Tom Breitigan; Edith Maravanyika; Jessie Schol; Joanne Stein; Eileen Fagan-Fittery.

A Transitional Care Nurse Navigator will help you plan for when it's time to leave the hospital

• The Transitional Care Nurse Navigator (TCNN) will discuss with you and your family what your care needs may be when it's time for you to be discharged.
• A TCNN will work with the multidisciplinary team to organize your care after discharge and schedule all your follow-up appointments.
• These nurses promote care coordination and make referrals to home-care agencies that can assist you after you arrive home.
• You will also get a call from your TCNN after your hospitalization to see how you are doing.