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Management skills for tomorrow's nursing home administrator.

What sort of training will you need to meet tomorrow's challenges? Here are the most likely "in demand".

Those words, written by management expert Peter Drucker in 1980, are particularly appropriate for nursing home administrators today. The field of nursing home administration is indeed turbulent, to say the least, and only the most sanguine of observers would predict that it will be any less so in the near future.

Today's nursing home administrators are faced with a frightening array of pressures, including cost constraints, increasing government regulation, intensified quality concerns, uncertainties regarding reimbursement, growing competition, demographic pressures, staffing shortages, and constant public scrutiny of what they do. While some of these pressures have been felt before, the number and intensity of them on nursing homes in the '90s are unlike anything seen in the past. If administrators are to survive in this environment, and their facilities to prosper, they will need to be adept at all aspects of management.

The skills needed by good managers are not new, as such. They are, however, new to some current nursing home administrators. Many of them have "come up through the ranks" as nurses or other professionals. Others have come from outside the long-term-care field. In either case, they have often found themselves in management positions without any formal management training.

The skills that they do have are, to a large part, defined by regulations. Though nursing home administrators are licensed by state licensing boards, educational requirements for licensure range from a high school diploma in some states to a college degree with a long-term care concentration in others. Even many of the states requiring baccalaureate degrees do not require that they be in management. The National Association of Boards of Examiners for Nursing Home Administrators, Inc. (NAB) is working valiantly to bring some uniformity to the state requirements, but much variation still exists. Meanwhile, Federal requirements, as included in the proposed OBRA '87 regulations, also do not as yet specify the nature of the degrees required by existing nursing home administrators.

Much of the focus of licensing boards is on assuring that administrators understand the nature of the services they offer, and can handle the day-to-day duties relating to those services. The national licensure exam used by many state boards has historically covered the topical areas of Patient Care; Personnel Management; Financial Management; Marketing and Public Relations; Physical Resource Management; and Laws, Regulatory Codes, and Governing Boards.

Today's nursing home administrator must master, or at least understand, each of these areas. In addition, he or she must learn about such relatively new concepts as service-based care, quality improvement, and new information technology.

Proficiency in all of these specialized skills is necessary for success as a nursing home administrator. However, even that will not be enough for the future. While all of these are vital to administration, and all involve some aspects of management, none specifically address the overall management of an organization and the people who make up its staff. There are other, more generic, management skills to be learned.

Essential Management Skills

Management is best defined as "the process of working with and through others to achieve organizational objectives in a changing environment."|2~ Notice the three components of that definition that specify the skills needed by effective managers: 1) working with others; 2) achieving organizational objectives; and 3) working in a changing environment.

Working With Others

The essence of management is working with people, usually subordinates, and bringing out their best. There are certain skills that can be learned which will increase an administrator's effectiveness in working with others. These include communication, delegation, motivation, understanding group behavior, and conflict resolution, each of which bears brief explanation here:

Communication skills are needed in every aspect of management. Few administrators think of themselves as poor communicators, but in reality, even fewer are as accomplished as they think they are. They need to know what constitutes good communication, in terms of both quantity and quality.

Delegation is a critical element of management, yet one at which many managers are not very adept. Successful management involves multiplying one's own talents through the efforts of others. When handled well, delegation can improve the functioning of the organization and can relieve the manager of some duties. Equally important is the empowerment it gives to other staff members. If they are to give their best to the organization, they must be allowed to take risks, and even to make occasional mistakes.

Motivation of subordinates requires leadership. A successful manager knows how to develop willing followers, even in difficult times. Motivation as a management skill involves knowing the difference between effective motivational techniques and short-term gimmicks that may produce only the illusion of motivation.

Group Behavior, and the factors that influence that behavior, can be identified and predicted, with appropriate knowledge. Understanding the subordinates for whom the manager is responsible, and how they are likely to react to certain situations, can avoid many common managerial mistakes.

Conflict Resolution constitutes a major part of any manager's job. When working with and through others, an administrator can expect conflict, and needs to know how to deal with it. Much of the skill of conflict resolution is based on a recognition that conflict is inevitable and even essential, and something which a manager must know how to face. Conflict is not always negative. When handled properly, it can be beneficial to the organization.

Achieving Organizational Objectives

It does little good for a manager to work successfully with and through others if those efforts are not directed toward meeting the goals of the organization. It is the manager's job to know what those objectives are and then move the organization toward their accomplishment. This, too, requires certain skills, including knowledge of organization design, team-building, priority-setting, and productivity improvement.

Organization Design skill involves understanding how organizations are structured to best meet their goals, the effect of those structures on the delivery of services, and the various design models that have been tried and tested in the field.

Team-Building is an essential skill for any manager, particularly one who deals with diverse talents, such as are found in nursing homes. There are techniques to be learned for creating organizational unity that will not stifle individual initiative -- a balance critical to any successful organization.

Priority-Setting is essential to achievement of goals and objectives. An administrator who is able to effectively determine priorities for the many tasks facing the organization is already well on the way toward accomplishing those tasks -- and minimizing confusion.

Productivity is a topic that has often received much lower emphasis in nursing homes (and other health care organizations) than in other industries. However, the environmental pressures mentioned earlier demand that nursing homes continually become more efficient in delivering quality services.

Working in a Changing Environment

A nursing home administrator must be adept at recognizing changes in the environment within which the organization exists, and must be proactive in addressing those changes. There are management skills and areas of knowledge that will help in that regard -- skills relating to strategic planning, managing change, and managerial ethics.

Strategic Planning skills are valuable, both in assessing environmental factors and in leading the organization in a positive direction. While some nursing home administrators have access to professional planners, all should understand basic planning processes, which can be applied in either formal or informal management situations.

Managing Change is a skill that can be cultivated. Successful changes need to be accomplished in an atmosphere of flexibility and preparation. Knowing how to create that atmosphere will enable a manager to be more effective in meeting the challenges of change, and capitalizing on its opportunities.

Managerial Ethics is a topic of increasing importance for nursing home administrators. As change takes place with ever-increasing speed and regularity, administrators need a solid grounding in ethical principles on which to base their actions.

These management skills, separately and collectively, are critical to the nursing home administrator of the 1990s and beyond. This most important industry holds both the promise of exciting new levels and types of service and an unprecedented demand for competent, innovative managers, capable of meeting the challenges they pose. Those managers will need to know not only the details of their business -- resident care, regulations, finances, personnel management, and physical resource management -- but they will also need, as they have never before needed, the basic personnel skills required of all managers, related to working with and through others to achieve their organizational objectives.

Those skills can be learned, and it is a rare nursing home administrator who would not benefit from some amount of management education at any point in his or her career.


1. Drucker PF. Managing in Turbulent Times. New York, NY, Harper & Row Publishers, 1980; 41.

2. Kreitner R. Management (fifth edition). Boston, MA, Houghton-Miflin Company, 1992; 8.

John R. Pratt is Director of the Long-Term Care Management Institute at Saint Joseph's College, Windham, Maine. He served for 25 years as a hospital chief executive and administrator, and has published numerous articles in professional journals, including "Strategic Planning in Long-Term Care Organizations," in The Journal of Long-Term Care Administration.
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Author:Pratt, John R.
Publication:Nursing Homes
Date:Apr 1, 1993
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