Expanded role of nurses in Swiss nursing homes and their engagement in quality improvement: A cross-sectional study

Aims: To report on the engagement of Swiss nursing homes and of nurses in expanded roles in quality improvement.Design: A cross-sectional study (2018-2019).Methods: Survey data from a sample of 115 Swiss nursing homes and 104 nurses in expanded roles. Descriptive statistics were used.Results: Most participating nursing homes reported carrying several quality improvement activities (median of eight out of 10 activities surveyed) but some were only engaged in five activities or less. Nursing homes working with nurses in expanded roles (n = 83) showed greater engagement in quality improvement than those working with none. Nurses with more advanced qualifications (Bachelor's or Master's degree) engaged more in quality improvement than nurses with standard training. Specifically, higher educated nurses were more involved in data-focused activities. Using nurses in expanded roles can be a way forward for nursing homes seeking to actively carry out quality improvement in their facilities.Conclusion: Although a large proportion of nurses in expanded roles surveyed were implementing quality activities, their level of engagement depended on their educational level. Our findings support the principle that higher level competencies are a key aspect of data-based quality improvement in nursing homes. However, as Advance Practice Registered Nurses will remain difficult to recruit in nursing homes, using nurses in expanded roles might contribute to quality improvement.