Roles and Influence of Nursing Assistants in Integrated Medical and Elderly Care Institutions: A Qualitative Study

Anni Song,1,* Xiaoling Yan,2,* Liqun Yao,3,* Mengwei Shao,4 Huiyue Zhou,1 Na Zhou,1 Huibin Si,1 Jiao Zhou,1 Xiaowan Li,1 Ying Li1 1Nursing Department, Ninth People’s Hospital of Zhengzhou, Zhengzhou, Henan, People’s Republic of China; 2Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China; 3Weifang Municipal Center for Disease Control and Prevention, Weifang, Shandong, People’s Republic of China; 4School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huiyue Zhou, Nursing Department, Ninth People’s Hospital of Zhengzhou, Zhengzhou, Henan, People’s Republic of China, Email [email protected] Na Zhou, Nursing Department, Ninth People’s Hospital of Zhengzhou, Zhengzhou, Henan, People’s Republic of China, Email [email protected]: The Chinese government has implemented policies to establish integrated medical and elderly care services (IMECS) institutions and develop the nursing assistants (NAs) to alleviate healthcare workforce shortages. However, the role definition of NAs remains ambiguous. Insights from registered nurses (RNs) can help clarify their roles and impacts.Objective: This study aimed to explore the roles and impacts of NAs in integrated medical and IMECS institutions.Methods: A descriptive qualitative study was conducted using purposive sampling at the largest IMECS institution in Zhengzhou, Central China, from December 2024 to February 2025. Semi-structured interviews were conducted with 23 RNs. Thematic analysis was employed to analyze the interview data.Findings: Four themes and twelve sub-themes emerged from the analysis: 1) role identity, 2) high role expectations, 3) role conflict, and 4) low role authorization.Conclusion: While RNs value NAs’ contributions, challenges in training and competency lead to job instability and restricted practice. Tailored strategies are recommended, with future multi-center studies needed for broader validation.Keywords: nursing assistant, qualitative study, older