Nursing technicians and healthcare assistants (HCAs) are assuming increasingly important roles in Saudi healthcare, playing a supporting role in the work of nurses with regards to patient care during the Vision 2030 reforms. This is a critical review of the literature published between 2020-2025 on the influence of HCAs on patient outcomes (e.g., safety, satisfaction), workflow (e.g., less administrative burden), and nursing (e.g., delegation, role clarity). Based on 32 studies, the results indicate positive outcomes: HCAs result in 20-46 per cent patient satisfaction and quality, 15-30 per cent workflow optimization, and increasing the nursing productivity by sharing tasks. Nevertheless, obstacles such as role ambiguity (presented in 70-85 percent of the research) and training gaps and urban-rural differences restrict effectiveness. Measures show moderate levels of knowledge improvement after the education (10-20%), and Saudi-specific results show cultural hierarchy. The most important studies are described in tables; the trends of impacts and obstacles are presented in graphs. The discussion criticizes the evidence bias against urban environments, irregularities in implementation, and suggestions include recommendations on standardised training, role clarification policy and integration of multidisciplines. As a review highlights, HCAs have the potential to further equitable, efficient care in Saudi hospitals and primary care, which fits the objectives of HSTP towards sustainable outcomes.