Hospital discharge navigation

Going home from the hospital can feel like the hardest part. You don't have to sort it out alone.

Discharge often comes quickly, with a lot of information at once. Guided by Nurse helps patients and families become better organized around discharge planning, so you can understand what you've been told, identify questions to raise, and feel more prepared for what comes next.

Common discharge worries

  • "Dad is being discharged tomorrow and we're not sure we're ready."
  • The instructions are long, and the family isn't sure what's most important.
  • Follow-up appointments, equipment, or services were mentioned but nothing is clearly arranged.
  • No one is sure which provider is responsible for which part of the plan.
  • The family lives in different places and needs to stay aligned.

How an RN advocate can help

Understand discharge instructions

Review what you've been given and identify what to ask the care team to explain.

Organize follow-up

Keep track of appointments and follow-up needs so nothing is missed.

Prepare your questions

Build a list of questions for the hospital team, rehabilitation, specialists, and primary care.

Clarify responsibilities

Understand who is responsible for which aspect of care across settings.

Plan the transition

Prepare for the move to home, rehabilitation, or skilled nursing.

Support the family

Help the family communicate and agree on next steps.

Guided by Nurse does not make discharge decisions, and does not replace the hospital team. Medication questions that require clinical decisions should be directed to the appropriate licensed treating provider or pharmacist.

Common questions

Questions families often ask

Can you help after a hospital discharge?

Yes. We can help you understand what you've been told, organize follow-up appointments and questions, and clarify who is responsible for what. Guided by Nurse does not make discharge decisions, and medication questions that need clinical decisions should go to the treating provider or pharmacist.

Does the nurse replace my doctor?

No. Your advocate works alongside your healthcare team, not in place of them. Your physicians, nurse practitioners, physician assistants, and pharmacists remain responsible for your medical care.

Can you diagnose medical conditions?

No. We do not diagnose medical conditions. We can help you understand the information your clinicians have given you and prepare questions to ask them.

Your Nurse. Your Advocate. Your Guide.

Preparing for a discharge?

Reach out as early as you can. A short conversation can help you feel more prepared.

Guided by Nurse is not an emergency medical service. If you believe you are experiencing a medical emergency, call 911 or seek appropriate emergency medical care.