Aims To identify transferable lessons from the introduction of Physicians Assistants (PAs) into the Paediatric Intensive Care Unit (PICU) in a large teaching hospital. The PICU had seen increasing admissions, but trainee hours had reduced. Along with transition to consultant-delivered service, three PAs were appointed in 2010 to provide long-term support to the multi-disciplinary team. PAs are well known in the US, but new to paediatrics and PICU.

Methods We sought to capture staff opinions and measure the function of PAs before starting, at 3 weeks and at 2 months after starting. An anonymous questionnaire, an online survey and semi-structured interviews were distributed to and conducted with all professionals working on the PICU. Areas explored were function of PAs, the impact on the PICU and teamworking.

Results Pre-start questionnaire – 50% of the doctors and 30% of the nurses answered the questionnaire. 10/20 responses stated the addition of PA's would ease/augment their individual role. 17/30 responses expected an overall positive impact on the unit and 13/30 expected an improvement in quality/continuity of patient care. 12/28 anticipated a threat, including reduced training opportunities and deskilling. 12/39 expected confusion regarding the role and lines of accountability of the PAs. 3 week online questionnaire – despite being sent to all 52 permanent staff, only nine completed the survey. Of the responses, two noted a positive impact, highlighting their hard work and enthusiasm, releasing more clinical time for patient care. 7/9 felt that the PAs would improve unit function in time. Concern was again expressed around training opportunities. One respondent detailed disparities in pay banding between PAs and nurses. 6/9 thought that the trust should have invested in advanced nurse practitioners instead. At 2 months, semi-structured interviews have highlighted an emerging respect for their contribution of function of the unit out of hours, patient assessment and patient-related administration. Concern of disparities in pay/abilities remains within some nurses.

Conclusion There are many solutions to workforce challenges. PAs are expected to become a viable one, but their introduction needs to encompass public relations and pay banding as well as operational and training needs.