The task
Original independent practice. Assume that today's date is 4 November 2026. You have reviewed Ms Frohlich at home and obtained her consent for referral. Allow 5 minutes for reading and 40 minutes for writing.
You are a registered nurse in a community nursing service. Using the case notes, write a referral letter to Ms Nina Goulden, Continence Specialist Nurse, Community Continence Clinic, 36 Park Road, NSW 2000, Australia. Request assessment of Ms Frohlich's persistent urinary urgency and leakage, explaining the practical barriers to toileting and the status of her infection investigation. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
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Which case notes belong in this letter?
Multiple sclerosis with urgency: referral
You are a registered nurse in a community nursing service. Using the case notes, write a referral letter to Ms Nina Goulden, Continence Specialist Nurse, Community Continence Clinic, 36 Park Road, NSW 2000, Australia. Request assessment of Ms Frohlich's persistent urinary urgency and leakage, explaining the practical barriers to toileting and the status of her infection investigation. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Mark every line: Include keeps the specific detail; Compress keeps the relevant gist in fewer words; Omit leaves it out. Then compare your choices with our reviewed analysis. Some choices are optional.
Download practice checklist (PDF)
One-page worksheet. Answers and reasons are on the linked webpage, so you can practise before checking.
Case notes
Patient details
- Name: Ms Doris Frohlich
- DOB: 09/02/1980 (46 yrs)
- Address: 12 Garden Street, NSW 2000
- Community nursing reviews: 14/10/26 and 04/11/26
Social background
- Lives with partner; independent decisions and personal care
- Works from home; travel increasingly tiring
- Collects antique postcards
- Complained that previous receptionist sounded unfriendly
Medical history
- Multiple sclerosis diagnosed 2018; ongoing specialist follow-up; usual fatigue and walking difficulties
- Remote wrist fracture; healed without limitation
14 October 2026: home visit
- Reports urgency for 6/52; leaks before reaching toilet
- No reported leakage with cough/sneeze
- Fatigue worse late afternoon; walks slowly with frame; no recent falls
- Narrow bathroom doorway excludes frame; difficult clothing fastenings delay toileting
- Stopped exercise group because worried about accidents
- Patient wonders whether symptoms mean a urine infection
- No dysuria, fever, flank pain or visible haematuria reported
- Agreed bladder diary and trial of easier clothing
4 November 2026: review
- Urgency/leakage persist despite slightly quicker clothing removal
- Urine culture collected today: pending; infection unconfirmed, no antibiotics prescribed; GP owns result review and direct patient contact
- Completed diary: 9–11 daytime voids, 2 overnight; leaks approaching toilet
- No bladder scan/emptying assessment yet; no previous continence-clinic assessment
- Reports bowels regular; no recent constipation
- No new limb weakness or change from usual mobility
- Absorbent pads used when leaving home; unsure which product suits
Plan
- Refer continence nurse: assess urgency/leakage and bladder emptying; advise products; liaise with occupational therapy re toilet access
- Diary accompanies referral; patient consents to sharing findings
- Requests initial telephone contact because clinic travel difficult; partner unavailable during working hours
- GP remains responsible for reviewing any new symptoms while referral pending
- Partner can assist with transport if clinic assessment required
Who is reading, and what do they need?
Ms Goulden needs the symptom pattern, functional obstacles, investigation status and requested specialist input. Ms Frohlich makes her own decisions and manages personal care, but late-afternoon fatigue, slow walking with a frame and difficult travel affect access. Her stopped exercise group and uncertainty about pads provide useful impact and product context; her partner can help with transport if assessment requires attendance.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Urgency for six weeks at 14/10; leakage before reaching the toilet. | This establishes the presenting symptom pattern and correctly anchors its reported duration to the first visit. |
| Multiple sclerosis since 2018; usual fatigue and walking difficulties. | This provides relevant neurological and functional context without asserting that multiple sclerosis has caused a particular bladder disorder. |
| Bathroom doorway excludes frame; difficult clothing fastenings delay toileting. | These concrete obstacles explain the requested occupational-therapy liaison and prevent the referral from treating leakage as purely physiological. |
| Urgency/leakage persist despite slightly quicker clothing removal; diary: 9–11 daytime voids, two overnight. | Persistence despite a practical adjustment and the recorded voiding pattern support specialist assessment rather than repeating advice already tried. |
| Today's culture pending; infection unconfirmed, no antibiotics; GP reviews result and contacts patient directly. | This separates a pending investigation from a diagnosis and makes result ownership clear to the specialist. |
| Assess urgency/leakage and bladder emptying; advise products; liaise with occupational therapy about toilet access. | All requested components define the specialist's remit and connect assessment with practical continence support. |
| No bladder scan, emptying assessment or previous continence-clinic assessment. | This identifies an assessment gap without implying that retention or incomplete emptying has already been found. |
| Diary accompanies consented referral; initial telephone contact requested because clinic travel is difficult. | This identifies available assessment material and a practical first-contact arrangement that supports access. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Collects antique postcards. | The hobby does not explain the continence problem or affect the requested assessment. |
| Previous receptionist sounded unfriendly. | This complaint does not establish an assessment barrier or a requested change in care. |
| Remote wrist fracture, healed without limitation. | The resolved injury does not explain the current clothing or toilet-access difficulties. |
| No reported leakage with coughing or sneezing at the 14 October visit. | This dated history can briefly refine the symptom pattern, but the urgency-associated leakage already explains the referral purpose. |
| Regular bowels; no recent constipation. | This is useful optional assessment background, rather than a compulsory detail for understanding the requested continence care. |
A paragraph plan for this case
Open with patient identification, consent and the requested continence assessment, anchoring symptom duration to the 14 October visit. Develop the persistent leakage, diary findings, multiple sclerosis context, bathroom and clothing barriers, and absent emptying assessment, selecting functional impact details only where useful. Close with the pending culture and GP responsibilities, the complete specialist request, accompanying diary and telephone-first access preference.
Where candidates slip on this task
- The six-week duration was reported on 14 October, not 4 November; retain that date anchor rather than presenting six weeks as the current duration or inventing an exact onset.
- When selecting or compressing the reported absence of cough/sneeze leakage, dysuria, fever, flank pain or visible haematuria, retain the 14 October date. These findings were not reconfirmed on 4 November and do not exclude infection. Neither does the reported absence of new weakness or mobility change.
- Her concern about infection is a question to investigate, not a diagnosis; retain GP ownership of the pending culture and any new symptoms while referral is awaited.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Nursing letter tasks
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- Referral to hospital-in-the-home for intravenous antibiotics referral letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Does the pending culture justify describing a urinary tract infection?
No. Keep infection explicitly unconfirmed and distinguish collection of the culture from receipt of a result. The notes record no antibiotics prescribed and assign result review and direct patient contact to the GP. Do not transfer that responsibility to the continence nurse.
Which functional details most directly support the referral?
Prioritise the doorway that excludes the frame and clothing fastenings that delay toileting, because these directly support occupational-therapy liaison. Fatigue, slow walking, activity restriction and pad uncertainty can add useful context. They should not be presented as proof of a specific bladder diagnosis.
Sources
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