Transfer of Care Nurse

Job summary

We have an exciting opportunity within the transfer of care hub for a band 5 discharge nurse. The successful candidate will work alongside a team of nurses and support the Band 6 & 7 nurses to manage complex patient discharges. The successful candidate will carry out patient assessment to facilitate safe discharges for all those patients who are community ready to leave hospital.

The successful post holders duties will involve attending wards daily to facilitate and support patients discharges through multi- disciplinary working. The successful candidate will work closely with all members of the wider multi-disciplinary team to ensure a home first approach is followed from the moment the patient is admitted to hospital.

If you are enthusiastic with a passion for improving patient outcomes within our home first approach, come and join our team.

Main duties of the job

The successful candidate will spend most of the working day based on their allocated ward areas, attending board rounds, supporting ward teams and other professionals with the discharge processes. Attending ward areas to speak with patient and relatives about their discharge plans with a home first approach.

To accept and action appropriate discharge to assess referrals allocated by the TOCH coordinator and ensure all necessary evidence is available to support the request for the referral to be progressed.

To enable patients to leave hospital in a timely manner once identified as being community ready and no longer have the right to reside. To minimise delayed discharges, improve patient flow and reduce the possibility of clinical deconditioning.

To work collaboratively, as part of the trust wide transfer of care hub, with ward based multi-disciplinary teams and community health and social care partners to agree discharge plans that reflect the ongoing care needs of patients and respect their wishes.

The service hours are 08.00-20.00 7 days per week.

About us

Please add your telephone number to your application form so we can contact you quickly if required.

One Team One Trust - There are many reasons to work at our Trust. From our commitment to putting people first to our accessible services and award winning teams. We have a passion for research, innovation and tackling inequalities. We are committed to respect, fairness and civility and promote a compassionate, caring and positive culture / working environment.

We welcome all applications irrespective of peoples race, disability, gender, sexual orientation, religion/belief, age, gender identity, marriage and civil partnership, pregnancy/maternity and in particular those from under- represented groups. Looking after our workforces health and wellbeing is a priority for us. We also provide access to high quality education, training, career progression and support. Flexible working is supported via our Flexible Working Policy.

The Trust employs around 8,746 people and provides a range of hospital services to a local community of around 430,000 residents. We also provide a range of more specialised services outside this area. We offer our staff outstanding benefits - Fitness Centre (SRH), libraries at both hospital sites, chaplaincy support and access to a Care Co-ordinator to help staff with childcare arrangements.If you use AI, and it poses a risk to the integrity of your individual recruitment process, we may withdraw your application at any stage of the process.

Details

• Date posted: 02 June 2026
• Pay scheme: Agenda for change
• Band: Band 5
• Salary: £32,073 to £39,043 a year
• Contract: Permanent
• Working pattern: Full-time
• Reference number: C9155-CMNM-0626-04
• Job locations: Sunderland Royal Hospital, Kayll Road, SUNDERLAND, SR4 7TP, United Kingdom

Job responsibilities

PLEASE REFER TO THE ATTACHED JOB DESCRIPTION FOR FULL DUTIES OF THE ROLE.

• Working as part of the Discharge planning team to ensure discharge plans start from when the patient is admitted to hospital.
• To work within the Transfer of care hub (TOCH ) under the supervise of the B6 Senior Nurse using the Discharge 2 Assess / Home First Model as soon as it is clinical safe to do so.
• This will involve daily visits to adult wards, offering advice and support to patients, families and carers.
• Supporting ward teams to facilitate safe and timely discharge from hospital.
• Will be responsible for a patient case load under the supervision of the Band 6 Discharge Nurse.
• Will attend Board Round and Ward Rounds. Speaking to patients, relatives, carers NOK and to all members of the MDT to ensure the patients/relatives are fully consulted through-out their hospital stay.
• Will inform patients and families that it is their responsibility to ensure the home is suitable for the patient to return to eg heating and food is available. The patients also have out door clothes to return home.
• Will discuss with the patient NOK that the expectation is that patients will be discharged home from the Discharge Lounge with their own transport. Only patients who are eligible for NHS free transport will be provided.
• To be responsible and accountable for the delivery of safe, effective and compassionate nursing care for patients designated to their care.
• To always work to the NMC Code.
• To supervise non-registered staff as stipulated by the NMC under the requirements of delegation.
• Provide effective leadership and assist with the management and organisation of the ward/department in the absence of the B6/B7
• To comply with the trusts vision, values and behavioural compact.