Nursing home administrators: roles, responsibilities, and management practices

Nursing Home Administrators

Long-term and nursing home facilities have become commonplace in many developed industrialized countries, and require adequate staffing to ensure job satisfaction and patient care. In addition to registered nurses and certified nurse assistants, the nursing home administrator plays an integral role in the functionality of nursing home facilities. The job of a nursing home administrator (NHA) is concerned with the management and high-level maintenance of these institutions that are designed to provide care to members of the elderly population. The NHA is regarded as a top manager in nursing home operations, oversees financial aspects of the home, adheres to health care regulations, and oversees the care of the residents and performance of the employees ("Nursing home administrator jobs," 2011). The NHA has a moderately good earning potential, and like most career positions within a nursing home, the NHA has educational requirements. There are growing professional concerns that the number of administrators in the industry is on the decline; this is in part caused by the high stress nature of the job, and is also attributed to the shortage in staff caused by the growing demand for nursing home facilities (Leister, 2009). The fulfillment of NHA positions is critical to maintain the proper functionality and operations of nursing home facilities.

Nursing home administrators are responsible for a variety of operational oversights within the nursing home facility. The NHA is responsible for patient outcomes, developing strategic plans and budget forecasts, and overall organizational viability (Sorbello, 2008). A highly effective NHA should also recognize the importance of addressing the needs of individual staff members, validating their needs, and facilitating a positive work environment that focuses on the value of care. It is not a novel concept that being an effective and respected boss induces better productivity, and it is with this principle that NHAs must operate. Leading by example, valuing care, having accountability, caring for staff members and patients are all critical to the NHA position (Sorbello, 2008). Overseeing day-to-day operations of the nursing home includes admitting patients, directing staff, advising staff, managing the building, accounting, budgeting, and financial planning ("Nursing home administrator jobs," 2011).

The job of an NHA is multifaceted, and requires both experience and education, as they must understand the clinical and business aspects of nursing. Education requirements for NHA positions vary, however a typical candidate must have a Bachelors degree and a registered nurse certification ("Nursing home administrator jobs," 2011). Degrees in heath care administration, health care management, financial management, and business administration are preferred. These requirements within the United States, however, vary from state to state. One study showed 15 states have higher RN standards, and 25 had higher licensed nursing standards (Zhang, Unruh, & Wan, 2006). The 2004 National Sample Survey of Registered Nurses reported by the Health Resources and Services Administration showed that 61% of all nurse administrators have a Bachelor or higher degree, while 39% have nursing diplomas or associate degrees (Decker, & Castle, 2009). The highest annual salary among nurse administrators belongs to hospital nurse administrators, whereas long-term care and NHA receive the lowest salary, with the average salary being approximately $75,000 (Decker, & Castle, 2009).

The job of an NHA is demanding, stressful, and requires the utmost attention to detail and a personable personality. Successful recruitment of nursing home administrators often comes from within the nursing home facility. Over time and with experience, registered nurses already working in a long-term facility can be qualified for the NHA position, and are preferred as they are familiar with the facility, residents, and other staff members. It is critical that NHAs are first qualified nurses, as their ability to relate to other nurses is essential to the organizational success of the nursing home ("Nursing home administrator jobs," 2011). Career paths for an NHA are rooted with education background and nursing experience. Although experience is necessary for being a successful NHA, a career path at minimum requires clinical licensing (Decker, & Castle, 2009).

The NHA is the management body over the facility, and their positions are in high demand. In the U.S. In 2008, approximately 17,000 nursing home administrators were responsible for the oversight of care for 1 million elderly adults and 1.3 million employees (Leister, 2009). Overseeing a large nursing staff, as well as vulnerable residents, are the daily demands of the NHA. The future of NHA field is concerning to researchers and professionals, as the number of licensed NHAs is on the decline. In Maryland, the number of licensed NHAs in 2002 was 601, and reached a low of 523 by 2005 (Leister, 2009). The state of Maryland needs approximately 40 to 50 new NHA graduates a year in order to simultaneously replace the retiring NHAs (Leister, 2009). Other studies consider the stress accompanied with the NHA field, and have identified a long list of stressors as contributors to the decline in newly issued NHA licenses. The greatest stress factors identified by the study involved the management of patient-family relations, for example, handling "unrealistic expectations of family members concerning care," and employee relations as main causes of job stress (Leister, 2009). The aging population within the U.S. is climbing, and so is the demand for nursing home facilities and NHAs. As the demand grows, the future of the field can experience not only salary increases, but greater stress to oversee more patients and a lowered patient to nurse ratio.