen next, such as contacting the GP or the ward, rather than listing symptoms on their own.
How do I know whether the reader already knows the patient?
Read the task instructions carefully. OET points out that job titles such as community nurse or family doctor do not, on their own, mean the reader knows the patient. If there is no clear sign of an existing relationship, give brief relevant background.
Does the closing sentence count towards the 180 to 200 words?
No. OET says only the body paragraphs count, so the address, date, greeting, reference line, closing sentence and sign-off are not included. Assessors do not count your words, but the on-screen counter in computer and OET@Home tests counts everything you type.
OET Writing next step
Find out whether your request paragraph is clear
Write the practice case above under timed conditions, or one of our nursing sample tasks, and send it for a Writing Assessment. You will see how your selection, paragraph order and final request read to an assessor, and what to change next.