Objective: To clarify practice by reviewing case reports on transitional care from certified nurse specialists, certified nurses, and Nurses Pertaining to Specified Medical Acts in hospitals. Methods: Case reports were investigated using keywords with the database of Ichushi web from 2012 onwards. Thirty-three cases were selected based on 24 references on transitional care by hospital-based nurses. Results: The present findings indicated nine topics: nurses’ specialty areas, patient information, the timing of involvement, practice in hospitalization, collaborating professions, the content of collaboration, assessment of the need for continued intervention after discharge, the content of continued support, and outcomes. According to the nurses’ specialties, wound, ostomy, and incontinence nurse （WOCN) was the most frequently reported based on 18 of the cases. The diseases of the target patients were characterized as multimorbidity, rare diseases, and intractable diseases. All cases indicated collaborations with other professionals; however, three cases described collaborations with other specialized nurses. Furthermore, none of the cases described the criteria for screening by nurses. Outcomes were organized into seven categories: improvement of physical and mental symptoms, transition to and continuation of home care setting, etc. Conclusion: Specialty nurses practiced home visits and outpatient follow-ups based on a complex assessment of the need for care using their expertise. More practice cases should be accumulated and shared for establishing screening systems and methods for evaluating outcomes based on interventions.