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Background: Although referring patients to community services is important for optimum continuity of care, referrals between hospital and community sectors are often problematic. Nurses are well positioned to inform patients about referral resources. The objective of this study is to describe the impact of implementing six nursing best practice guidelines (BPGs) on nurses' familiarity with patient referral resources and referral practices. Methods: A prospective before and after design was used. For each BPG topic, referral resources were identified. Information about these resources was presented at education sessions for nurses. Preand post-questionnaires were completed by a random sample of 257 nurses at 7 hospitals, 2 home visiting nursing services and 1 public health unit. Average response rates for preand postimplementation questionnaires were 71% and 54.2%, respectively. Chart audits were completed for three BPGs (n = 421 preand 332 post-implementation). Post-hospital discharge patient interviews were conducted for four BPGs (n = 152 preand 124 post-implementation). Results: There were statistically significant increases in nurses' familiarity with resources for all BPGs, and self-reported referrals to specific services for three guidelines. Higher rates of referrals were observed for services that were part of the organization where the nurses worked. There was almost a complete lack of referrals to Internet sources. No significant differences between preand post-implementation referrals rates were observed in the chart documentation or in patients' reports of referrals. Conclusion: Implementing nursing BPGs, which included recommendations on patient referrals produced mixed results. Nurses' familiarity with referral resources does not necessarily change their referral practices. Nurses can play a vital role in initiating and supporting appropriate patient referrals. BPGs should include specific recommendations on effective referral processes and this information should be tailored to the community setting where implementation is taking place. Published: 28 June 2007 BMC Nursing 2007, 6:4 doi:10.1186/1472-6955-6-4 Received: 15 December 2006 Accepted: 28 June 2007 This article is available from: http://www.biomedcentral.com/1472-6955/6/4 © 2007 Edwards et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.