Enhancing ICU Nurse Redeployment Practices: A Qualitative Improvement Study of Support Interventions

Introduction

Nurse redeployment is a common strategy healthcare organizations employ to meet the dynamic staffing needs across various clinical areas (Marks et al., 2021). It is a common theme during the COVID-19 pandemic when staff were relocated from different hospital areas to address increased staffing requirements to meet patient needs (Dunning et al., 2024; San Juan et al., 2022; White et al., 2025). This is a traditional practice that needs more clarification on its actual meaning for both staff and management (Matlakala, 2015). Redeployment is part of the multi-employer agreement negotiated by the New Zealand Nurses Organization (NZNO) between nursing staff and Health New Zealand (Te Whatu Ora). Redeployment is not optional for staff, unless there is a clear contraindication to being reallocated to another hospital area (NZNO, 2025). This rule applies to more than 34,000 registered nurses employed by Health New Zealand nationally (NZNO, 2025).

A literature review shows that redeployment occurred predominantly during the COVID-19 pandemic, with staff from general wards being reassigned to work inside the Intensive Care Unit (ICU) (Marks et al., 2021; San Juan et al., 2022). Most studies identify similar patterns of staff experience that can be summarized into increased stress (physical, psychological, and emotional) and lack of support and structure (communication, expectations, and interpersonal) (Chilson et al., 2024; Karim et al., 2023; White et al., 2025). The search also reveals that there are limited studies examining the experiences of ICU staff being redeployed outside the ICU. Between Australia and New Zealand, only one study from each country over the last five years has investigated this topic (Karim et al., 2023; White et al., 2025). Another study by Abdulmohdi and Huang (2025) examines redeployment of critical care staff in the United Kingdom. All the mentioned studies yield similar results from surveys and interviews, albeit from different countries and time periods.

Literature on the definition of redeployment varies from short term to long term, planned to unplanned, and within services to between services. The meaning, however, was similar in that they all mean—movement of a staff from the usual work environment to another area, usually in response to staff shortage (Abdulmohdi & Huang, 2025; San Juan et al., 2022). There is no clear context for when and how a staff member can decline redeployment in reviews. In New Zealand, nursing staff bound by their contracts cannot refuse to work in another area when required; however, they may escalate to the charge nurse or manager a limitation in performing a task, and could request to work as a team rather than take direct patient responsibility (NZNO, 2025). This practice is not new and is recognized at both national and international levels; however, it gained particular attention during the pandemic (Peters, 2023).

This study examines the evidence, effectiveness, and experiences of staff regarding the implementation of the recommendations from the previous study to enhance the overall experience of staff redeployment. Frequently replicated reports are around increased feelings of anxiety, stress, frustration, and fear, while also contributing to increased sick time, and may indirectly affect staff turnover. Recurring themes of training, support, and education are evident in most research on redeployment; however, there is no internationally or locally accepted method for completing this process (Chilson et al., 2024; White et al., 2025). The most commonly used term is orientation, with a strong emphasis on education and training on soft skills such as communication (Abdulmohdi & Huang, 2025; Karim et al., 2023; San Juan et al., 2022; White et al., 2025). The buddy system was chosen for its ease of application, resource availability, on-the-job exposure, and training, which promote teamwork and foster positive relationships among staff (Molle & Allegra, 2021; Rebeiro et al., 2017).

ICU nurses in the study site were redeployed for a total of 6183 hours and 4533 hours in 2023 and 2024, respectively. These numbers underscore the importance of this practice for both staff and patients. The initial study by the authors around staff perceptions of redeployment has identified several concerns and pointed out some recommended interventions to improve the redeployment experience for staff (Karim et al., 2023). Concerns included both positive and negative emotions about redeployment as well as structural changes that have been suggested. This study aims to explore the process of implementing the recommendations from the initial study and feedback from staff after the interventions (Chilson et al., 2024; Jones, 2023; Ward & McComb, 2018).

Methods

Data Analysis

The interviews were reviewed independently by the three co-authors which included two experienced researchers and one clinical nurse. All the co-authors held Master's degrees in Nursing and had previous experience in quality improvement initiatives. The clinical unit is accredited and affiliated with the Australia and New Zealand Intensive Care Society (ANZICS) and Clinical Trials Group.

Data obtained from the interviews were analyzed using an inductive data analysis method to gain a clear understanding of what the participants were aiming to express for each answer (Azungah, 2018). Descriptive coding was employed by the researchers, and 85% of the codes were found to be consistent, with the remaining discrepancies resolved through discussions and data comparison conducted online. The main themes (see Figure 1) were achieved by asking about “what is going on” and identifying “how things are working” with a focus on the participant rather than the researcher. Answers were grouped into relevant themes and subthemes (see Figure 2), which were identified by the principal researchers, and the co-authors performed peer verification. There was a 90% agreement among researchers, and the remaining issues were resolved through meetings and discussions. The coding and theme identification were performed manually by the authors and made available online for other authors to access. Regular meetings between all authors were held via video conference to discuss recruitment, decisions, clarification, and coding. Data saturation was agreed upon by all authors when no new themes and codes were noted.

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Figure 1.

Main themes.

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Figure 2.

Subthemes were identified and categorized into each main theme based on participants’ answers.

Results

A total of 7 out of 21 (33%) possible participants volunteered to participate in the interviews. This reflects the actual number of participants who agreed to participate in the interviews. However, 85% of all staff who participated in the redeployment shifts provided responses anonymously through written or typed notes (see Appendix). A response rate of 33% is low, but it does not reflect the actual total number of responses received during the process. All eligible staff were informed that anonymized notes would be reviewed, but could not be included in the analysis—only data from interviews were analyzed. Clear and valid reasons were raised by staff who expressed concerns about anonymity, data use, and how their participation would influence future redeployment experiences when interacting with colleagues they will likely encounter in the future (see Appendix). Purposive sampling enabled adequate representation with a suitable mix of participant demographics and skills that reflect the unit staffing (see Table 1). Gender was not specified in the participant demographic table due to the limited number of eligible male participants in the study, which could influence data and anonymity. The sampling method, in addition to the voluntary participation, consistency of answers, and data saturation, provided confidence to support the authors on the reliability and validity of the findings. The recruitment period, including dates, was specified in the study process and timeline (see Appendix). The anonymity of participants’ answers was crucial to staff participation, which was clearly stated in the participant information sheets.

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Table 1.

Participant Demographics.

Participant (P)	Total Years of Nursing Experience	Initial Registration (NZ or Overseas)	Previous NZ Ward Experience
P1	14	Overseas	No
P2	4	NZ	Yes
P3	14	Overseas	No
P4	18	Overseas	No
P5	16	Overseas	No
P6	4	NZ	Yes
P7	16	Overseas	No

The main themes (see Figure 1) around redeployment and having a buddy shift that was evident during the interviews were Communication challenges, Risks, Emotional burden, and Perspective.

Results showed that staff who participated in buddy shifts experienced similar issues to those previously reported by redeployed staff. Instead of focusing on the goals of the buddy shift, which were communicated beforehand to both the staff and their buddy, almost half of all participants reported working alongside their buddy, dividing tasks, and, in some situations, completing them independently during the buddy shift due to the high workload.

Communication was the most frequently repeated and earliest theme that emerged. It was reiterated throughout multiple responses across various questions during the interview, and was the focal point of most issues encountered by participants during their buddy shift.

Almost all (N = 6, 86%) reported communication challenges (see Table 2). The issues around communication included a lack of communication, unclear instructions, and an inability to escalate concerns, both at an interpersonal and a team level. Communication breakdown, fragmentation, and exclusion made redeployed staff feel isolated and not a member of the team. Communication was mainly task-focused and task-oriented, with uncertainty on how concerns needed to be escalated. Staff also expressed varied levels of expectations of jobs or tasks they were anticipated to perform, which reflected insufficient communication about skills or tasks that the staff were able to or competent to perform. One participant (N = 1, 14%) provided a positive comment about communication and verbalized, “There was a clear chain of communication; when I arrived at the unit, I’d ask directly for the charge nurse.”

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Table 2.

Answers Associated With Themes.

Themes	Key Phrases and Subthemes
Communication challenges	Lack of Communication P1: “There was no proper communication; they just told me to go to this ward and help them, but they didn’t tell me what I was supposed to do there.” P2: “ I was not introduced to the unit but was given a list of tasks to do.”
	Unclear Instructions P1: “The next person I was assigned to was not prepared for that so they just told me to do what I can do.” P5: “ The nurses in the unit did not get the same information about what I could and could not do.”
	Escalation of concerns P3: “I was not sure on how I can report issues or how to escalate concerns” P4: “At least give us an opportunity to say that we do not want to go there.” P7: “They will have time to answer us but we have to continuously ask.”
Risks	Safety concern P1: “ I was concerned about getting medication errors.” P3: “ I will not do things that I am unsure of and which I am not ok at all to do.” P6: “ I did not receive any technical training in any competencies that I was not signed off on.” P7: “We needed to be very clear about what I can do within our scope. I am told that you are obliged or responsible.”
	Task uncertainty P2: “ I often wonder is this what they wanted out of me? There is an element of concern about whether this is or is not what they expected me to do.” P5: “ If we are not trained to do a task, we are not helpful to them or us as well.” P6: “I could not complete some tasks that I was asked, as I did not know how to do it.”
Emotional burden	Task division P1: “ The workload is not divided fairly. I feel like being used up.” P3: “When I reach there, they have a task board and they say that these are all the things I need to do.” P4: “ I was given a whole list of tasks as I get there and I was expected to finish it before break.”
	Negative comments P2: “ I have been told “It is frustrating. Are you really willing to help us with our problem?”” P7: “ I was asked: “Why can you not do the same things as we do in the ward?””
	Negative sentiment P1: “ It is very tiring. It can cause burnout.” P4: “ I was anxious, I did not know whether I was doing what was required of me.” P5: “ I feel unfulfilled, it's very task based. It feels like we are not making a lot of leads.” P6: “ I feel lost. I do not even know what some of the wards look like if I have not been before.”
Perspective	Receiving and providing feedback P1: “ There was no way for us to provide a feedback about the whole redeployment process.” P3: “ I did not know whether I was doing a good job as no one told me.”
	Suggestions for future P2: “We need more orientation in other wards.” P5: “ I would like to suggest training and orientation to other areas aside from ED and PACU.” P6: “I feel that it is important to have basic competencies like IV insertion as it is one of the main things that they ask us to do when we are redeployed.”

This is followed chronologically by risks or perceived risks to both patients and staff; where technical skills, variations in practice across different units, and self-awareness of limitations were discussed. Most participants (N = 4, 57%) expressed concerns around risks associated with redeployment (see Table 2). The subthemes associated with this included safety concerns around interventions and uncertainty about task assignments. Staff were responsible for practicing within their legal scope and needed to speak up for themselves. Medication errors were mentioned as one of the main and serious issues raised. Staff also identified technical skills that were not commonly practiced in the unit but were expected to be performed when redeployed, such as phlebotomy. Follow-up on how staff redeployed were doing during the shift occurred irregularly, depending on the shift coordinator. There was uncertainty at the completion of a task, whether it was what needed to be completed, and if it was satisfactory.

Emotions and sentiments (mostly negative) were expressed clearly throughout the interviews and aligned with the theme of communication. Most participants expressed negative emotions (N = 5, 71%) toward the experience of being redeployed (see Table 2). The subthemes identified included task division, which they felt was not allocated fairly, receiving negative comments, and having negative sentiments about the redeployment as a whole. Staff reported an imbalance in the workload allocated to redeployed staff compared to others working within the ward. The timeframe and expected completion were also different and communication around task completion timeframes were reported to be shorter in comparison.

Participants have also experienced being told by upset staff about the redeployment process, around taking a patient load, with comments such as “It is frustrating. Are you really willing to help us with our problem?” Another participant was told, “Why can you not do the same things we do in the ward?” Participants expressed negative sentiments toward being redeployed. Some statements from participants included, “I was anxious.” “I feel unfulfilled, it is very task based” and “It is very tiring. It can cause burnout.”

The emergence of personal perspectives on how to improve redeployment occurred mostly midway through the later part of the interviews, where the focus shifted from the participants’ experiences to what they would like to achieve or what others in the future might experience. Most participants (N = 5, 71%) verbalized their personal perspectives on redeployment and the buddy shift (see Table 2). A recurrent comment was the need for more orientation and training. Specific areas, such as PACU and ED, were mentioned as key areas for gaining valuable experience and exposure for future deployment. A particular recurring skill that staff identified as vital was IV insertion, due to the frequency with which redeployed staff are asked to perform this task. A couple of participants also suggested the value of feedback, wanting to understand more about how the wards felt during their redeployment. A participant pointed out that “There was no way for us to provide feedback about the whole redeployment process.”

Discussion

This quality improvement study highlights the actions taken to enhance staff experience during redeployment and seeks feedback on the experience of the redeployment buddy shift. The feedback highlights similar themes that have been historically reported by staff during redeployment. The interviews also suggested that staff are keen to receive feedback and be involved in planning future redeployment. A key outcome of this project is the improvement of redeployment experience, addressing both current needs and future planning for new staff.

Our results suggested that while the buddy shift yields positive outcomes, such as increased orientation, greater exposure to other areas, and a desire for feedback, long-standing issues related to communication and negative experiences remain unresolved. Furthermore, it highlighted the challenges in achieving the goals of improving communication and enhancing team dynamics, which are essential for better and safer staffing and care outcomes (Marks et al., 2021). Interview data suggested that limitations of the buddy shift were accentuated by the difficulties of catering to staff in a busy area. The areas most frequently requiring additional support are those with increased workload acuity and staff shortages, or both (Tang et al., 2025). Realistic and focused objectives, such as familiarization with the layout, identification of tasks that can be competently performed by redeployed staff, and escalation of concerns, have been overshadowed by chronic issues surrounding staff shortages, increased workload complexity, and mixed emotions. While some participants reported positive experiences, most concerns identified in the previous study remain unchanged.

Communication challenges have been the main issue reported by most staff participants. There was a sense of uncertainty around what needed to be done during redeployment, and staff were critical about task assignments. Staff were not introduced to the team, unsure about what needed to be done, and the primary team was uncertain about what the redeployed staff could do. Clear and effective communication is a cornerstone of safe, effective, and high-quality healthcare. Communication is vital to the proper and optimal functioning of the nursing team. Without effective communication, the care provided to patients by staff is at risk, and staff are left isolated in challenging situations (Abdulmohdi & Huang, 2025). Healthcare teams benefit from effective communication by improving team dynamics with proven positive effects on team dynamics, collaboration, and coordination, and promoting a sense of belongingness (Marks et al., 2021; Ward & McComb, 2018). It is crucial that the busier the area, the more effective the communication is (Abdulmohdi & Huang, 2025). Some focus points for staff communication include clear instructions, closed-loop communication, active listening, and communication structure that directly impacts overall patient outcomes and staff satisfaction, and experience (Brunton & Cook, 2018; Tang et al., 2025).

Staff verbalized a sense of vulnerability, acknowledging that medication or procedure errors are inevitable if they are continuously redeployed without adequate training on clinical and technical skills. Each participant's main buddy has a full workload; in one participant's scenario, the assigned buddy had to be changed mid-shift. The buddy served as both a mentor and a preceptor for staff who are new to the area (Rebeiro et al., 2017). They were designed to offer hands-on support, guidance, and coaching to staff members working with them (Jones, 2023; Molle & Allegra, 2021). This becomes challenging if it is added to a standard workload. The nursing workforce in New Zealand is multicultural, with almost half (46%) of total registered nurses being internationally qualified with prior experience before working in the country. The participants in this study reflected the national demographic mix of registered nurses in most units in New Zealand. Most participants are experienced nurses, and the majority have experience overseas; however, they have only worked in New Zealand for less than a year at the time of participation. Experience in areas of specialty may not necessarily be transferable in all areas of nursing practice (Brunton & Cook, 2018).

Frequently requested tasks, such as venipuncture, are not a skill commonly practiced in the critical care unit (home ward) due to the presence of invasive monitors that allow for blood sampling for most patients. Specific technical and clinical skills, such as drain management, titrating infusions, and setting up devices and equipment, are taught to nurses depending on the specific requirements of their assigned area. Although this is part of the education program, it is not prioritized over skills that will be used in the unit. Essential skills for all healthcare staff include communication, empathy, cultural safety, time management, critical thinking, and accountability (Dunning et al., 2024; Ossenberg et al., 2025). It highlighted the variation in technical skills required for each clinical area and specialty, which is a consideration but not the determining factor when allocating staff to wards for redeployment (Dunning et al., 2024; White et al., 2025).

Staff also expressed concerns about an imbalanced workload, noting that a high number of tasks are often allocated to keep redeployed staff fully occupied during redeployment. Effective workload sharing is determined by assessing the task, assigning it to the most appropriate person for the job, and collaborating with the team on planning and evaluation (Buchan et al., 2022; Peters, 2023). This emotion was further compounded for some staff who experienced being given inappropriate comments about their competency when a task was declined because it involved an unfamiliar procedure. Staff should be supported in verbalizing concerns, decline to perform assignments when appropriate, and be helped to learn transferable skills. They should also be educated to grow as professionals (Chen et al., 2021; Chilson et al., 2024).

The positive aspects of the interview centered on staff recognizing the need to upskill, gain more exposure, and provide insight into how the process can be improved. Staff recognized the need to work as a team and help each other out (Dunning et al., 2024; San Juan et al., 2022). Being a part of a team and having a sense of belongingness are factors that can improve job satisfaction and decrease burnout (Buchan et al., 2022; Ossenberg et al., 2025). This reflects the positive attitude of the nursing team that can serve as a basis for future planning and improvement.

Strengths and Limitations

This is a follow-up research study examining interventions that can enhance the experience of redeployment for ICU staff to other clinical areas. There is currently no national or international guideline to support preparedness for staff redeployment. The authors acknowledge that redeployment is a practice that will continue; however, there is considerable room for improvement to enhance patient safety, improve staff experience, and optimize organizational workflow. The interventions implemented in this study are based on the application of previous known research on staff experiences in redeployment. The findings are limited to a single site and cannot be generalized; however, they can serve as a basis for comparison in other hospitals within the country that operate within the same health system and contracts. The findings of this study offer valuable insights and suggestions for future research on this topic.

Implications for Practice

This paper fills a gap in literature by specifically exploring the experiences of critical care nurses routinely redeployed to cover shifts in response to gaps in adequate and safe staffing. The findings do not provide a conclusive nor concrete answer to the current issue on staff redeployment, however provide a strong basis for increasing the amount of training and education for staff, review of operational policies, and the need for further research to provide evidence in making redeployment work better for patients, staff involved and organization or health system utilizing this as an ongoing tool to provide staffing cover. Unless issues can be addressed and effective action taken, the redeployment process will put patients at risk, lead to inefficient use of nursing resources, and increase stress and negative sentiments among staff. Lastly, the findings of this study can be applicable to future proofing, planning, and strengthening of the nursing workforce flexibility and preparedness to respond to global pandemics such as the previous COVID-19, where this concept was highlighted internationally.

While the authors acknowledge that substantial resources have been allocated for the buddy redeployment shift, more resources are needed based on the feedback received. This should encompass ongoing training and research. Overall improvement can be achieved by identifying the rationale, engaging participants, and implementing opportunities driven by both external (regulatory) and internal drivers (staff) to advance current practice (Stouten et al., 2018).

Conclusion

The findings revealed that the challenges that ICU nurses experience during redeployment to other areas are similar to those encountered during their buddy shifts. Communication was a major challenge identified by participants, with concerns around safety and task focus also being highlighted. Although resources were allocated and a plan was in place to support new staff in redeployment, the gap in expectations and learning needs remains significant. The buddy shift to the new and unfamiliar work area provides context and exposure, but it remains challenging to determine how much exposure or orientation to other hospital areas is feasible and what it can achieve.

Supplemental Material

Supplemental Material