Learnings, challenges and processes of prioritizing initial programme theories on contextually appropriate nurse staffing models with a multinational team: a realist methodology case example

Aim

To describe the processes, consensus-building activities, learning and challenges of prioritizing initial programme theories on appropriate nurse staffing models across a multinational research team of academics, trainees and knowledge users from four countries.

Design

Realist review involving literature review, multinational stakeholder engagement and prioritization of programme theories. Realist reviews explore what works, for whom and in what contexts, enabling the development and testing of initial programme theories.

Data Sources

Data sources included (1) a literature review to identify existing theories on optimal nurse staffing models, (2) input from methodological and health system decision makers experts to identify context-mechanism-outcome configurations and prioritize initial programme theories and (3) feedback from health decision-makers and nursing staff through focus groups to augment and prioritize a final set of initial programme theories for subsequent testing.

Outcomes

We summarize the key learnings we gained regarding: (1) effectively communicating the value and unique aspects of realist methodology to team members with varying levels of expertise; (2) achieving a compromise between rigour and relevance in the design of the review itself in working within ‘social laboratories’ and (3) the logistics of conducting a multinational realist investigation: navigating working remotely, differences in time zones and differences in context and language.

Conclusion

Prioritizing initial programme theories on nurse staffing through a multinational realist review is both feasible and valuable. Clear communication, balancing rigour with relevance and managing logistical challenges are essential to producing context-sensitive and evidence-informed staffing models.

Relevance to Clinical Practice

Developing evidence-informed staffing models requires local context consideration and stakeholder collaboration. This study offers (a) practical insights for nurse leaders and managers on balancing rigour and relevance, (b) effective team communication and (c) navigating logistical challenges in multinational teams to prioritize programme theories for clinical translation to improve patient care and staff wellbeing.

Reporting Methods

Consolidated criteria for reporting qualitative research (COREQ).

Patient or Public Contribution

Health care decision makers, care managers, researchers and academicians were involved.

What This Paper Adds to the Wider Global Clinical Community

Demonstrates how a multinational realist approach can generate context-sensitive and evidence-informed nurse staffing models with global relevance.

Provides practical strategies for balancing methodological rigour with local context and for communicating realist methods across teams with varied expertise.

Offers transferable lessons on managing logistical challenges in international research, supporting collaboration to improve safe staffing and workforce sustainability worldwide.