Anticipatory nursing work and the co-construction of discharge readiness in coronary care units: A cross-national qualitative study

Abstract Background: Hospital discharge from coronary care units (CCUs) is commonly framed as a discrete clinical or administrative endpoint. This event-based conceptualisation obscures the ongoing nursing and interprofessional work undertaken across the admission to stabilise discharge readiness. Aim: To theorise discharge readiness in CCUs as anticipatory nursing and interprofessional work and to examine how professional roles, organisational systems and service contexts shape discharge across two national context. Design: Qualitative study utilising reflexive thematic analysis. Methods: Semi-structured interviews and focus groups were conducted with 37 clinicians (nurses, allied health professionals and medical staff) working in CCUs in Australia and the United Kingdom. Reflexive Thematic Analysis was undertaken inductively within each dataset, followed by higher-level interpretive integration. Results: Four interrelated themes conceptualised discharge readiness as: (1) anticipatory nursing work initiated at admission and sustained through ongoing assessment, coordination and documentation; (2) negotiated readiness achieved through interprofessional alignment and distributed expertise; (3) discharge documentation as a site of organisational tension shaping workflow and communication; and (4) discharge flow constrained by system-level pressures, downstream service availability and policy logics. Across both national contexts, nurses were positioned as custodians of discharge readiness through continuous monitoring, relational coordination and informal risk management, although enactment varied by organisational setting. Conclusion: This study contributes to nursing scholarship by positioning discharge readiness not as a single decision point, but as an emergent outcome of anticipatory nursing labour, interprofessional negotiation and organisational systems. By making visible the distributed and often hidden work underpinning discharge, the findings extend existing models of transitional care and provide a theoretically grounded foundation for strengthening discharge practice in coronary care nursing.