More Than Surviving: Keys to Thriving as an Administrator

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:

    One of my most favorite things, and it’s kind of a sickness, I think, is when people come in really mad. And, if I can diffuse them and calm them down, I love being able to do that! So, where some people might say, “Oh, I hate angry families,” I like the challenge of it!

The Number One Thing
The residents of long-term care give meaning to the lives of administrators in many ways. From opening windows into their souls-some for the last time-to allowing an administrator to use his or her gifts in a purpose-driven manner, the needs of residents are key components of administrators’ abilities to engage in meaningful work that informs their overall satisfaction. For Brenda, serving a higher purpose is achieved by successfully “keeping the doors open” in a constrictive financial environment. For Tom, it is fighting for the underdog that brings him so much satisfaction. He relayed how he saw a chance to engage in meaningful work after a homeless would-be resident with comorbidities was dropped from Medicaid after failing to pay $18 in premiums:

    And here’s a brittle diabetic, very blind, in his 40s, homeless, a lot of problems, been in the hospital every two weeks for about three months. And I guess I’m a person, if I think there’s a person that needs insurance coverage, I don’t take no for an answer. So, after getting nowhere with the local government people who said, “We’re sorry, that’s just how it is,” I called the governor’s office, got one of his assistants and, by the end of the day, had permanent coverage for this resident.

To bring meaning to another person’s life is central to administrator satisfaction. As Alice explained, it is in treating a person with decency and respect, in allowing a family to “let go” with security, and in making the choice to love someone out of free will. Although administrators can’t help but wonder if someone will fall in the night, or from where critical staff will come from next, they realize that their peers in other lines of work are sitting in cubicles plugging numbers all day while they are directly influencing the betterment and care of a lonely, lovely generation.

And that is, by far, the number one thing.

Jennifer McCarthy, PhD, MPH, is a researcher at the University of California, San Francisco. She conducted the research on which this article is based during the spring and summer of 2004 while affiliated with Oregon State University. For further information, phone (415) 476-0599. To send your comments to the author and editors, please e-mail To order reprints in quantities of 100 or more, call (866) 377-6454.

Suggested Reading
Pratt JR. The disappearing administrator: Results of a national survey. Nursing Homes/Long Term Care Management 2002;51(4):24, 26-9.
Singh DA, Schwab RC. Retention of administrators in nursing homes: What can management do? Gerontologist 1998;38:362-9.

Research Approach
The administrators’ quotes in the accompanying article were drawn from the author’s personal interviews with 30 nursing home administrators in 20 cities of a northwestern state. The names and locations of the interviewees are disguised to protect confidentiality. The author asked the administrators to discuss their satisfaction and dissatisfaction within the position, on the basis of research (see “Suggested Reading”) indicating high turnover and declining recruitment in the profession. She then analyzed their responses using interview-based research methods.

Topics: Articles , Facility management , Leadership