Voices of Administration

Table 8. Voices of Administration

Printer Friendly...Table 8

Sample &
Determine the relationship between perceived importance and actions.
  • Southeastern state
  • 49 nursing home administrators
  • Survey with 4 point rating scales
  • 48 items within major categories
  • Positive & significant relationships found between importance and participation ratings in most major role categories.
  • These are:
  •   - complying with policies, standards, regulations,
  •   - fostering positive working relationships in the organization
  • High importance, low participation
  •   - developing long range plans,
  •   - budget development,
  •   - reaching out into the community
  • Low importance and low participation
  •   - nursing research activities,
  •   - devoting attention to public policy and its effect on the institution
Abedzaden & Heine, 1992
Determine if higher educational standards correspond to a higher preparedness for NH administrators
  • Oklahoma and Connecticut
  • 263 nursing home administrators
  • Mail survey
    Administrators rated functioning, 4 pt. scale
  • Connecticut required a bachelors degree, to be a NH administrator, while Oklahoma did not
Education did not seem to have a significant effect on job performance and preparedness for nursing home administrators. The years of experience had a direct effect on performance and preparedness of administrators. Al-Assaf, Taylor, & Langston, 1992
Determine expertise priorities by size of HC agency and administrator tenure.
  • USA - all members of home care associations
  • 226 home care agency administrators
  • Mail survey
 Expertise Priorities
Size of Agency1st2nd 3rd4th
Tenure of Respondent1st 2nd3rd4th
1-2 yearsOper.FiscalP&DClin.
2-8 yearsFiscalOper.P&DClin.
8 + yearsOper.FiscalClin.P&D
Anderson, 1989
Identify characteristics of effective NH executives
  • North Carolina
  • 35 nurse executives &
  • 37 nursing home administrators
  • Mail survey with 5 point Likert response set
Nursing Executive Importance Ratings
Support from NHA4.81
HRM skills4.74
Flexible & able to negotiate4.43
Fiscal management skills (lowest)3.68
NH Administrator Importance Ratings
HRM skills4.8
Knowledge re: gvm't & accrediting agencies4.54
General nursing skills4.51
Ballard, 1995
Determine opinions regarding important measures of nursing home quality.
  • National survey
  • Randomly selected NH administrators & DONs
  • Mail survey following outline of federal certification forms, 17 categories & 161 specific items
  • Top three areas:
  •   1 Quality of care
  •   2 Quality of life
  •   3 Resident Rights
Harrington et al., 1999
Hear perspectives on causes of staff shortages in home care agencies.
  • National survey
  • 841 home care administrators
Causes of homemaker / aide shortage:
Low wages60%
Poor benefits35%
No advancement34%
Top Causes for RN shortage:
Non-competitive salaries36%
Increased paperwork20%
Decreased RN pool17%
Contributing factors
Increased paperwork72%
Non competitive salaries69%
Decreased RN pool41%
Weekend work35%
No advancement34%
Poor role image29%
Poor benefits28%
Increased shift work19%
Jones, 1988

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Identify how home care agency administrators identify common quality problems.
  • National survey
  • 128 adminis-
    trators or DONs
    of exemplary home care agencies
  • 1-3 hour telephone surveys with semi-structured interviews
  • Open-ended questions, then coding done for problem scenarios
  • Top Methods How Administrators will Identify Problems:
  •   -Employee notifies
  •   -Other staff notifies
  •   -Supervisor notifies
  •   -Client/family notify
  •   -Supervisory visit
  •   -Documentation
  •   -Other
  • Problem & expected method to identify problem:
  • Client-worker clash
  • client feedback,
  • Unreliable worker-,
  • client feedback, supervision, documentation, other staff
  • Patient deteriorates
  • audits, staff feedback, supervisory visit
Kane, Frytk, & Eustis, 1997
To determine why nursing staff turnover so high.
  • Massachusetts
  • Nursing home administrators and DONs
  • Data from state records, then open ended questions in interviews
  • Found all nursing homes had turnover problem, regardless if for-profit, not-for-profit, small or large home
  • None of the variables studied appear to lower turnover rates, question: Why is situation so nearly universal?
  • Found both management and nursing personnel dissatisfied
  • Each group focused on their own needs
  • No mention of patient directly
Kraus, 1974
Determine state requirement for resident satisfaction surveys in nursing homes and assisted- living facilities.
  • USA -50 states
  • 50 directors of health services
  • Mail survey, TC follow-up
  • Of 50 states:
  •   12 use satisfaction measure
  •   7 have on-going measurements required, usually annually
  •   4 use face to face interviews;
  •   3 mail surveys
  • Response rates varied from 51 to 87%
Lowe, et al., 2003
Examine the effect of Medicaid prospective reimbursement system on the management behavior of nursing home administrators.
  • Maine
  • Survey in 1984 & 1986 (n=106 and 92 nursing home adminis-
  • Survey solicited information on cost control strategies and mechanisms / responses to re-
    imbursement incentives
  •   -In 1984 high proportions of administrators used cost control methods, higher proportions in 1986 used cost control methods.
  •   -All cost centers were being more effectively monitored.
  •   -Substantial increases in number of heavy care Medicaid patients.
  •   -Managed facilities in ways that allowed them to benefit from special incentive features of prospective system.
  •   - Most popular responses were to maintain a high occupancy, retain a stable proportion of heavy care Medicaid patients.
Reid and Coburn, 1996

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Explore reasons for nursing home administrator turnover.
  • Texas
  • 72 graduates of an AIT course (45 long stayers and 27 left field)
  • Telephone survey with
  •   - personal factors
  •   - NH position factors
  •   - expectations
  •   (5 pt scale)
  • High turnover administrators had:
  •   - more job dissatisfaction
  •   - expectations not met re; staff turnover, time demands of work, pressure from regulatory agencies
  • Organizational emphasis on efficiency & autonomy over work.
  • Insufficient resources to meet licensure pressures
  • Reasons attracted to job:
  •   -wanted to help people or
  •   -wanted to reform or improve nursing home care
  • Low turnover administrators:
  •   -had close, caring relationships with elders
  •   -had worked in another capacity in nursing home
  •   -reason attracted to job was one of relatives worked in homes, enjoyed working with elderly or acquaintance recruited them.
Rubin & Shuttles-
worth, 1986
Identify relative amount of time spent and importance attributed to specific job activities of home care nurse execs.
  • Penn & New Jersey
  • LTC Executives
  • 57 home care
  • 25 nursing home
  • Mail Survey of 51 activities rated on 4 point scale regarding time spent and importance
HC & NH Executives' Top Ranked Activities
22Maximizing reimbursement
34Financial Performance
45Quality Assurance
53Interpreting impact of changes
6///Defining goals of organization
79Identify standards of nursing care
86Regulatory surveys
97Communicating to staff
10///Dealing with client complaints
///10Develop policies & procedures
Scalzi & Wilson, 1993
Determine which factors, attitudes, and personal factors can predict tenure of NH administrators
  • Michigan and Indiana
  • 552 nursing home administrators who stayed in LTC from previous job
  • Mail survey, 42 questions, rated on 4 point scale
Top Ratings of Administrators (4 point scale)
Skill Compatibility3.22
Performance Outcomes3.31
Community attachment3.10
  • Predictors for > 3 years employment:
  •   - past job stability
  •   - community attachment
  •   - nature of job separation
  • Found relationship between facility operational outcomes & administrator's organizational commitment
Singh & Schwab, 2000
Investigate which job dimensions influence nursing home administrators tenure
  • Michigan & Indiana
  • 552 nursing home administrators
  • Mail survey
  • Dimensions significant to longer tenure
  •   1. Realized expectations (re: supervisor, ethical/moral values, philosophies)
  •   2. Organizational demands & skill compatibility (by staff, residents, families & satisfaction with current staff)
  •   3. Commitment to the organization (trust, enthusiasm, loyalty, concern for org success, motivation to perform)
Singh & Schwab, 1998
Determine what nursing home administrators use for their management control reports
  • Southern California
  • 43 nursing home administrators from proprietary institutions
  • Survey questionnaires & interviews regarding management control practices & Examine data reports to state health department.
Reports with Highest Monthly Use
Dept. Expense Reports 92% - 97%
Process Control reports 70% - 97%
Computerized accounting, admissions/discharges, department work hours
Revenue Source Reports 92% - 97%
Inventory Control Reports 70% - 82%
Income Control Reports 79% - 94%
  • Cash flow, income statement, balance sheet
  • Reports used least frequently
  •   51% volunteer hours
  •   42% laundry processed
  •   42% report on FTE staff
Smith & Chatfield, 1985

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References for Table #8

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