10 Stupid Mistakes I Made as a New Nursing Home Administrator

Everyone is going to make mistakes.  I certainly have made my fair share.  Especially going into the role of a nursing home administrator which I really didn’t know anything about.  I’m lucky to have survived in this industry!   Here are a few mistakes I made as a rookie nursing home administrator.  Learn from my mistakes so you don’t have to repeat them for yourself.

1.  Not studying the regs everyday. The watermelon book is required reading…daily.  Pick 1 regulation a day and study it  until you know it. Rinse. Repeat.

2.  Not spending enough time in the business office. It’s very important to understand how billing works so you can manage it.  Make it a point to spend time in the business office and understand the office operations – A/R, A/P, and Payroll.

3.  Signing contracts.  Yeah… don’t do this. Most companies have a contract approval process which involves their legal department reviewing the contract and having certain things rephrased.  You will get in trouble for not following the process.

4.  Questioning a family – putting blame on them even when it’s their fault.  At one of my very first buildings, I had the family of a brand new admission making a complaint in my social services director’s office.  So, she calls me to come to the office.  Totally threw me under the bus.  I walked into a hornets’ nest!  This family had their dad admitted the night before and they had multiple concerns in less than 24 hours.  I was new to nursing home administration and, at the time, my building was not running great, so many of their concerns were valid.  They were going on about how dad didn’t get the right medication, how there was no bedside commode in the room when he arrived, how his light stayed on for what must have been an hour, etc.  They were just raking me over the coals.  Then they told me that they sat there and watched a resident fall and timed us to see how long it would take a staff member to respond.  I forget the exact time they gave, 5 minutes or something.  Instead, I made the mistake of saying, “You watched a resident fall and didn’t tell anyone or get any help?” Take my advice – don’t use that line.

I couldn’t believe they did that!  My question sounded perfectly reasonable in my head.  It must have come out pretty badly though as the conversation just went further south from there.  My lack of knowledge on how to talk with families resulted in a nice scathing letter to my corporate office on how poorly I had treated them, how I didn’t care about nursing home residents, and why people like me should never be given an administrator license.  I had to apologize over that little conversation error.  I got a copy of the letter.  It motivated me for awhile to improve.  Then, after a couple of years, I realized they were just nuts and so I discarded the letter and any guilt I carried over the conversation.

5.  Not apologizing. At some point, your staff members will drop the ball.  It could be something small or maybe not so small.  Many people are worried that if they apologize for the incident, that they are accepting liability for it.  So, instead of giving the family an “I’m sorry” they instead become defensive over the incident.  Many of your families just want to make sure they are being heard.  There’s nothing wrong with telling someone you’re sorry that an incident happened.  It doesn’t mean that you are responsible for it or could have prevented it.  I am sorry that Jane Doe fell at my building the other day…but there’s nothing I could have done to prevent it with the information I had at the time.  It’s ok to let someone know you care.

6.  Passing out paychecks early. I got dinged on this twice.  Many times there is an electronic transfer of funds from an operating account to the payroll account at a certain time – let’s say three o’clock on Friday payday.  If employee Suzy Q comes to you and asks for her check early because she’s going out of town at noon, please don’t give it to her.  Yes, of course she’ll wait until three o’clock to cash it.  No, she understands the funds aren’t there yet.  The next thing you know, you’re getting a call from corporate asking why people are cashing their paychecks before 3:00 pm.

7.  Not managing my expenses closely enough. I was very guilty of this early on.  I made plenty of revenue but spent it all in expense overages.  I would justify the overages by telling myself that we “needed” this or that.  My department heads would just let this happen.  They would overspend their budgets, I wouldn’t hold them accountable, and so they’d do it again the next month.  Even worse, I found myself accepting flimsy excuses – “It was a five week month.” Ummm….ok.  Now, I know better.  I managed those same departments, got everything I needed, and kept my budget under control.  If I can do it, they can do it.  No more free rides.

8.  Spending MY money. Guys, don’t spend your own money.  I did this so often starting out.  I would lose receipts, so I wasn’t able to expense it.  I once lost a $600 receipt.  I had to put my Microsoft Office skills to test and “create” a new one.  One of the companies I worked with early on had financial cash flow problems – they didn’t pay their bills well.  Our facility began to get cut off with all our local vendors for nonpayment.  We got put on a cash-only basis with many of them.  Worse still is the facility’s operating petty cash wasn’t replenished timely.  So, what did I do?  Of course I bought it out of my pocket.  I just thought, “I’ll expense it.”  The problem was that expense checks were not being turned around timely either.  After multiple purchases out of “Mark’s money” to ensure my residents had what they needed and not seeing any expense checks coming back, one day I tallied up what was owed to me.  $14,000.  Wow!  I almost had a heart attack!  I couldn’t believe I had that much out there.  I got most of it back…eventually.  I haven’t worked for that company in 7 or so years, but I still receive a small check every couple of months from $30 to $100 to pay on the two grand they still owe me from back then.  Take it from me, don’t use your money.

9.  Joking around with staff. There has to be a line somewhere, so draw it.  Starting out I had to learn a lot from my staff, so automatically that put me at a disadvantage.  I wasn’t viewed as a leader even if I was the boss.  To add to the problem, I talked to everyone as if they were my friends, joking around and stuff.  Guys, honestly, that doesn’t get you anywhere.  It’s your job to coach, mentor, and develop your team, not be their buddy.  You will be more respected and be more successful by remembering what your goal is rather than who likes you.

10.  Admitting patients we couldn’t care for. This is a bit more serious as it can have fatal consequences.  You need to have a strong team in place, in particular, a strong DON.  One that can give you specific information on what types of patients you can actually handle and what you can’t.  Don’t make the mistake of admitting a fresh trach patient – as I did – when your facility hasn’t handled trach patients in 2 years.  Nothing good is coming out of that.

Well, there you have some of my screw-ups.  I hope that it was beneficial.  At least, be careful not to make the same mistakes I did.

Good day, my friend!

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11 Responses to “10 Stupid Mistakes I Made as a New Nursing Home Administrator”

  • BKC on

    Great list! This might just anonymously end up in the inbox of my administrator…with a slightly revised title. 2, 9, and 10 really hit home for the situation in my building. Thanks!

  • Mark on

    Hey, no problem, BKC! We all screw up – Lord knows I have a lot. Sometimes it helps if someone points it out and gives us a nudge in the right direction. Good luck with the situation in your building!

  • Stan on

    One of the best nursing home blogs I’ve seen. Keep up the great work!

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  • Doris on

    Excellent post! I have seen many of those mistakes and worse. Thanks for sharing and helping others to prevent these type of situations.

  • Mark on

    Thanks so much!!

  • cjosmith12 on

    I wish I had this advice 15 years ago when I started my first administrator job. Great article!

  • Mark on

    Ha! Me, too, CJ!

  • Kyle on

    As a new administrator…very helpful. Thanks.

  • Mark on

    Thanks, Kyle!

  • Mark Stevenson on

    All of the posts are great. I made some of those mistakes as a rookie Assisted Living Administrator. Getting too chummy with staff or getting too chummy with female staff is DANGEROUS. I am a tall dark and handsome dude, so they say, and when I didnt pay attention to one weird staff member she claimed sexual harrassment. NOW, its everybody is equal and everyone is treated the same, door ALWAYS open to my office and I play it right down the middle. I will be a SNF Admin in a month, so I have learned from my ALF days

  • Mark on

    Yep. It’s good to already have experience that will translate to the SNF role. Saves you a lot of headaches.


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