General Medicine · Medical Literature
Evaluation of the role development and implementation of advanced practice nurses in an Austrian university hospital: a mixed methods research protocol
Abstract
Introduction 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. Methods and analysis 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. Ethics and dissemination 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
Clinical relevance
Advanced practice nursing (APN) roles are increasingly recognized as essential to managing healthcare complexity, yet implementation in Austria remains nascent compared to international standards, creating a significant evidence gap in the German-speaking European context. The University Hospital Salzburg's structured 2020 APN initiative—spanning multiple specialties with formal role development, network creation, and skill-mix adaptation—represents a unique natural experiment in APN integration at the system level. Clinicians and healthcare administrators should attend to this study as its findings will directly inform workforce planning, interprofessional collaboration models, and APN role justification in health systems where APN is still emerging.
Key findings
1. This is a prospective mixed methods research protocol, not a completed outcomes study; no primary efficacy or safety data, effect sizes, confidence intervals, p-values, or NNT/NNH are yet available from this publication. 2. The University Hospital Salzburg introduced its first APNs in 2017 and launched a formal, multi-specialty APN implementation initiative in 2020, providing a defined cohort and temporal framework for longitudinal evaluation. 3. The study employs an explanatory sequential mixed methods design, integrating validated quantitative instruments with qualitative expert interviews and focus groups, targeting outcomes across clinical, professional, and organisational domains. 4. Participants will include APNs, registered nurses, nurse assistants, nurse managers, and physicians, enabling a comprehensive multi-stakeholder perspective on APN role impact. 5. Quantitative results will prospectively inform qualitative interview guide development and sampling strategy, with integration via joint display methodology—a methodologically rigorous approach to mixed methods triangulation. 6. The study timeline spans June 2025 to November 2027; findings are not yet available, and all outcome data must be considered pending until study completion and peer-reviewed dissemination.
Practice implications
Clinicians and nurse leaders in health systems where APN roles are emerging should monitor this study's forthcoming findings, as it will provide one of the first structured, multi-disciplinary evaluations of APN implementation in a Central European university hospital setting, with direct relevance to role design and interprofessional integration. The protocol's framework—anchoring APN development in international frameworks, formal networks, and scientific mentoring—may serve as a replicable model for institutions planning APN expansion prior to availability of final outcome data. At this stage, no changes to clinical practice or APN deployment strategies can be evidence-based from this publication alone; it should be revisited upon completion of the full study in late 2027.