Evaluation of the role development and implementation of advanced practice nurses in an Austrian university hospital: a mixed methods research protocol.

Abstract

Advanced practice nurses play a vital role in addressing the growing complexity of healthcare. Although well-established internationally, advanced practice nursing in Austria remains in its early stages. The University Hospital Salzburg introduced its first advanced practice nurses in 2017, and in 2020 launched a comprehensive initiative to develop and implement advanced practice nursing roles across multiple specialties. This initiative included role development based on international frameworks, the creation of an advanced practice nurse network, scientific mentoring and an adapted skill and grade mix. This study aims to evaluate the development and implementation of advanced practice nursing roles at the University Hospital Salzburg across multiple disciplines and at the system level. It will analyse their impact on clinical, professional and organisational outcomes, integrating the perspectives of various healthcare professionals as well as the advanced practice nurses. This mixed methods study will follow an explanatory sequential design. Advanced practice nurses, registered nurses, nurse assistants, nurse managers and physicians will be invited to participate. The quantitative phase will employ validated instruments and research team-developed questionnaires. Quantitative results will inform the development of the interview guide and sampling strategy for the qualitative phase. In the qualitative phase, expert interviews and focus groups will be conducted, with data analysed thematically. Quantitative and qualitative findings will be integrated using a joint display across clinical, professional and organisational levels. The study will be conducted from June 2025 to November 2027 at an Austrian university hospital. According to the Ethics Committee of Salzburg, formal ethical approval was not required. Study findings will be disseminated through publications in peer-reviewed journals, presentations at scientific conferences and internal events for participants. July 2026. DRKS00036497.