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Background: Increasing evidence suggests that clinician well-being influences patient, workforce, and organizational outcomes. Despite increasing attention to well-being among licensed clinicians (e.g., nurses and physicians), collective evidence about well-being among healthcare assistants, such as nursing and medical assistants, is limited. Healthcare assistants make up a substantial portion of the clinical workforce delivering direct patient care. The well-being of healthcare assistants is critical to ensure an ample workforce supply. The objective of this systematic review was to contribute a reproducible search, summary, appraisal, synthesis, and critique of the literature about well-being among healthcare assistants, including factors that induce or inhibit burnout, and to identify gaps in evidence that warrant future research., Methods: We performed a literature search across 4 databases with keywords using BOOLEAN operators. After an initial title and abstract screen, a search of relevant reference lists, and full text review was peformed independently by 2 researchers. Study quality was evaluated using Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. We extracted study characteristics, results, and deductively analyzed each study's alignment with the United States National Academy of Medicine's Clinician Well-Being Model., Results: We identified 28 articles meeting our inclusion criteria. Our synthesis indicated that most studies investigated personal factors (e.g., financial stressors or physical, emotional, and spiritual health) as opposed to organizational or policy factors (e.g., occupational policies or workplace culture) that may impact well-being. Younger workers and those with fewer years of experience appear to have higher burnout risk. Sleep health, improved unit-based culture (respect and increased decision-making with nurses), shorter shifts, and increased social support appear to be the most protective against burnout., Discussion: There remains a scarcity of evidence about factors impacting well-being among healthcare assistants. Existing literature focuses on individual, as opposed to external or organizational, contributory factors to burnout or well-being risk. Future studies should use specific methods to define and measure healthcare assistant roles, isolate harmful individual and organizational factors, and measure more specific sub-concepts of well-being such as depression. Such studies can contribute greatly to the overall understanding of healthcare assistant health and wellness, which subsequently may promote optimal patient and organizational outcomes., Tweetable Abstract: The hidden workforce: Systematic review demonstrates gaps in evidence about wellbeing and burnout among healthcare assistants and aides., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Registered nurses have increasingly taken on new, integrated roles across a variety of health care settings, thus leading to a lack of clarity among titles used to identify registered nurses. Protected titles, such as "registered nurse," identify regulated professionals, whereas informal job titles identify nurses by their education or practice area. The variation in education requirements of registered nurses and the inconsistency in titles used to identify registered nurses in primary care internationally limits the ability to compare research findings and policies across countries. There is also minimal documentation on the education requirements specific to registered nurses in primary care., Objectives: This study aims to (a) outline protected titles and education requirements for registered nurses; and (b) identify job titles and education requirements specific to registered nurses in primary care internationally., Methods: A modified document analysis with key informant consultations was employed. Organization for Economic Co-operation and Development and key partner countries were considered for inclusion ( n =42). Online searches were performed using keywords (e.g. nurse, title, nursing education) to identify data focused on protected titles and education requirements of registered nurses, and job titles and education requirements of registered nurses in primary care. Data were extracted from online sources and verified for accuracy and completeness by key informants, identified for each country through online searches or professional networks., Results: Out of the 42 eligible countries, 24 countries were included in the final analysis. Five countries were excluded for their lack of available documents in English or French and 13 countries were excluded due to an inability to verify data with key informants. The findings show that "registered nurse" is the most common protected title internationally. Other protected titles include "general nurse" and "nurse." Many unofficial job titles for registered nurses in primary care were identified, including "primary care nurse," "general practice nurse," and "community nurse." Twelve countries had no specific job title for registered nurses in primary care. Consistently, there was no mandatory education required for registered nurses to practice in primary care. However, many countries had primary care-specific programs available for nurses to gain knowledge in this area., Conclusions: This study confirms that job titles used to identify registered nurses in primary care vary considerably across countries. A unified understanding of international nomenclature for this role can support and facilitate future research, education, and policy development to recognize and optimize primary care nursing by improving access and quality of care for individuals, families, and communities., Tweetable Abstract: Globally, job titles of RNs in primary care vary considerably and there are no formal primary care education requirements to practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors. Published by Elsevier Ltd.)

Background: Research examining RNs' experiences during the COVID-19 pandemic is lacking, thus inhibiting efforts to optimize nursing care delivery and patient outcomes during the current pandemic and future public health emergencies., Objective: To explore the experience of being a registered nurse caring for patients with COVID-19 at an urban academic medical center during the early stages of the pandemic., Design: Qualitative descriptive study, guided by Donabedian's Quality Framework for Evaluation of Healthcare Delivery which focuses on structures, processes, and outcomes of care delivery., Setting: Urban academic medical center in the northeast United States., Participants: Registered nurses cared for or caring for patients with COVID-19, age ≥18 years old, and English-speaking., Methods: Participants were recruited for individual in-person semi-structured interviews. Interviews occurred during March and April 2020 and were recorded and transcribed. Transcripts were analyzed by two researchers using emergent qualitative content analysis to identify themes., Results: Twenty-one registered nurses participated in the study. Three themes emerged from the data, included one relevant to structures and two relevant to processes of care during the pandemic. Registered nurses perceived the clinical context as highly dynamic, but quickly adapted to pandemic-related care delivery. They felt a "sense of duty" to care for patients with COVID-19, despite being fearful of acquiring or spreading infection. Compared to clinical colleagues, registered nurses reported increased patient exposure and performed tasks previously assigned to other clinical team members., Conclusion: Roles and nursing practice processes evolved to meet the demand for care despite challenges. Registered nurses require adequate protection for their frontline role which may consist of increased patient exposure compared to clinical colleagues, emotional support, and clear clinical guidance. A deeper understanding of how a public health emergency, such as the COVID-19 pandemic, affects nursing practice can guide future efforts to optimize healthcare structures, nursing care processes, and patient outcomes. Our study can inform strategies for providing registered nurses with adequate communication, protection, and resources during the COVID-19 pandemic and future similar public health emergencies., Competing Interests: None, (© 2020 The Authors.)