{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:03:07Z","timestamp":1785499387641,"version":"3.56.0"},"reference-count":42,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,20]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Estimated start of the qualitative phase<\/jats:title>\n                    <jats:p>July 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>DRKS00036497.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119182","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:40:22Z","timestamp":1785498022000},"page":"e119182","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the role development and implementation of advanced practice nurses in an Austrian university hospital: a mixed methods research protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3602-6133","authenticated-orcid":false,"given":"Kathrin Julia","family":"Pann","sequence":"first","affiliation":[{"name":"Nursing Management, Coordination of Clinical Nursing Science and Research, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"},{"name":"Doctoral Program Nursing and Allied Health Sciences, Department of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7920-1718","authenticated-orcid":false,"given":"Simone Elisabeth","family":"Gruber","sequence":"additional","affiliation":[{"name":"Nursing Management, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8977-9767","authenticated-orcid":false,"given":"Roland","family":"E\u00dfl-Maurer","sequence":"additional","affiliation":[{"name":"Nursing Management, Coordination Development Clinical Nursing Practice, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9185-707X","authenticated-orcid":false,"given":"Franziska","family":"Moser","sequence":"additional","affiliation":[{"name":"Nursing Management, Director of Nursing, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1004-7617","authenticated-orcid":false,"given":"Andre","family":"Ewers","sequence":"additional","affiliation":[{"name":"Nursing Management, Coordination of Clinical Nursing Science and Research, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"2026073104400881000_16.7.e119182.1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.zefq.2016.11.002","article-title":"State of development of the role of academic nursing staff at German university hospitals in 2015","volume":"120","author":"Tannen","year":"2017","journal-title":"Z Evid Fortbild Qual Gesundhwes"},{"key":"2026073104400881000_16.7.e119182.2","unstructured":"International Council of Nurses . Guidelines on advanced nursing practice. 2020. Available: https:\/\/www.icn.ch\/system\/files\/documents\/2020-04\/ICN_APN%20Report_EN_WEB.pdf [Accessed 15 Apr 2025]."},{"key":"2026073104400881000_16.7.e119182.3","doi-asserted-by":"publisher","DOI":"10.1111\/jnu.12199"},{"key":"2026073104400881000_16.7.e119182.4","article-title":"Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study","volume":"88","author":"Wheeler","year":"2022","journal-title":"Ann Glob Health"},{"key":"2026073104400881000_16.7.e119182.5","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/jan.15775","article-title":"Advanced practice nursing in Europe-Results from a pan-European survey of 35 countries","volume":"80","author":"De Raeve","year":"2024","journal-title":"J Adv Nurs"},{"key":"2026073104400881000_16.7.e119182.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2011.10.022"},{"key":"2026073104400881000_16.7.e119182.7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.zefq.2020.06.012","article-title":"Advanced Nursing Practice in Austria under consideration of outcome measurement","volume":"155","author":"Glarcher","year":"2020","journal-title":"Z Evid Fortbild Qual Gesundhwes"},{"key":"2026073104400881000_16.7.e119182.8","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1111\/jan.15074","article-title":"Advanced practice role delineation within Finland: A comparative descriptive study","volume":"78","author":"Jokiniemi","year":"2022","journal-title":"J Adv Nurs"},{"key":"2026073104400881000_16.7.e119182.9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1024\/1012-5302\/a000980","article-title":"Mapping advanced practice nurses\u2019 scope of practice, satisfaction, and drivers of role performance","volume":"38","author":"Beckmann","year":"2025","journal-title":"Pflege"},{"key":"2026073104400881000_16.7.e119182.10","doi-asserted-by":"crossref","first-page":"4791","DOI":"10.1111\/jan.15752","article-title":"Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey","volume":"79","author":"Beckmann","year":"2023","journal-title":"J Adv Nurs"},{"key":"2026073104400881000_16.7.e119182.11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1024\/1012-5302\/a000912","article-title":"Role understanding of expert nurses in primary and acute care in Germany: A descriptive cross-sectional study","volume":"36","author":"Seismann-Petersen","year":"2023","journal-title":"Pflege"},{"key":"2026073104400881000_16.7.e119182.12","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1111\/jan.15840","article-title":"Evaluation of the implementation of advanced practice nursing roles in France: A multiple case study","volume":"80","author":"Schwingrouber","year":"2024","journal-title":"J Adv Nurs"},{"key":"2026073104400881000_16.7.e119182.13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1024\/1012-5302\/a000924","article-title":"Implementation of a nurse practitioner role in inpatient surgery: A mixed-methods study in a pre-post design","volume":"36","author":"Dach","year":"2023","journal-title":"Pflege"},{"key":"2026073104400881000_16.7.e119182.14","doi-asserted-by":"crossref","unstructured":"D\u00f6ring N . Forschungsmethoden und Evaluation in den Sozial- und Humanwissenschaften. 6th edn. Berlin, Germany: Springer, 2023.","DOI":"10.1007\/978-3-662-64762-2"},{"key":"2026073104400881000_16.7.e119182.15","unstructured":"Creswell JW , Plano Clark VL . Designing and conducting mixed methods research. Sage publications, 2017."},{"key":"2026073104400881000_16.7.e119182.16","doi-asserted-by":"crossref","first-page":"2754","DOI":"10.1111\/jan.15536","article-title":"Decision tree for identifying pertinent integration procedures and joint displays in mixed methods research","volume":"79","author":"Younas","year":"2023","journal-title":"J Adv Nurs"},{"key":"2026073104400881000_16.7.e119182.17","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/jan.14264","article-title":"Characteristics of joint displays illustrating data integration in mixed-methods nursing studies","volume":"76","author":"Younas","year":"2020","journal-title":"J Adv Nurs"},{"key":"2026073104400881000_16.7.e119182.18","doi-asserted-by":"crossref","unstructured":"Kuckartz U . Mixed Methods: Methodologie, Forschungsdesigns und Analyseverfahren. Springer-Verlag, 2014.","DOI":"10.1007\/978-3-531-93267-5"},{"key":"2026073104400881000_16.7.e119182.19","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12116"},{"key":"2026073104400881000_16.7.e119182.20","unstructured":"\u00a7 28. Qualification Registered Nurses BGBL. I NR. 108\/1997 . 1997 Available: https:\/\/www.ris.bka.gv.at\/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10011026 [accessed 27 Jul 2025]."},{"key":"2026073104400881000_16.7.e119182.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2004.03235.x"},{"key":"2026073104400881000_16.7.e119182.22","first-page":"671","volume-title":"Hamric and Hanson\u2019s advanced practice nursing: An integrative approach","volume":"xxiv","author":"Tracy","year":"2019"},{"key":"2026073104400881000_16.7.e119182.23","doi-asserted-by":"publisher","DOI":"10.1177\/1077558708317802"},{"key":"2026073104400881000_16.7.e119182.24","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1748-5908-9-7","article-title":"Organizational readiness for implementing change: a psychometric assessment of a new measure","volume":"9","author":"Shea","year":"2014","journal-title":"Implementation Sci"},{"key":"2026073104400881000_16.7.e119182.25","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034380","article-title":"Translation and psychometric evaluation of the German version of the Organisational Readiness for Implementing Change measure (ORIC): a cross-sectional study","volume":"10","author":"Lindig","year":"2020","journal-title":"BMJ Open"},{"key":"2026073104400881000_16.7.e119182.26","doi-asserted-by":"publisher","DOI":"10.1097\/00005110-200105000-00006"},{"key":"2026073104400881000_16.7.e119182.27","doi-asserted-by":"publisher","DOI":"10.1097\/00005110-200009000-00008"},{"key":"2026073104400881000_16.7.e119182.28","unstructured":"Spence Laschinger HK . Conditions for work effectiveness questionnaire I and II. Western University Canada; 2012. Available: https:\/\/view.officeapps.live.com\/op\/view.aspx?src=https%3A%2F%2Fwww.uwo.ca%2Ffhs%2Fhkl%2Ffiles%2Fcweq.docx&wdOrigin=BROWSELINK"},{"key":"2026073104400881000_16.7.e119182.29","unstructured":"Knispel J , Wittneben L , Slavchova V , et al . Skala zur Messung der beruflichen Selbstwirksamkeitserwartung (bsw-5-rev) (zis). 2021. doi:10.6102\/zis303"},{"key":"2026073104400881000_16.7.e119182.30","doi-asserted-by":"publisher","DOI":"10.1006\/jvbe.2000.1753"},{"key":"2026073104400881000_16.7.e119182.31","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1024\/1012-5302\/a000912","article-title":"Rollenverst\u00e4ndnis von Pflegeexpert_innen in der Prim\u00e4r- und Akutversorgung in Deutschland","volume":"36","author":"Seismann-Petersen","year":"2023","journal-title":"Pflege"},{"key":"2026073104400881000_16.7.e119182.32","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1024\/1012-5302\/a000985","article-title":"Pflegerische Qualifikationsniveaus und Umsetzung von Aufgaben f\u00fcr eine Advanced Nursing Practice in \u00d6sterreich","volume":"37","author":"Herzog","year":"2024","journal-title":"Pflege"},{"key":"2026073104400881000_16.7.e119182.33","doi-asserted-by":"crossref","unstructured":"Moosbrugger H , Kelava A . Testtheorie und Fragebogenkonstruktion. Berlin: Springer, 2020.","DOI":"10.1007\/978-3-662-61532-4"},{"key":"2026073104400881000_16.7.e119182.34","unstructured":"Health and Nursing Act (1997) . \u00a715. Kompetenzen bei der medizinischen diagnostik und therapie. BGBL. I Nr. 108\/1997. 1997. Available: https:\/\/www.ris.bka.gv.at\/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10011026 [Accessed 27 May 2025]."},{"key":"2026073104400881000_16.7.e119182.35","first-page":"21","article-title":"Power comparisons of shapiro-wilk, kolmogorov-smirnov, lilliefors and anderson-darling tests","volume":"2","author":"Razali","year":"2011","journal-title":"Journal of Statistical Modeling and Analytics"},{"key":"2026073104400881000_16.7.e119182.36","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12117"},{"key":"2026073104400881000_16.7.e119182.37","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1007\/978-3-658-21308-4_44","volume-title":"Handbuch Methoden der empirischen Sozialforschung","volume":"2019","author":"Helfferich","year":"2019"},{"key":"2026073104400881000_16.7.e119182.38","unstructured":"Lamnek S , Krell C . Qualitative Sozialforschung: Mit Online-Material: Beltz. 2016."},{"key":"2026073104400881000_16.7.e119182.39","doi-asserted-by":"crossref","unstructured":"Braun V , Clarke V . Thematic analysis: A practical guide. 2021.","DOI":"10.4135\/9781036232078.n9"},{"key":"2026073104400881000_16.7.e119182.40","unstructured":"WMA declaration of helsinki\u2013ethical principles for medical research involving human participants. 2024."},{"key":"2026073104400881000_16.7.e119182.41","unstructured":"EU general data protection regulation . General data protection regulation. 2016. Available: https:\/\/gdpreu\/tag\/gdpr\/#:~:text=The%20General%20Data%20Protection%20Regulation,to%20people%20in%20the%20EU [Accessed 27 May 2025]."},{"key":"2026073104400881000_16.7.e119182.42","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:40:27Z","timestamp":1785498027000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":42,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,31]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2026-119182"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119182","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}