Complex Discharge Nurse

Liverpool University Hospitals NHS Foundation Trust; United States; À distance; USD 37 000 - 48 000; Plein temps

Résumé du poste

Liverpool University Hospitals NHS Foundation Trust is seeking a proactive Registered Nurse to join the Complex Discharge Team. You will coordinate discharge planning, collaborate with ward teams, community partners and local authorities to ensure timely, person-centred discharges for patients with complex needs.

The role focuses on identifying discharge barriers, supporting Home First and Discharge to Assess, and using digital patient flow systems to monitor journeys and drive improvements in

Qualifications

• Registered Nurse with current NMC registration and practice
• Experience in discharge planning or care coordination is desirable
• Strong communication and multi-disciplinary collaboration skills

Responsabilités

• Coordinate safe, timely discharge planning from admission through discharge.
• Identify and resolve barriers to discharge and reduce delays.
• Act as a key contact for patients, families and external agencies.
• Support MDT meetings and discharge planning reviews to progress actions.

Connaissances

NMC Registration

Discharge planning

Case management

Communication

Teamwork

Patient advocacy

Formation

Registered Nurse (NMC)

Description du poste

Liverpool University Hospitals NHS Foundation Trust has an exciting opportunity for an enthusiastic and motivated Registered Nurse to join our dynamic Complex Discharge Team. This role offers the opportunity to develop specialist knowledge and experience in discharge planning, patient flow and case management whilst working within a supportive multidisciplinary environment. The successful candidate will work closely from ward teams, community partners, local authorities and care providers to coordinate safe, timely and person-centred discharges for patients with complex health and social care needs. The Complex Discharge Nurse plays a key role in identifying and resolving barriers to discharge, supporting the implementation of Home First and Discharge to Assess principles, and ensuring patients receive the right care in the right place at the right time. Using digital patient flow and clinical utilisation systems, the post holder will monitor patient journeys, coordinate discharge actions and support ward teams to deliver high-quality discharge planning. This is a rewarding opportunity to enhance clinical, leadership and communication skills whilst contributing to improved patient outcomes, patient experience and effective hospital flow. Responsible for coordinating safe, timely and effective discharge planning from admission, ensuring needs are identified early and plans progressed throughout the patient journey.

• Provide proactive case management for patients with complex discharge needs, overseeing assessments, referrals, actions and timescales.
• Identify and elevate discharge barriers early to reduce avoidable delays and length of stay.
• Act as a key contact for patients, families, ward teams and external agencies.
• Work with the MDT, Transfer of Care Hub, community services, Local Authorities and care providers to coordinate safe discharge.
• Support daily board rounds and MDT reviews, progressing EDDs, discharge plans and outstanding actions.
• Provide specialist advice on complex discharge processes and pathways, including Discharge to Assess, CHC Fast Track, end-of-life care and placements.
• Review medically optimised patients and elevate barriers to discharge.
• Promote Home First and least restrictive discharge principles.
• Maintain accurate discharge documentation and contribute to service improvement and patient flow.
• Coordinate and manage the discharge planning process for patients with complex health, social care and continuing care needs from admission through to discharge.
• Ensure all patients have a documented discharge plan, Expected Date of Discharge (EDD) and identified actions to support timely discharge.
• Undertake comprehensive assessments and coordinate discharge pathways for patients requiring complex packages of care, rehabilitation, nursing home placement, Continuing Healthcare Fast Track, end-of-life care services and other specialist discharge pathways.
• Identify, monitor and proactively manage barriers to discharge, escalating delays appropriately to maintain patient flow and minimise unnecessary hospital stays.
• Ensure discharge plans reflect patient wishes, strengths, individual needs, safeguarding requirements and the least restrictive care option available.
• Support the implementation of national discharge guidance, Home First principles and Discharge to Assess pathways.
• Act as the named discharge coordinator for patients with complex discharge needs, providing a consistent point of contact throughout their hospital stay.
• Involve patients, relatives and carers in discharge planning and decision-making, ensuring they receive clear and timely information regarding discharge arrangements and available support services.
• Facilitate discussions relating to discharge planning, future care needs and care options, maintaining a patient-centred approach at all times.
• Support patients and families to understand discharge processes and set realistic expectations regarding discharge planning and community support.
• Work in close partnership with medical teams, therapists, social workers, mental health practitioners, community providers and local authority colleagues to facilitate seamless discharge planning.
• Lead and contribute to multidisciplinary team meetings, board rounds and discharge planning discussions to progress patient discharges and resolve delays.
• Develop and maintain effective working relationships with internal and external stakeholders to support integrated discharge pathways and improve patient outcomes.
• Liaise with community health services, social care teams, care providers and voluntary sector organisations to ensure continuity of care following discharge.
• Coordinate referrals to community health services, social care, intermediate care, care home placements and other support services to ensure appropriate arrangements are in place prior to discharge.
• Facilitate Continuing Healthcare, Fast Track, nursing home, residential care and other complex discharge assessments in line with local and national guidance.
• Ensure equipment, transport, medication, funding approvals and support services are arranged and confirmed prior to discharge where required.
• Monitor and track patient progress through discharge pathways, ensuring actions are completed within agreed timescales.
• Escalate delays and operational challenges affecting patient flow through the appropriate management and governance structures.
• Provide specialist advice, guidance and support to ward staff regarding discharge planning processes, policy requirements and complex discharge pathways.
• Promote best practice and support staff in developing knowledge and skills relating to discharge planning and patient flow management.
• Act as a role model for person-centred discharge planning and integrated working across organisational boundaries.
• Participate in audits, quality improvement initiatives and service development projects aimed at improving discharge processes, reducing delays and enhancing patient outcomes.
• Contribute to the collection, analysis and reporting of discharge performance data and key performance indicators.
• Maintain accurate, timely and comprehensive patient records using electronic patient record systems and discharge planning tools.
• Ensure all assessments, referrals, discharge plans and communications are documented in accordance with professional, legal and organisational standards.
• Produce high-quality reports, assessments and transfer of care documentation to support safe and effective transitions between services.
• Maintain confidentiality and comply with all Information Governance, Data Protection and Caldicott requirements.
• Practice in accordance with the NMC Code and Trust policies and procedures.
• Maintain professional registration and undertake continuing professional development to ensure knowledge and skills remain current.
• Work autonomously whilst recognising limits and seeking support when appropriate.
• Manage competing priorities effectively within a fast-paced acute hospital environment.
• Uphold the Trust's values and behaviours and contribute positively to team working and service delivery.
• Ability to work as a team and autonomously
• Ability to prioritise workload
• To have highly developed interpersonal skills
• To be able to communicate in an effective and persuasive manner at all times even under pressure
• Presentational skills
• To be able to challenge current practice whilst maintaining relationships
• Ability to record information verbal and written accurately, Knowledge of iPM
• Managing and interpreting data
• To develop reports, protocols and policies
• Ability to manage competing and at times conflicting demands
• High level of organisational skills, Demonstrable relevant NHS experience linked to how patients flow through the organisation
• Clinically relevant experience in the assigned specialities
• Proven success in challenging Consultants, Nurses, AHPs
• To have a flexible approach to work ensuring minimum levels of service provision are maintained, Essential criteria
• RGN
• ECDL, Understanding of national and local key performance indicators
• Ability to use the Microsoft office software package
• Understanding of patient flow at Divisional and Trust level
• To manage complex and conflicting information, You must have appropriate UK professional registration.
• Liverpool University Hospitals NHS Foundation Trust comprises Aintree University Hospital, Broadgreen Hospital & Royal Liverpool University Hospital.

The Trust is committed to promoting a healthy work‑life balance and achieve fair, equitable and consistent practice. We welcome flexible working requests and will consider a variety of flexible working arrangements from day one of your employment. Not all roles are suitable for every flexible working opportunity all of the time. Flexible working options may include reduced hours, compressed hours, fixed shifts, time back in lieu and home working. The Trust is committed to promoting equality and diversity; we value the contribution of individual talent, skills, knowledge and experience and aim for a workforce demography representative of the local community. We encourage applicants from the following groups that are currently under‑represented in our workforce black, Asian and minority ethnic, lesbian, gay, bisexual and Transgender (LGBTQ+), disabled, male and age 16-24. Trust policy requires that the cost of submitting & processing the successful applicant/s DBS application be recovered via salary deduction following start in post. The amount of £25.70 (standard disclosure) or £46.70 (enhanced disclosure) will be deducted from salary, in manageable monthly instalments for up to 3 months following commencement of employment. Bank posts require upfront payment. From April 2017, Skilled visa applicants and their adult dependant(s) will be required to provide a criminal record certificate from each country they have lived in consecutively for 12 months or more in the past ten years. Applicants requiring sponsorship may wish to determine the likelihood of obtaining sponsorship for this position by assessing themselves against the criteria on the gov.uk website - https://www.gov.uk/check-uk-visa. This organisation has a zero‑tolerance approach to the abuse of children, young people and vulnerable adults. All staff must ensure they adhere to the organisations safeguarding children and adults' policy and comply with the Local Safeguarding Children and Adult Board procedures. Staff should be mindful of their responsibility to safeguard children and adults in any activity performed on behalf of the organisation in line with the requirements of statutory guidance and legislation. All employees (and volunteers)are expected maintain their safeguarding knowledge and skills by completing mandatory safeguarding training which includes understanding and recognising the signs of abuse and neglect and taking appropriate action. As an organisation, we have adopted the Merseyside Domestic abuse workplace scheme which supports our staff who are experiencing Domestic Abuse /any forms of sexual violence.

Liverpool University Hospitals NHS Foundation Trust comprises Aintree University Hospital, Broadgreen Hospital & Royal Liverpool University Hospital. We are part of NHS University Hospitals of Liverpool Group, formed on 1 Nov 2024 from the coming together of LUHFT and Liverpool Women's NHS Foundation Trust. The Group was born from a shared aim to improve the care we provide our patients. UHLG is one of the largest employers in the region, with over 16,800 colleagues dedicated to caring for our communities - from birth and beyond. For the 630,000 people across Merseyside, we are their local NHS. We provide general and emergency hospital care, alongside highly specialised regional services for more than two million people in the North West. Aintree University Hospital is the single receiving site for adult major trauma patients in Cheshire and Merseyside and hosts a number of regional services including an award‑winning stroke facility. Broadgreen Hospital is home to elective surgical, diagnostic and treatment services, together with specialist patient rehabilitation. Liverpool Women's Hospital specialises in the health of women and babies, delivering over 7,200 babies in the UK's largest single site maternity hospital each year. The Royal Liverpool University Hospital is the largest hospital in the country to provide inpatients with 100% single bedrooms and focuses on complex planned care and specialist services.

Note: Under current Home Office Immigration Rules we are currently unable to offer right to work visa sponsorship for Band 2 and 3 roles with a salary of less than £25,000 pa as they do not meet the UK Visas & Immigration criteria.