Healthcare aide involvement in team decision-making in long-term care: A narrative review of the literature.

AIMS AND OBJECTIVES: To provide an overview and synthesis of the current evidence on healthcare aides' involvement in team decision-making in long-term care. BACKGROUND: Healthcare aides provide the most direct care to residents in long-term care homes and are uniquely positioned to influence the quality of care. Yet, they are not typically included in team decisions for improving resident care. As demand for long-term care increases, it is essential that we have a comprehensive understanding of ways to support healthcare aides' role on the interprofessional team for decision-making about resident care. DESIGN: Narrative review. METHOD: Five electronic databases were searched for articles published in English between 2008 and 2020. Thematic analysis was conducted to synthesise findings using an organising framework. Reporting followed the PRISMA-ScR. RESULTS: Twelve studies were included. Results indicate that work environment factors that influenced (supported or hindered) healthcare aides' involvement in decision-making included information access/availability, hierarchical staffing structures and supervisor support/shared governance. Relational processes that influenced team decision-making included team communication and collaboration, information sharing and exchange, and the quality of work relationships among team members. Strategies are discussed that could address the identified barriers and support healthcare aides' active involvement in team decisions regarding resident care. CONCLUSIONS: This review highlights the pervasive underutilization of healthcare aides, who have the most knowledge of residents to support person-centred care. There remains a paucity of research on healthcare aides' involvement in team decision-making. Research is needed to examine the effectiveness of interventions to support healthcare aides' participation in decision-making and the impact on staff and resident outcomes. RELEVANCE TO CLINICAL PRACTICE: It is crucial that healthcare aides are afforded opportunities to be part of the interprofessional team for information sharing and decision-making for resident care. Managers play a key role in supporting healthcare aides' inclusion in decision-making.

NCLEX-RN© preparation resources available online in French: An integrative review.

AIM: This review describes the availability of online French NCLEX-RN© preparation resources for candidates BACKGROUND: One entry to practice requirement for Canadian nurses is to successfully pass a licensing exam upon graduation from their educational program. In 2015, the American NCLEX-RN© replaced the Canadian entry to practice licensing examination which was offered in Canada's two official languages: English and French. The NCLEX-RN© was developed in English and later translated to French. Since its implementation, Francophone candidates and educators in Canada have reported a lack of preparatory resources available in their language and have had substantial lower NCLEX-RN© pass rates, consistently below 50% METHODS: An integrative review using Whittemore and Knafl's framework was conducted between February and May 2019, and updated in September 2020, through online searches of CINAHL, PubMed, Science Direct and Google Scholar databases. Grey literature was included from 2012 onwards. Results are presented narratively. RESULTS: A total of 17 French language preparatory resources were found. These resources were categorised into four main groups: (1) What is the NCLEX-RN© ?; (2) What do I need to do prior to writing the NCLEX-RN© ?; (3) What is assessed through the NCLEX-RN© ? and finally, (4) How can I practice before taking the NCLEX-RN© ? CONCLUSION: Limited French-language NCLEX-RN© preparatory resources exist for Francophone candidates. Furthermore, practice questions in French are few compared to what is available in English IMPLICATIONS FOR NURSING AND NURSING POLICY: Other countries may consider implementing an entry to practice exam such as the NCLEX-RN© because of its availability in both the French and English language, as well as the possibility of translating the exam to other languages, creating a potential market for this test around the globe. The lack of preparatory resources in French is a major concern to Francophone candidates undertaking such a high-stakes examination in their language. Nursing stakeholders and policy leaders should acknowledge that such gaps place Francophone writers in a disadvantaged position in comparison to their Anglophone counterparts.

A comparative analysis of NCLEX pass rates: Nursing health human resources considerations.

AIMS: To examine performance differences among different writers of the National Council Licensure Examination-Registered Nurse (NCLEX-RN) examination in Canada; to compare Canadian and U.S. writer pass rate data; and to identify if changes in the Canadian nursing workforce can be related to the introduction of NCLEX-RN. BACKGROUND: In January 2015, the entry-to-practice licensing examination changed from the Canadian Registered Nurse Examination to the NCLEX-RN, and pass rates declined. METHODS: This comparative analytic study examined NCLEX-RN pass rate data for 2015, 2016 and 2017 using publicly available data. The Canadian data were compared with that from U.S. nurses taking the examination. RESULTS: Overall year-end pass rates among Canadian writers appeared to improve significantly in 2016 (95% to 96.3%, p < 0.001, from 2015 to 2016) but declined again from 96.3% to 90.4% in 2017 (p < 0.001). Pass rates remain significantly lower for first attempt Canadian writers compared to first attempt U.S. writers (2015: 69.7% vs. 84.5%, p < 0.001). CONCLUSIONS: The change in licensing examination had a major impact on pass rates for new graduates entering the nursing profession and potentially the number of new nurses entering the profession in Canada immediately after graduation. IMPLICATIONS FOR NURSING MANAGEMENT: A loss of entry-level workers to the nursing profession in Canada affects workforce management strategies, particularly with respect to worker shortages.

Comparison of response rates on invitation mode of a web-based survey on influenza vaccine adverse events among healthcare workers: a pilot study.

BACKGROUND: Web-based surveys have become increasingly popular but response rates are low and may be prone to selection bias. How people are invited to participate may impact response rates and needs further study as previous evidence is contradictory. The purpose of this study was to determine whether response to a web-based survey of healthcare workers would be higher with a posted or an emailed invitation. We also report results of the pilot study, which aims to estimate the percentage of adults vaccinated against influenza who report recurrent systemic adverse events (the same systemic adverse event occurring successively following receipt of influenza vaccines). METHODS: The pilot study was conducted in November 2016 in Toronto, Canada. Members of a registry of adults (18 years and older and predominantly healthcare workers) who volunteered to receive information regarding future studies about influenza were randomly assigned to receive either an email or postal invitation to complete a web-based survey regarding influenza vaccinations. Non-respondents received one reminder using the same mode of contact as their original invitation. RESULTS: The overall response rate was higher for those sent the invitation by email (34.8%) than by post (25.8%; p < 0.001) and for older versus younger participants (ptrend < 0.001). Of those who responded, 387/401 had been vaccinated against influenza at least once since adulthood. Of those responding to the question, 70/386 (18.1%) reported a systemic adverse event after their most recent influenza vaccine including 22 (5.7%) who reported a recurring systemic event. Systemic adverse events were reported more often by males 18-49 years old than by other groups (p = 0.01). Recurrent systemic adverse events were similar by age and sex with muscle ache being the most commonly reported recurrent reaction. More respondents who reported only a local adverse event (93.1%) planned to be vaccinated again next year than those with a systemic adverse event (69.7%; p = 0.04). CONCLUSIONS: In this convenience sample of registry volunteers, response rates were generally low, but were higher for the emailed than posted invitations and for older than younger adults.

The Intergenerational Impact of Management Relations on Nurse Career Satisfaction and Patient Care.

OBJECTIVE: This article provides insights into the role of management relations on nurses' career satisfaction across different career stages. BACKGROUND: Managers and positive relations with staff are critical to improving job satisfaction, career development, and retention for new graduates to mid- to late-career nurses. METHODS: Using a descriptive qualitative approach, we conducted a thematic analysis of 18 focus groups held in 8 Canadian provinces with 185 student, early-career, and mid- to late-career nurse participants. RESULTS: Student participants expressed the need for a supportive environment to enable successful transition to practice. Early-career nurses expected effective leadership at the unit level, effective communication, and positive working relationships to enable best care outcomes. Mid- to late-career nurses were most dissatisfied with management interactions and relationships. CONCLUSIONS: Management relations are important across all career stages, affecting patient care and job satisfaction. Findings provide insight into how nurse-manager relations can be enhanced from new graduate support to guidance in career development and ongoing recognition and respect for nurses throughout their careers.

An integrative review of nurses' prosocial behaviours contributing to work environment optimization, organizational performance and quality of care.

AIM: To rigorously review the literature on the prosocial workplace behaviours of nurses. BACKGROUND: Prosocial workplace behaviours, predominantly organisational citizenship behaviours have been theoretically and empirically found to promote individual and group level performance in various industries. However, little consensus exists in the literature regarding the impact of nurses' workplace behaviours on the work environment and organisational performance. EVALUATION: An integrative literature review was conducted on studies between 1980 and 2016. Nineteen articles were included related to nurses' prosocial behaviours and performance. RESULTS: A positive relationship was noted between workplace behaviours and individual level performance and unit level performance. Albeit multifactorial, leadership and the social structure of the work environment are important factors contributing to the workplace behaviour-performance relationship. CONCLUSIONS: Prosocial behaviours influence the social functioning of the work environment and offer insights into the delivery of quality care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognize the influence of leadership style and characteristics in the work environment that encourage employee participation in prosocial behaviours. These additional voluntary efforts by nursing staff may improve organisational effectiveness and quality of care. Inclusion of these behaviours in performance reviews and as cultural norms may help to foster a more collaborative work environment.

Antifungal genes expressed in transgenic pea (Pisum sativum L.) do not affect root colonization of arbuscular mycorrhizae fungi.

Genetically modified crops have raised concerns about unintended consequences on non-target organisms including beneficial soil associates. Pea transformed with four antifungal genes 1-3 ß glucanase, endochitinase, polygalacturonase-inhibiting proteins, and stilbene synthase is currently under field-testing for efficacy against fungal diseases in Canada. Transgenes had lower expression in the roots than leaves in greenhouse experiment. To determine the impact of disease-tolerant pea or gene products on colonization by non-target arbuscular mycorrhizae and nodulation by rhizobium, a field trial was established. Transgene insertion, as single gene or stacked genes, did not alter root colonization by arbuscular mycorrhiza fungus (AMF) or root nodulation by rhizobium inoculation in the field. We found no effect of transgenes on the plant growth and performance although, having a dual inoculant with both AMF and rhizobium yielded higher fresh weight shoot-to-root ratio in all the lines tested. This initial risk assessment of transgenic peas expressing antifungal genes showed no deleterious effect on non-target organisms.

The socialisation of new graduate nurses during a preceptorship programme: strategies for recruitment and support.

AIMS AND OBJECTIVES: The purpose of this study is to gain greater understanding of new graduate nurses' organisational socialisation and to help inform recruitment and support strategies for this population. To this end, it uses Van Maneen and Schein's theory of organisational socialisation to explore new graduate nurses' perceptions of role conflict, role ambiguity, job satisfaction and turnover intent at the end of their preceptorship programme. BACKGROUND: The literature on new graduate nurses reflects concerns with high turnover rates during early work experiences. Under-preparation of and lack of support for new graduate nurses are often-reported reasons for these high turnover rates. Preceptorship programmes have been implemented to specifically address these challenges. DESIGN: This study uses a cross-sectional multisite design with a survey. METHODS: A sample of 45 new graduate nurses completed a quantitative survey at the end of their preceptorship programme. Descriptive statistics and Pearson's correlation analyses were conducted to explore the relationships. RESULTS: New graduate nurses in this study experienced low role ambiguity, role conflict and turnover intent and high job satisfaction. Their job satisfaction was associated with low role conflict and role ambiguity. Working in their first job of choice was related to less role conflict and role ambiguity. Having previous experience on the unit was not a meaningful variable. CONCLUSIONS: New graduate nurses who reported a greater understanding of their work roles and less role conflict and were working in their first job of choice were generally more satisfied with their job. Previous experience on the unit was not related to any of the socialisation outcomes in this study. However, the transition experienced during clinical placements and early work experiences may be different. RELEVANCE TO CLINICAL PRACTICE: The results of this study provide managers and educators with greater insight into the socialisation of new graduate nurses, as well as concrete strategies for recruitment and support.

Intersecting Health Policy and the Social Determinants of Health in Pediatric Type 1 Diabetes Management and Care.

THEORETICAL PRINCIPLES: Type 1 diabetes health technologies are evolving. This is an expensive chronic condition to manage, hence a combination of public and private healthcare funding sources, as well as out-of-pocket payments support disease management. The aim of this paper is to describe two conceptual underpinnings, which can appropriately position the health policy and clinical context of pediatric type 1 diabetes management and care. PHENOMENA ADDRESSED: "The Main Determinants of Health" framework is used to position pediatric T1D management and care within the model's four interconnected layers: the structural environment, social and material conditions, support systems and individual health behaviors. A health policy in Ontario, Canada, the Assistive Devices Program for insulin pump therapy is also discussed relative to the model's outermost layer: the structural environment. Four dimensions of control, which characterize the "street-level bureaucrat" role including "distributing benefits and sanctions; structuring the context; teaching the client role; and, psychological benefits and sanctions" then position the policy context of the diabetes nurse educator role relative to the Assistive Devices Program policy. RESEARCH LINKAGES: These conceptual underpinnings could extend beyond the pediatric T1D landscape to position global research in other nursing practice areas, as well as with other patient populations and professional disciplines such as social work and medicine.

Public Understanding of the Role of Nurses During Ebola.

PURPOSE: To examine media portrayals of nurses and their roles during the 2014-2015 Ebola epidemic in western Africa. METHODS: The study used document analysis and in-depth content analysis to review and assess literature on the Ebola epidemic. A total of 234 potentially relevant articles were identified; 109 were excluded and 125 were included in the analysis. FINDINGS: The analysis revealed a gap in system preparedness for global health events and a lack of public awareness of the critical role of nurses. Little attention was paid to nurses and their knowledge and expertise as they worked through the Ebola event. The perception of nurses evolved over the epidemic. CONCLUSIONS: Portrayals of nurses and their work during the Ebola epidemic evolved over the epidemic, from positive to negative, and health systems were shown to be unprepared for a major epidemic. CLINICAL RELEVANCE: Media coverage of major health events can demonstrate system inadequacies, but inaccurate and misleading portrayals of nurses and the nursing profession can undermine and diminish the image of the nursing profession.

The history of nurse imagery and the implications for recruitment: a discussion paper.

AIM: This paper presents a discussion of the history of nurse imagery in the context of recent career choice research and the need for contemporary images for nursing recruitment. BACKGROUND: The critical and growing shortage of nurses is a global concern. Understanding how individuals come to know nursing as a career choice is of critical importance. Stereotypical imaging and messaging of the nursing profession have been shown to shape nurses' expectations and perceptions of nursing as a career, which has implications for both recruitment and retention. DATA SOURCES: Relevant research and literature on nurse imagery in relation to career choice and recruitment were identified through a search of the CINAHL, PsychINFO, Sociological Abstracts, PubMed; Medline and Embase databases from 1970-2012. DISCUSSION: Historical images of nurses and nursing remain prevalent in society today and continue to influence the choice of nursing as a career among the upcoming generation of nurses. Students interested in nursing may be dissuaded from choosing it as a career based on negative, stereotypical images, especially those that position the profession as inferior to medicine. IMPLICATIONS FOR NURSING: Understanding the evolution and perpetuation of popular images and messages in relation to the profession has implications for not only how we recruit and retain future generations of professional nurses but also holds implications for interprofessional collaboration between nursing and other health disciplines. CONCLUSION: Strategies for future recruitment and socialization within the nursing and the health professions need to include contemporary and realistic imaging of both health professional roles and practice settings.

Workforce Integration of Philippine-Educated Nurses who Migrate to Canada through the Live-in Caregiver Program.

Nurses who migrate through the Canadian Live-in Caregiver Program face significant barriers to their subsequent workforce integration as registered nurses in Canada. This study applies the concept of global care chains and uses single case study methodology to explore the experiences of 15 Philippine-educated nurses who migrated to Ontario, Canada, through the Live-in Caregiver Program. The focus is the various challenges they encountered with nursing workforce integration and how they negotiated their contradictory class status. Due to their initial legal status in Canada and working conditions as migrant workers, they were challenged by credential assessment, the registration examination, access to bridging programs, high financial costs, and ambivalent employer support. The results of the study are pertinent for nursing policymakers and educators aiming to facilitate the integration of internationally educated nurses in Canada.

Les infirmières qui migrent par l'intermédiaire du programme canadien des aides familiaux résidants font face à des obstacles importants après leur intégration à la population active en tant qu'infirmières au Canada. Cette étude applique le concept de chaînes mondiales des soins et utilise une méthodologie fondée sur l'étude de cas unique pour explorer le vécu de 15 infirmières formées aux Philippines et qui ont migré en Ontario, au Canada, par l'intermédiaire du programme des aides familiaux résidants. L'étude se penche notamment sur les divers défis qu'elles ont dû relever dans le cadre de leur intégration en milieu de travail infirmier ainsi que sur la façon dont elles ont composé avec leur niveau de classe contradictoire. En raison de leur statut juridique au Canada et de leurs conditions de travail en tant que travailleuses migrantes, elles ont dû surmonter les obstacles que représentaient l'évaluation de leurs titres de compétences, l'examen d'accréditation, l'accès aux programmes de transition, les coûts financiers élevés et le soutien ambivalent d'employeurs. Les résultats de l'étude offrent de l'information pertinente aux décideurs et aux éducateurs qui œuvrent pour la profession infirmière et pour l'intégration des infirmières formées à l'étranger au Canada.

The historical social positioning of nursing and medicine: implications for career choice, early socialization and interprofessional collaboration.

For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two professions and their relationships with and among each other in relation to career choice, early socialization and patient care delivery. An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.

Waiting and watching: Nurse migration trends before a change to the National Council Licensure Examination as entry to practice for Canada's nurses.

BACKGROUND: A number of factors in the health care environment, including a change in regulatory policy, may affect a country's nursing workforce and nurse migration and mobility. PURPOSE: This study compared the characteristics of Canadian-educated nurses who had migrated to the United States to work with their colleagues in the United States and Canada in anticipation of a change in Canada's RN entry to practice requirements in 2015. METHODS: We conducted a retrospective comparative study of nurses in Canada and the U.S. using 2008 data from the US National Sample Survey of Registered Nurses and the Canadian Institute of Health Information. DISCUSSION: There was little change in the number of Canadian-educated nurses working in the United States in 2008 compared with 2004. We found differences between U.S. nurses and Canadian-educated nurses working in the United States in educational level, work status, work location, and age. No differences were found between Canadian-educated nurses working in the United States and those working in Canada. CONCLUSIONS: This research highlights the value of international comparisons of the nursing workforce, especially in the context of anticipated regulatory changes, which may affect a country's nursing health human resources.

Molecular markers as a complementary tool in risk assessments: quantifying interspecific gene flow from triticale to spring wheat and durum wheat.

Triticale is being considered as a bioindustrial crop in Canada using genetic modification. Because related spring wheat (Triticum aestivum) and durum wheat (T. durum) may exhibit synchronous flowering and grow in proximity, determination of interspecific gene flow when triticale is the pollen donor is necessary to evaluate potential risk. Pollen-mediated gene flow risk assessments generally rely on phenotypic markers to detect hybridization but DNA markers could be powerful and less ambiguous in quantifying rare interspecific gene flow. Six cultivars representing four species [spring wheat, durum wheat, triticale and rye (Secale cereale)] were screened with 235 spring wheat and 27 rye SSR markers to evaluate transferability and polymorphism. Fifty-five polymorphic markers were used in conjunction with morphological characterization to quantify interspecific gene flow from a blue aleurone (BA) triticale line to two spring wheat cultivars (AC Barrie and AC Crystal) and one durum wheat cultivar (AC Avonlea). Approximately 1.9 Million seeds from small plot experiments were visually screened in comparison with known hybrid seed. In total 2031 putative hybrids were identified and 448 germinated. Morphological analysis of putative hybrid plants identified five hybrids while molecular analysis identified 11 hybrids and two were common to both. Combined, 14 hybrids were confirmed: 10 spring wheat × triticale (0.0008 % of harvested seed): seven AC Barrie × BA triticale (0.001 %) and three AC Crystal × BA triticale (0.0005 %); and four durum wheat × triticale (0.0006 %). The occurrence of rare hybrids does not present a substantial risk to the development of GM triticale.

Telehealth management in movement disorder: a retrospective study.

BACKGROUND: Management of chronic diseases such as movement disorders can be challenging. Nurse-administered telephone follow-up programs have demonstrated clinical and cost efficacy in a variety of health care models. However, their efficacy in movement disorders has not been sufficiently addressed. This observational study fills a knowledge gap by reporting the nature of individuals utilizing a nurse-administered telephone service and the reasons for and the outcomes of calls. METHOD: Consecutive calls received by the clinic for a 12-month duration were recorded. A sample of 312 calls from 132 patient charts was analyzed. Variables for analysis and coding schema were determined a-priori and included demographic information as well as information around the reasons for and outcomes of calls. The narratives of documented calls were reviewed retrospectively and responses coded for analysis by a separate researcher. Data was analyzed using descriptive statistical methods. RESULT: Patients made the majority of calls (49%). 27% of calls related to worsening symptoms and another 35% of calls related to medication issues or renewals. The mean call duration was 15.93 minutes. The majority of calls were received mid-way between clinic visits (M = 89.24 days). The nurse resolved 84% of calls independently. The mean number of calls per patient was 2.93. Issues reported by patients were resolved (approximately 90%) without need for follow-up emergency, family, or subspecialty clinic visits. CONCLUSION: The results underscore the complexity of medical issues in a movement disorders population. The current study provides support for a nurse-administered telephone follow-up program in movement disorders.

Choosing nursing as a career: a narrative analysis of Millennial nurses' career choice of virtue.

The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences and professional expectations of Millennial nurses (born 1980 or after) is a critical component of recruitment and retention strategies. This study utilized Polkinghorne's interpretive, narrative approach to understand how Millennial nurses explain, account for and make sense of their choice of nursing as a career. The positioning of nursing as a virtuous choice was both temporally and contextually influenced. The decision to enter the profession was initially emplotted around a traditional understanding of nursing as a virtuous profession: altruistic, noble, caring and compassionate. The centricity of virtues depicts one-dimensional understanding of the nursing profession that alone could prove dissatisfying to a generation of professionals who have many career choices available to them. The narratives reveal how participants' perceptions and expectations remain influenced by a stereotypical understanding of nursing, an image that remains prevalent in society and which holds implications for the future recruitment, socialization and retention strategies for upcoming and future generations of nurses.

The social context of career choice among millennial nurses: implications for interprofessional practice.

Health human resource and workforce planning is a global priority. Given the critical nursing shortage, and the fact that nurses are the largest group of healthcare providers, health workforce planning must focus on strategies to enhance both recruitment and retention of nurses. Understanding early socialization to career choice can provide insight into professional perceptions and expectations that have implications for recruitment, retention and interprofessional collaboration. This interpretive narrative inquiry utilized Polkinghorne's theory of narrative emplotment to understand the career choice experiences of 12 millennial nurses (born between 1980 and 2000) in Eastern Canada. Participants were interviewed twice, face-to-face, 4 to 6 weeks apart prior to commencing their nursing program. The narratives present career choice as a complex consideration of social positioning. The findings provide insight into how nursing is perceived to be positioned in relation to medicine and how the participants struggled to locate themselves within this social hierarchy. Implications of this research highlight the need to ensure that recruitment messaging and organizational policies promote interprofessional collaboration from the onset of choosing a career in the health professions. Early professional socialization strategies during recruitment and education can enhance future collaboration between the health professions.

Changes in patient health outcomes from admission to discharge in acute care.

Clinical databases comprising data that are available at a national level provide the opportunity to explore the relationships between nursing interventions and patient health outcomes. This research examined baseline and changes in patient health outcomes between admission and discharge using data from 59 157 acute-care hospital-based patient records at 44 hospitals in Canada. Statistically significant improvements in all of the health outcomes were noted, with the exception of pressure ulcers. The standardized indicators offer a mechanism for evaluating the effectiveness and quality of nursing care interventions.

Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic. METHODS: We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data. RESULTS: Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models. CONCLUSION: The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes.