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Nurse Officers Stave Off COVID-19 Burnout With Help of Interim Execs

Analysis  |  By Carol Davis  
   March 22, 2021

Health systems are employing temporary nurse leaders to help executives take a much-needed break.

Nursing executives experiencing stress and fatigue from COVID-19 are getting relief, in the form of time off and workload help, from interim executives to provide the break they need to avoid burnout.

Much of the burnout discussion has focused on frontline and direct care nursing staff, especially during the COVID-19 pandemic. But chief nursing executives and other nurse leaders operate within the same volatile environments while also managing organizational, disciplinary, and operational stress, according to the study, Nurse Leader Burnout: How to Find Your Joy.

Some nurse executives have had few, if any, days off since COVID-19 was declared a pandemic by the World Health Organization (WHO) last March, says Brian Krehbiel, a senior partner and expert on interim leadership with WittKieffer, a global executive search firm headquartered in Chicago that specializes in senior-level, mid-level, and interim executive search.

"In hot spot areas hit early on—New York, Seattle, etc.—people have been working 6-7 days a week since March," he says. "The impact on the workforce has been the most acute in places hit hard by COVID and in those places where inpatient capacity is in short supply."

That's why some health systems are placing interim executives into rotation to help current executives take a much-needed break and return to a regular work schedule, he says.

Krehbiel talked with HealthLeaders about this trend. This transcript has been edited for clarity and brevity.

HealthLeaders: How often are health systems turning to interims to give their CNOs a break?

Brian Krehbiel: This is something really new—in the past couple of months—as hospitals have gone through the cycle and it’s become clear that even though we have the COVID vaccine, it’s going to be a slow process. At the end of 2020, nurses were asking if the hospitals were changing their PTO carryover processes and it really shined a light on how little PTO was being used. All in all, stress levels on employees are something health systems are going to have to address fairly quickly.

HL: What are some of the effects, at that leadership level, of working so much?

Krehbiel: I've had the opportunity to discuss the toll this is taking with health system CEOs and HR executives. A lot of nurses have the instinct to sacrifice for the greater good, meaning that they work and work until their cup of energy wears down and stress starts to take a greater toll. Now, a year after COVID started spreading across the U.S., we’re getting to the point where these CNOs are frazzled.

HL: Who are the interim CNOs that you recruit and what qualities and skills do you look for when you're recruiting them? 

Krehbiel: Typically, the leaders looking to fill these roles are late in their careers and want to stay active, but also want more flexibility in where and when they do their work. Most importantly, we look for an interim’s ability to communicate and deal with complex situations. Obviously, talent is important, but we also try to make sure their personality meshes with the organization’s culture well, so they feel at home and there is a high level of mutual trust.

HL: What happens when an interim CNO is placed in an organizational culture and structure that varies from his or her background? Have you seen issues arise because of this? 

Krehbiel: It is hard to send someone from Louisiana to Manhattan or vice versa. We try to make the best match possible so that when an interim enters the rotation at a new organization it is a smooth handoff.

HL: How does adding an interim into a hospital system work, exactly?

Krehbiel: Currently, these search processes are occurring virtually. We can typically find a credible interim within one week compared to a search for a permanent placement, which would take six to nine months. These interim placements are often overqualified, coming into a 200-bed hospital with experience at a 600- to 700-bed hospital. For example, we worked with two interim CNO placements who went to hospitals in the Northeast and were able to get everything stabilized quickly. Now, one of those interims has been asked to stay on permanently and the other did so well that the hospital is delaying its search for a permanent CNO for six months.

HL: How long would an interim serve in that role?

Krehbiel: For COVID-related interim CNO placements, we typically have the interim go for 12 weeks. An average interim placement is a seven-month process, but for [COVID-related help], it would be a bit shorter. It’s also very customized to each facility.

HL: Besides giving nurse leaders much-needed time off, what are other benefits of hiring an interim right now?

Krehbiel: Permanent CNO job searches are taking longer right now, as many candidates don’t want to change cities, schools, etc., right now. We have found it easier to hire interim CNOs quickly compared to filling these permanent roles. Additionally, organizations are often more comfortable hiring an interim virtually, whereas they would prefer to meet with a permanent replacement in person before making a decision. Because these interims are often overqualified, they can usually adjust and transition pretty easily as well.

HL: How do you measure success in these types of placement?

Krehbiel: We take our direction from our client hospitals and measure our success against the priorities they have outlined at the inception of the project.

“A lot of nurses have the instinct to sacrifice for the greater good, meaning that they work and work until their cup of energy wears down and stress starts to take a greater toll.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


Nurse leaders experience COVID-19 burnout while also managing organizational, disciplinary, and operational stress.

Nurses inquiring about PTO carryover revealed how little PTO was being used.

Because interim nursing executives are often overqualified, they usually adjust and transition easily.

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