Educating patients at discharge: Perceived responsibilities among nurses and residents at an academic medical center

Safe discharge requires clear coordination across multiple interprofessional team members. Discharge education roles are often unclear; our study sought to identify the primary person responsible for patient discharge education and compare the perceptions of nurses and residents regarding the patient discharge education process.

We conducted a cross-sectional survey of internal medicine residents and staff nurses at an urban academic medical center. We asked: (1) who was primarily responsible, and (2) who was best suited for patient education (nurse, intern, resident, or attending). We compared residents' and nurses' perceived responsibility across 9 elements of discharge education, and whether each element was primarily a nursing, physician, or shared responsibility. We compared perceptions using summary statistics and chi-square tests.

Respondents included 82 residents and 108 nurses. Among residents, 32% were unsure who was primarily responsible for discharge education while 44% felt the senior "resident" was best suited. Across discharge education elements, most respondents felt tasks were "shared", but this was not universal. Compared to residents, more nurses felt responsibilities were "shared." This was significantly different for: pointing out signs that may prompt care (75% nurses vs 54% residents said "shared," χ²(2) = 38.0, p < .001, V= 0.45), symptom management (75% vs 49%, χ²(2) = 40.1, p < .001, V= 0.46), and explaining the reason for appointments (53% vs 35%, χ²(2) = 15.8, p < .001, V= 0.29).

The distribution of discharge education responsibilities is ambiguous across disciplines. Many nurses and residents believe discharge education is a shared responsibility, but specific roles and responsibilities lacked consensus. More nurses than residents perceived responsibilities as shared.

Care teams need better consensus on who should lead patient discharge education efforts. Defining interprofessional responsibilities is essential to a safer patient experience. Institutions should establish clear expectations and ensure providers are aligned on a shared mental model for optimal discharge education.