A realist inquiry to examine the implementation of Advanced Nurse Practitioner roles in General Practice settings: A realist review protocol.

Background: In Ireland, an ageing population with increasingly complex medical needs and a reduced workforce capacity pose significant challenges for healthcare planning and resourcing. To support capacity building, many countries are seeking innovative workforce solutions to meet the growing demand for healthcare. Expanded nursing roles, such as advanced practice nurses, are being introduced to general practice in many countries. In Ireland, the Advanced Nurse Practitioner (ANP) role is predominant in acute hospitals and integrated care settings. However, an increasing number of nurses working in general practice are pursuing advanced nursing practice. This realist review protocol outlines a framework for evaluating evidence on the implementation of the ANP role in general practice. The review aims to gather robust evidence to generate theories about the implementation of the ANP role and, critically, to understand how the role is implemented, for whom, in what circumstances, in what respects, and how. Methods: The protocol outlines five critical steps required to conduct a realist review: 1) defining the scope and developing initial theories, 2) developing the search strategy, 3) extracting data and reviewing evidence, 4) synthesising evidence and formulating conclusions and 5) refining theory and disseminating findings. Each stage outlines the specific expectations for that stage of the review. Conclusion: The implementation of the ANP role in Irish general practice is a new phenomenon and requires further understanding and exploration. It is envisaged that this protocol will establish a robust framework for evaluating the ANP role in general practice. The insight generated by this realist review will, in turn, help determine if the advanced nurse practitioner role has a worthy place in the future of Irish general practice.