Management skills for tomorrow's nursing home administrator

Nursing Homes, April, 1993 by John R. Pratt

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.