Integration of Care Assistants Into Intensive Care Nursing Teams: A Multimethod Study

This study explored (1) the expectations and experiences of intensive care unit (ICU) nurses regarding the integration of care assistants, focusing on skill mix, work environment, collaboration, clinical leadership, perceived quality of care and work satisfaction, and (2) how care assistants enact and experience their role in an adult ICU environment.

A multimethod, survey-based study was conducted at two time points, using a pre-post design among 119 ICU nurses and a cross-sectional design among 13 care assistants. The study was conducted in two adult ICUs of a large tertiary hospital. Questionnaires included self-developed items and items derived from validated instruments (e.g., Clinical Leadership Scale, Practice Environment Scale of the Nursing Work Index and Job Content Questionnaire). Open-ended questions were included to capture qualitative insights.

Response rates among ICU nurses were 79.8% (n = 95) at baseline and 48.7% (n = 58) at follow-up, while the response rate among care assistants was 84.6% (n = 11). Before integration, most ICU nurses (71.6%) expected positive outcomes, such as reduced workload through the involvement of care assistants, although concerns regarding care quality were reported by 53.7%. Post-integration, collaboration was rated positively by 82.8% of ICU nurses; however, concerns about care quality persisted (58.5%), and 55.2% opposed continuation of the initiative. Among care assistants, 54.5% found working in the ICU enjoyable, while 81.8% indicated that their assigned tasks did not align with their prior knowledge and skills. Despite these concerns, perceived quality of care was rated 8/10 by both ICU nurses and care assistants at both time points.

Although the integration of care assistants into ICU teams was initially expected to support workforce capacity and workload distribution, persistent concerns regarding care quality and patient safety underscore the need for clearer role delineation, adequate training and structured implementation strategies to support sustainable integration.