As part of a junior fellowship post in my trust I am conducting a project that seeks to find out what nurse-led discharge really means, but so far it has raised more questions than answers.
Even within our trust the term “nurse-led discharge” means different things to ddifferent people and I suspect there is considerable variation across the country.
The terminology itself appears to be ambiguous. When we talk about nurse-led discharge, are we saying that nurses are driving decisions or are they facilitating those made by doctors?
I have witnessed some good examples and within the area I work discharges are regularly nurse-led. Patients coming in for daycase procedures have a clear and concise plan written up by the team after treatment and 99% of the time this is successful. It is only when there is no firm plan in place or there have been unforeseeable complications that the patient is not discharged at the agreed time or date.
That said, nurse-led discharge is not without its challenges and questions.
Firstly, are nurses encouraged to make autonomous decisions or do doctors hand that responsibility over? Are nurses supported when carrying out nurse-led discharge and have their training needs been identified? Is there clear guidance to back the nurse’s decision making and autonomy? And, lastly, what are the benefits to carrying out nurse-led discharge?
In my experience so far the first two questions remain unanswered. On some wards nurse-led discharge (and I use the term loosely) is successful and in fact without the proactive teams involved in discharging patients from some areas patient flow would suffer.
Why are these areas successful? The key is these wards have clear guidance in place and work as a team to ensure the patient is seen in a timely manner and the nurse is fully supported to carry out the discharge.
On other wards, nurse-led discharge rarely happens and this is down to staff feeling apprehensive about discharging patients, medical staff not having a clear criteria to support discharging patients and a lack of documented support and guidance.
I believe that there could be a great many benefits if nurses were encouraged and supported to lead discharge. I feel that it would empower staff, improve patient flow, reduce the pressure placed on junior doctors and, more importantly, encourage teamwork.
This can only be done through learership within the trust and the fellowship roles have given us the opportunity to identify the gaps in patient care and hopefully work collectively to bridge those gaps in the future.