Interim Nursing Leadership and its Ins and Outs

The use of interim nurse leaders is common, but information on how-to help them transition to their roles is not. Mayo Clinic's nurse administrator Dale Pfrimmer shares advice on how to support interim leaders.

A certain level of uneasiness is natural when there's a change in nursing leadership. While the new leader is busy trying to get his or her arms around a new positon and develop a mission, vision, goals, and priorities, staff must adapt to a new leadership style and new initiatives.

And if this weren't complicated enough for both parties, adjusting to a new captain of the ship is even trickier when the leadership position is for an interim period.

Having been in an interim position in the past and also having hired interim nurse leaders, Dale Pfrimmer, RN, MS, NE-BC, nurse administrator at the Mayo Clinic in Rochester, MN, recognizes there are certain nuances to being an interim nurse leader. But, while using interim leaders is a common practice, information on how to help those taking the positions achieve success is sparse, he says.

"I had utilized interims a number of times and when I did a literature search [so I could] give them articles to help them prepare, [but] there just wasn't much out there at all," he says.

So armed with the hope of sharing success strategies, Pfrimmer and his co-authors wrote the article "Interim nursing leadership: A win-win opportunity," which appeared in the September 2015 issue of Nursing Management. He recently spoke with me and offered his thoughts on interim nurse leadership.

One-Size Doesn't Fit All
It may be assumed that those stepping into interim roles have their eyes set on winning permanent leadership positions, but Pfrimmer says that's not always the case.

"Usually, people are interested in the role, and this is a nice way to take it out for a test drive," he says. "I do think that there are probably about one-third of individuals who aren't interested in the role, but [they take it because] they want to see a smooth transition for the sake of the unit and for the patients."

When Pfrimmer took a role as an interim unit director in a neuroscience ICU, he was in the latter group. He went in with the intention of keeping the ship steady until a permanent unit director could be found and when he realized nursing leadership and administration was the career path for him, he was surprised.

"That was a turning point in my career. I loved being an ICU bedside nurse, so that was kind of an eye-opening experience," he says. "Becoming the nurse manager, I realized I could help the unit function smoothly for all shifts. It just felt like I could do greater good."

When hiring for an interim position, Pfrimmer looks for candidates who will also place a value on furthering the greater good.

"I look for someone who has the qualities of servant leadership; who says, 'I'm here for the unit and I want to support the staff and ensure a smooth transition,' vs. 'I've always wanted to be in charge,'" he says.

A Need-to-Know Basis
Though putting the team ahead of yourself is admirable, Pfrimmer does not recommend jumping into a position without first getting more details. Potential interim leaders need to be informed about exactly what they're getting into.

Some questions Pfrimmer recommends an interim job candidate ask before accepting a position include:

• What's the anticipated length of tenure?
• What are the expected challenges?
• What kind of orientation is available?
• What are my motives for pursuing this?
• How will my relationships with coworkers change?

Staff nurses contemplating a move to a leadership role should be especially mindful of the answer to that last question.

"I think this is really difficult for staff nurses stepping up into this role because oftentimes you're stepping into a role of supervision with colleagues who perhaps have a lot more experience than you do or are a lot older than you are," he says.

Support for Success
To help establish an interim leader's credibility and authority, it's wise to set up a leadership buddy system.

"From the organization's stand point, even though this is an interim leader, they still need a structured orientation and an assigned preceptor and a lot of support in the role," he says. "At least, here's your contact and, ideally, here's a few people you can call when you have questions."

This is especially important if a staff nurse is filling the position as he or she may not know the ins-and-outs of leadership's day-to-day responsibilities.

"A big piece of the pairing is just the socialization into the role—introducing them into key stakeholders, making sure they know what meetings they're supposed to be at and where they're supposed to go," he says. "Much of our costs in nursing are related to staffing, so part of that structured orientation should be having them meet with the individuals from finance to explain the basics, 'Here's the bottom line. Here's what you need to know. Here's what we're watching closely.'"

Physical presence is another way to help show support. Pfrimmer suggests administrators do patient and unit rounds with the interim leader.

"We really have to be in close communication from my position, from the administration side, to make sure we're still in lockstep with the interim until there is the formal passing of the baton," he says. "It is a huge change for a work area and that causes angst among the other staff," he says.

"You want someone in there that can calm the waters and give a sense of sense of relief that, 'We're in good hands here until we know the next step.'"