Today's administrator and DON: the jobs aren't what they used to be—three distinguished practitioners tell why

Nursing Homes, Nov, 2004 by Sandra Hoban, Todd Hutlock

Over the years, the positions of administrator and director of nursing (DON) have evolved significantly. The DON position has gone from a hands-on clinical perspective to one that requires skills above and beyond the DON's chosen profession--nursing. Administrators have similarly seen their already heavy responsibilities increased. In addition to knowledge about the frail elderly and those with long-term disabilities, today's administrator and DON must have the administrative skills of Lee Iacocca, the computer talents of Bill Gates, the legal acumen of Supreme Court Chief Justice William H. Rehnquist, the regulatory knowledge of CMS Administrator Mark McClellan, MD, PhD, the economic foresight of Alan Greenspan, and the people skills of Dale Carnegie. Nursing Homes/Long Term Care Management invited two experienced DONs and one award-winning administrator to share their assessments of the changes in these key long-term care positions.

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Today's Administrator

Dawn R. Rowe, CNHA, has been working in nursing homes for almost 30 years, starting at age 14 in laundry and housekeeping, and then as a nursing assistant. She obtained her administrator's license in 1988, and she has been with Life Care Centers of America for 11 years; for the last five years, she has been at Life CareCenter of Tullahoma, in Tullahoma, Tennessee, a city of 18,000 roughly equidistant from Chattanooga and Nashville. Earlier this year, Rowe was given the Distinguished Administrator Award by the American College of Health Care Administrators (ACHCA). Nursing Homes/Long Term Care Management recently caught up with Rowe and got her opinions on the challenges facing today's administrator.

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In your opinion, what is the administrator's biggest challenge?

Rowe: I think a lot of that depends on the area that you're from. In some areas, it's obviously going to be staff shortages. But generally speaking, the biggest challenge is getting a compassionate staff to care for the residents the way that you want them to, at the level and standard of care you want. That is achieved through being able to provide them with the amount of education and training they need. However, administrators may not be allowed to have as much staffing and training resources as they'd like. That makes the challenge more difficult. These resources can be limited by census, regulations, reimbursement, and other external forces that are sometimes difficult to control.

Do you look back and see that things are different in nursing homes today as opposed to when you started working in them?

Rowe: I do. I've worked in a lot of different areas--a mountainous area, the inner city, affluent areas, and now in a small town--and changing cultures play a big part in things. But I'm one of those people who won't take no for an answer. You can't just tell me that the nurses aren't out there. If you aren't getting the staff you need from simply placing a newspaper ad, it means you aren't working hard enough. You need to go to the nursing schools and offer scholarships and get creative in other ways. You can offer volunteer programs and reach potential staff members in high schools.

How have you personally managed to adapt to these changes so successfully?

Rowe: I think you always have to be willing to change. You have to know that you're never going to stop growing, and your job on earth is never done until the good Lord calls you home. Never accept defeat and never lose your creativity. Sometimes, I'm not the one who has the answer--many times, my staff has it. I feel that I'm as strong as my worst CNA, but I've managed to hire the best people out there. They know what makes a great environment and what attracts people to our facility.

How is your facility affected by staffing issues?

Rowe: As I said earlier, I think this differs from place to place. In our facility, therapists are very hard to attract because we are in a small town, whereas I have no problem attracting CNAs and, in fact, at times I have a waiting list for them to come and work for us. In a big city, I likely couldn't find a CNA to save my life, but I'd have all the therapists I need. Everybody has their own set of challenges that are affected by culture and geography. You need to stay creative to solve them. I know an administrator in Colorado who went to Texas to recruit CNAs and paid their moving expenses to relocate. Life Care as an organization is bringing in a lot of nurses from other countries. You just have to stay ahead of the game!

What are some of the things that you do to maintain staff and keep them positive and motivated?

Rowe: In our facility, if any CNA wants to go to nursing school, we'll pay for it if she stays employed here at least part-time and agrees to work for us for a year after she graduates. The program at our local school, which is about a ten-minute drive from here, takes 18 months to complete and costs us about $2,000--that's less than it would cost to pay for a nurse from an agency. It's a wonderful investment, and if you want to maintain a quality staff, you have to invest in them. You can invest through education and through making a work environment that appeals to them. Staff need the recognition--they work for praise, not a raise necessarily. I have an open-door policy here, and they know that they can go to me as easily as they can go to a supervisor if they have issues.