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More Than Surviving: Keys to Thriving as an Administrator

August 1, 2005
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For administrators, true job satisfaction comes from bringing meaning to other peoples' lives by Jennifer McCarthy, PhD, MPH
BY JENNIFER MCCARTHY, PHD, MPH More than surviving: Keys to thriving as an administrator
Why do administrators like their work? A scientific investigator probes for answers
It is 6 p.m. and Kayla, a young and boisterous nursing home administrator, is dancing in the dining hall and taking residents' drink orders. She knows who likes cocoa and who wants two sugars and a cream. Knowing that the day staff have left the building gives Kayla the freedom to refresh and relax in the company of her residents, and this joyful fervor symbolizes the importance of her work. She strives to impact others' quality of life and is genuinely enjoying herself along the way.

"Making somebody happy," Kayla explains, makes worthwhile "the battles that you're doing with profit-and-loss statements and budgets and state and federal government regs."

With an awareness of nursing home administrators' decreased entrance into the profession and high rates of turnover nationally, I spent part of 2004 interviewing administrators of various tenures and facility types to learn about their job satisfaction. I learned that administrators are altruistic in nature and occupy their positions for the "right" reasons. They also happen to be largely satisfied. In fact, the same administrators who rhetorically asked, "Why would anyone want to do this job?" were the same administrators who knew full well why they do this job.

It is not to say that nursing home administrators had only positive outlooks on the industry. When asked about their least satisfying experiences, they named a host of rather shocking contributors to job dissatisfaction. However, in the midst of engaging narratives, some key themes emerged to help explain why these administrators were not merely surviving, but thriving.

The Human Factor
As with Kayla, nursing home administrators are satisfied when they have the opportunity to directly engage in social and altruistic interaction with their residents. This is the big-ticket item for administration, and opportunities for hugs and hand-squeezes in the hallway provide meaningful outlets for professionals immersed in corporate reports and daily crises.

For one small facility administrator, satisfaction emerged when a resident, for whom grooming was "extremely difficult," regularly allowed her to cut his fingernails. For another administrator who I'll call Bob, it was breakfast that counted most. Upon asking staff about how he could help one morning, staff snickered and sent him in the direction of a notoriously difficult eater. Beaming with pride, Bob explained that this woman's eating habits were fully improved after his visits with her, and she began to wait for him at mealtimes.

Intimate knowledge of the rich histories accompanying residents also contributed to administrator satisfaction. Alice, a long-tenured administrator, integrated her passion for genealogy into her work. During a county-enforced placement reassignment for one resident, she successfully reconnected him to first cousins after family had lost track of him in the system 15 years earlier. Alice was also prepared to face Becka, a longtime resident who "loved men," when she one day knocked on Alice's office door and cried, "Nobody knows me! I don't know why I'm here! Nobody even knows me!" Laughing as she recounted the story, Alice described opening a drawer, removing Becka's file, and recounting aloud her family history, to which Becka slowly responded, "Well, I guess ya do know me!"

The human factor contributing to administrator satisfaction is also inherently practical. All administrators are, of course, "busy," and by and large are supported by competent, dependable department heads who do not require micromanagement. As one administrator explained, "I'm really lucky. My dietary manager's wonderful and has managed that department without my interference and done beautifully." For Shawna, a faith-based facility administrator, having confidence that her staff is "the best there is" allows her to "rest assured that if I ask one of them to take care of something, they will do it. And that is job satisfaction."

Successfully Serving
Terms such as "mission," "impact," and "making a difference" were used by administrators to help explain satisfying and meaningful job factors. Administrators with faith-based natures or within faith-based environments may be more likely to embrace the running of a nursing home as a "mission," and this perception of a "higher purpose" might itself work as a strategy for coping in difficult times. Shawna explained, "We remind each other, right up the ladder, that there are greater things than us. There is a mission." This support system based on shared values is satisfying for Shawna because it is in stark contrast to "the everyday, run-of-the-mill, backstabbing, make-the-dollar facility."

The process of achieving success and successfully making a difference was more satisfying to administrators than simply believing in the profession's cause. Achievement was in fact the most oft-cited dimension of job satisfaction among the nursing home administrators I interviewed. One long-tenured administrator described a scenario of turning a "nasty place" with indifferent owners into a strong facility with robust financials and a waiting list. Susan, a mid-career administrator, relayed a similar account of taking on a very challenging building and watching the facility make money for the first time in its history. For Laura, the optimism of producing expected outcomes shaped the vantage point of her working world. Boasting a 99% success rate on changing negatives to positives, Laura noted: