Switzerland faces challenges in long-term care due to its high life expectancy and the resulting increased prevalence of non-communicable diseases and functional dependence among older adults. Nursing homes are addressing increasingly complex acute care needs amid health-care professional shortages. The nurse practitioner role has emerged globally as a key strategy to enhance the accessibility, quality, and coordination of care in these settings. While the role was recently legislated in the canton of Vaud, there's a scarcity of solid scientific data on nurse practitioner implementation and impact in Switzerland. The aim of this study is to assess the implementation of the nurse practitioner role in nursing homes in order to develop a toolkit that supports the sustainability of this new role’s deployment in Switzerland. Methods and analysis: This two-phase study will evaluate the implementation of the nurse practitioner role in two distinct nursing homes in the canton of Vaud, using the PEPPA Plus model (based on Donabedian's framework) as a guide. Phase 1 employs an embedded mixed-method case study design across three work packages (WPs). WP1 uses Rapid Ethnography (observations, interviews, document analysis) to assess structural elements influencing implementation before and one year after nurse practitioner deployment. WP2 uses a prospective descriptive quantitative design where NPs log their activities per act daily or five consecutive days each month over the course of one year. WP3 uses a longitudinal multi-method approach, combining a pre-post quasi-experimental quantitative component to measure resident, staff, and institutional outcomes (e.g., hospitalizations, pressure sores) at 3, 6, and 12 months, with qualitative in-terviews. Phase 2 (WP4) will use Thoele's three-step methodology—data preparation, focus group evaluation, and toolkit design—to develop a best practices toolkit to support the nurse practi-tioner role's sustainability based on Phase 1 results. For Phase 1 analysis, data from each nursing home will be analyzed separately (intra-case analysis) and then compared (inter-case analysis). Qualitative data (interviews) will be analyzed using thematic content analysis and triangulated with quantitative data for a comprehensive understanding. Quantitative outcomes will be analyzed using descriptive statistics and generalized linear models (e.g., Poisson regression) for pre-post comparisons over two six-month periods.
