Scoping review separates nursing surge capacity from surge capability

A scoping review of nursing and health-system preparedness literature found that surge capacity and surge capability remain distinct concepts: the former concerns expanding beyond routine services to absorb increased demand, while the latter concerns delivering specialized or complex care under the same conditions. Among the sources retrieved, surge capacity had a stable definitional core, but no dedicated concept analysis, framework or measurement instrument for surge capability was identified. The authors’ suggestion that an organization may be “capacity-rich but capability-poor” is conceptual and was not tested directly by any included study.

The review used Joanna Briggs Institute scoping-review methods and reported in accordance with the PRISMA-ScR checklist, although no protocol was registered. The researcher searched PubMed/MEDLINE, CINAHL, Embase, Scopus and Web of Science on 15 June 2026 for English-language sources published from 2000 through 2026, supplementing those searches with citation searching and grey literature. Eligibility criteria followed the Population–Concept–Context framework and covered empirical studies of any design, concept analyses, reviews, consensus documents and grey literature. Of 666 records identified, 510 duplicates were removed, 156 unique records were screened and 97 full texts were assessed. The final synthesis included 23 sources published between 2006 and 2025: nine addressed the definition and evolution of surge capacity, six differentiated capability from capacity and 10 synthesized nursing competencies, with two sources contributing to two objectives.

The synthesis described three phases in the development of the surge-capacity concept: component, stratification and adaptive phases. Despite this evolution, its core remained quantitative and structural, emphasizing expansion, scale and resources rather than the delivery of specialized or complex care. National preparedness doctrine pairs capacity and capability operationally, but the review found that this pairing did not constitute a developed concept of capability. Only one historical review explicitly paired the two constructs; the broader distinction was otherwise derived from health-system resilience literature. Surge-capability evidence was also disconnected from established surge frameworks, having developed in parallel with them rather than being integrated into them. The search found no dedicated surge-capability concept analysis, framework or measurement instrument, leaving the construct less clearly operationalized than surge capacity.

The nursing evidence offers a limited basis for understanding how capability might develop. Competency evidence suggests that it may be buildable through training, although this inference rests on a single uncontrolled evaluation. Self-assessed competence was unreliable, and the competencies associated with surge work now extend to nurse-leader competencies. The review identified three potential implications if surge capacity and surge capability are treated as interchangeable: preparedness measures based on volume and expansion may not capture specialized-care capability; systems may not be comparable when they use the same capacity terminology despite differing capabilities; and workforce planning may overlook competencies needed for complex care. None of these implications was examined directly in an included source.

The evidence supports several research priorities, including a dedicated concept analysis of surge capability and a validated capability instrument anchored in existing psychometric nursing-competency work. These are recommendations for preparedness research, leadership, education and policy, not clinical directives or evidence that a particular training program improves outcomes. The review’s conclusions must also be read within its design: all screening, eligibility assessment, data charting and synthesis were conducted by a single reviewer. Although eligibility criteria were piloted, full-text exclusions were re-examined and every record-level decision was recorded in an auditable screening log, these procedures were not equivalent to independent duplicate screening and may have increased the risk of selection, extraction and interpretive error. Consistent with scoping-review methodology, the researcher did not appraise methodological quality. The resulting synthesis therefore maps the state of 23 English-language sources and identifies conceptual and measurement gaps; it does not establish a causal relationship between capacity, capability or clinical performance.

Subject of Research: A scoping review distinguishing health-system surge capacity from nursing surge capability and identifying priorities for preparedness measurement.

Article Title: Surge capacity versus surge capability in nursing and health system preparedness: a scoping review

Article References: Thobaity, A. A. (2026). Surge capacity versus surge capability in nursing and health system preparedness: a scoping review. BMC Nursing. https://doi.org/10.1186/s12912-026-05557-0

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05557-0

Keywords: nursing preparedness, health-system resilience, surge capacity, surge capability, nursing competencies, pandemic response, mass-casualty care, preparedness measurement, scoping review, workforce planning, Surge, capacity