Table 4 Nurses’ sentiments on utilisation of CAs

1

Effectiveness and Continuity of care

▪ Continuity of patient care [48, 54]

Positive

▪ Few work interruptions [54]

▪ More tasks are completed (reduced risk for missed care) [45, 52, 59, 68, 75, 76]

▪ More time for high acuity nursing tasks [45, 48, 59, 75, 76]

▪ Reduced waiting times [48, 52]

▪ Covering absenteeism [51, 54, 59]

Neutral

▪ High staff turnover among nurses (whether supplemental or substitution model) [51, 54, 59]

▪ Reduced nurse–patient contact time and interaction [54]

Negative

▪ Feeling of fragmented, dehumanized care [27, 48, 77]

2

Health workforce deployment and supervision

▪ Extra pair of hands for monitoring patient status [39]

Positive

▪ Supplements nurse staffing [51, 54, 59]

▪ Replacement/Substitution for nurses [51, 54, 59]

Negative

▪ Extra workload on supervision of delegated tasks [42, 51, 54, 59]

▪ More time spent on induction, training, and supervision [42, 51, 54, 59]

▪ Pressure to delegate due to staff shortage [76]

▪ Resistance, resentment, and scepticism by qualified staff [27, 48, 77]

▪ Nurses’ unwillingness to shift some tasks [27, 48, 77]

▪ Variability role assignments limits nurses' ability to effectively delegate and supervise [27, 48, 77]

▪ Some assistants have reading and writing difficulties [75]

▪ Unclear accountability lines for actions [42, 54, 78]

3

Motivation and Job satisfaction

• Increased job satisfaction [59, 79]

Positive

• Reduced workload via task-shifting [52, 59, 78]

• Nurse burnout [42, 51, 54, 59]

Negative

• Reduced job satisfaction [54]

4

Professional identity

• Patients confuse between professional nurse and ward assistants [48]

Negative

• Feelings of role ambiguity(confusion) and conflict [27, 48, 77]

• Role deprivation and loss of professional identity [48, 52]

5

Staff safety

• Violence and abuse towards the nurse [51, 59]

Negative

6

Inter-cadre communication

• Improved communication between nurse and assistants [64, 80]

Positive