Nursing Home Administration – What Type of Person Does it Take?

I’m always amazed when someone tells me they want to become a nursing home administrator.  Especially knowing what I know now.  When I started out, I simply thought that it was a respectable career and that it was all financially oriented.  Boy, was I wrong!  I had no idea that you’re involved in every area of running a skilled nursing facility and have to make decisions you’ve never even thought about before.

I have had several people ask me how to break into the industry and I have offered tips along the way with a friendly question, “Sure that’s what you want to do?  It’s not for everybody.”  And that’s true.  It’s not for everybody.  It takes a special person to do what we do.  You have to be both logical and creative; firm but caring; compassionate but a bit toughened when it comes to criticism.

What I mean by that is you have to have thick skin.  You can’t let what others think influence your decisions that much or get to you emotionally.  I have critics all over the place.  Every family member tells us we’re not doing things right… while their suggestions most certainly would land me a few F-tag deficiencies if implemented.  Every staff member thinks we’re playing favorites when they don’t get their way… even though their way would leave us short-staffed every wekend.  Every surveyor doesn’t understand why our systems don’t operate perfectly… when the surveyor has never ran a facility.  Every hospital ER nurse and physician thinks nursing home nurses don’t know what their doing… even though the ER staff is more qualified to patch patients up instead of doing what we do – manage complex disease processes 24 hours a day – day in and day out.

Yes, we have a lot of critics, detractors, backseat drivers, and armchair quarterbacks.  A lot of people who have no idea what it really takes to run a successful nursing home or how many hours after 5 pm – when most people are clocking out – you’ve had to put in to ensure your patients received everything they needed.  They don’t realize that we’re here for a higher purpose than to just make them happy.  I can’t allow their criticisms to affect me or else I simply wouldn’t come back to work.  I’d find a better job that paid more with less stress.

While I appreciate and will consider the opinions of the outspoken critics, in the end, I will do what I believe is right for my residents – with you, without you, or through you – regardless if you agree or disagree.  If the armchair quarterbacks knew how to run a facility, they’d be running a facility.  But, they’re not.  At the end of the day, it’s still me.  I’m still doing what the others aren’t.  I’m still trudging along when others have gone home for the day.  I remind myself that this is a marathon, not a sprint. It’s a battle of attrition and that the long and steady pace I’ve set will continue to carry me forward.

To all the detractors and critics, I didn’t see you ensuring our residents were safe during the tornadoes.  I didn’t see you going and picking up staff during the snowstorms.  I didn’t even see you putting together a fire watch schedule or making rounds when the fire alarm panel decided to stop working.  As a matter of fact, I didn’t even see you go out and get your mother an Arby’s sandwich when she decided she wasn’t eating anymore last week.  Luckily, I did that for you and she enjoyed the sandwich.  You see I take care of her 24 hours a day, not just when you visit.

It’s very easy to stand back and criticize others, but it takes a strong person to take all the criticism and still do the right thing when they know a critic isn’t going to be satisfied.

That’s what kind of person it takes to be a nursing home administrator.  Be sure to bring your armor!

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13 Responses to “Nursing Home Administration – What Type of Person Does it Take?”

  • 31years ago I was 31, the age of my administrator. When he asked me if I would like to close our meeting in prayer I say, “Yes, sir.” I refer to him as ‘sir’ because I’m not speaking to ‘an’ administrator, I’m responding to a young man who has an old man’s wisdom and discernment. In a devotional that included a true story of a shepherd and a naval commander, I referred to my administrator as, “Our shepherd and Our captain.” and said, “We are depending on YOU to save us because YOU are our shepherd and captain.” Your article has been good to read and reminds me of our great administrator; a man I deeply respect, at half my age.

  • Mark on

    Thank you so much for the kind words Chaplain Smith! I really appreciate it!

  • Rey on

    Excellent dose of reality. A+

  • Mark on

    Thank you Rey!

  • Danita on

    This was deep on many levels! Sounds like you are a servant-leader. I would like to thank you for sharing this information. I am applying for an AIT position with The Good Samaritan Society and this is information was definitely needed!

  • Mark on

    Thanks Danita! I’m glad it was useful. Good luck with your AIT application.

  • Dena on

    That is an awesome article. Very well articulated and very true! I will never stop being amazed by the families that come in and see their loved one every day or several times a week. There aren’t many that do it and it does my heart good to see them. I will also never stop being amazed by thos that never come in or come once a year and have so much to say to us!

  • Mark on

    Thanks, Dena. Very true!

  • James Baker on

    AMEN and AMEN….Did you mention hearing aid and eye glasses recovery and laundry!

  • Mark on

    How could I leave those out? The laundry ghost strikes another facility!

  • Mark Stevenson on

    Great article…caring for the elderly and dealing with the revolving door of staff and staying compliant and keeping corporate happy is TOUGH. You must have thick skin, fellow Administrators in which to rely on and and confidence in your conviction on how to properly run a building and not be afraid to make mistakes and own them

  • Doug Williams on

    “It’s not for everybody.” “You have to have thick skin.” Truer words were never spoken. For nearly nine years, I did the very things you speak of and then some for more hours than I can count, most of the time to the benefit of our residents and families. Because I do NOT have thick skin, however, I spent way too much time and energy trying to make the “squeakiest wheels ” – namely the residents, family members, and staff – happy, at the expense of the trust of my supervisors. As it stands, having been let go from two facilities in less than two years, despite a successful stint in between, I fear my time in this career may have come to an end. Readers: Heed Mark’s advice well. You MUST know the regulations like the back of your hand. They are the context within which you have to operate to survive, let alone succeed, as a nursing home leader. On this basis, you must CONSISTENTLY and CLEARLY communicate expectations to department heads regarding all things necessary to the success of a nursing facility (census, expense control, care delivery systems, environmental cleanliness, etc.) and hold them accountable for meeting them. While, as an administrator, you must have your finger on each of a building’s many pulses at any given point of time, you can’t keep the heart beating strong and the facilities arteries clear all by yourself. Without their complete buy-in to and execution of clear directives, a building has no hope of hardwiring systems of care delivery and service that survive the departure of a strong leader.

    Reading this post makes me realize I truly loved serving the most vulnerable among us in this capacity, and what a privilege it was to have the responsibility I had. I did make a difference at times, and have only myself to blame for not surmounting the road blocks. Make no mistake: there WILL be road blocks to reaching these goals. While there are always a core of folks who are truly dedicated to doing whatever it takes to ensure we are able to do all we can for our residents, there are a varying number of others who will do everything in their power to throw you off track. Without a firm sense of what you need to do to be successful, the ability and willingness to clearly communicate that vision, and the willingness and strength to educate, work alongside others and hold them and yourself accountable for results, your chances of long-term success in this industry will be negligible. I will do all I can to convince someone to give me another chance, but I’m under no illusion regarding the difficulty of this challenge because I will not pass the buck of responsibility for my situation.

    If you are considering entering the profession, be forewarned. This position is one of the toughest around, and requires a very unique skill set. It is not for everybody. I hope this is helpful to someone.

  • Mark on

    Thanks, Doug, for sharing your heartfelt experience. It really hits home. I think you’re exactly right – new administrators or even individuals thinking of coming into the field need to hear what it’s really like.

    What I’ve found is that it sometimes takes awhile to find an organization that it’s possible to be successful in. I have changed companies multiple times not necessarily because I wasn’t performing but more along the lines that I didn’t feel the company and it’s leadership at that time was right for me.

    An option that I’d like to share with those who have the flexibility of moving around a bit is that you can always be an interim administrator. This gets your foot in the door of a company without being tied to it permanently. While serving as the interim, you can evaluate the company & its leadership and see if it’s a good fit for you. Observe how the leadership treats its other administrators. Look to see if their budgets and staffing make sense. Are the administrators dealing with borderline harrassment from consultants or are things handled professionally?

    You can also evaluate the facility and determine how much of a headache it’s going to cause you, which frontline staff really control the building’s morale, etc. If it’s not a good fit, well, you’re just there temporarily. If, however, you think it is a good fit, all you have to do is deliver results while you’re there and tell them you’re interested in staying on board (if they haven’t hired a permanent NHA yet). Let them work out the details with the recruiter if you used one.


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