Nurse Effectiveness: A Quintuple Aim Scoping Review Protocol (Preprint)

BACKGROUND Nurses are foundational to high-performing health systems, with robust evidence supporting their impact on access, quality of care delivery, and health outcomes. Worldwide, health-care systems are under increasing pressure to deliver accessible, high-quality, and cost-effective care. The Quintuple Aim (QA) framework outlines five domains for achieving equity and sustainability in health care. This review will examine nursing contributions to the QA’s core goals of: enhancing patient and provider experiences, improving clinical outcomes (including reducing mortality and promoting safety), cost-effectiveness, and advancing health equity. OBJECTIVE Guided by this framework, this scoping review will map and synthesize global evidence on nursing contributions across diverse practice settings, focusing on the roles of six nursing designations - registered practical/licensed practical nurses, registered psychiatric nurses, registered nurses, clinical nurse specialists, nurse practitioners, and nurse anesthetists, in advancing the QA. To date, there has been no review synthesizing evidence on nurses’ contributions to advancing the QA across sectors and care settings. It is posited that the evidence underscores nurses’ foundational role in driving transformative change and their significant impact on advancing sustainable, high-performing health systems. Mapping outcomes to QA framework strengthens the alignment of nursing impact with policy frameworks, to support evidence-informed system‑level decision‑making. METHODS A systematic approach guided this scoping review, following the Arksey and O’Malley methodological framework and refined by the Joanna Briggs Institute methodology for scoping reviews [1,2]. A comprehensive search was conducted across the following databases: MEDLINE, Embase, and CINAHL for peer-reviewed studies published between January 1, 2000, and September 30, 2025. A data framework will be presented [3] and evidence will be mapped to the relevant QA domain and quality indicators [4]. RESULTS Screening for six nursing designations conducted between October 21, 2024 and September 30, 2025 resulted in 78,948 records following the removal of duplicates, with the greatest concentration of literature on population health outcomes. Interim analysis of the nurse practitioner subset revealed emerging indicator categories related to hospital avoidance, patient satisfaction, and improved access to care. Data extraction is in progress, with anticipated study completion in August, 2026. CONCLUSIONS This scoping review protocol outlines a comprehensive approach to mapping global evidence on nurses’ contributions to the QA, highlighting their impact across patient and provider experience, clinical outcomes, cost-effectiveness and health equity. This protocol will guide the synthesis of evidence across QA domains, identifying areas of relative strength, and offers a transferable framework suitable for diverse contexts. The protocol for this scoping review is registered in the Open Science Framework database (registration DOI: 10.17605/OSF.IO/XD6WK) [5].