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 Same As The Old Boss? Study Finds Link Between Short-Tenured Administrators, Nursing Directors, And Survey Deficiencies

America’s nursing homes have struggled for years with ways to hang on to good staff, but a new study suggests that it may be as important to hang on to the bosses as the frontline workers.
 
A team of researchers from the University of Maryland and the University Red Cross College of Nursing in Seoul has crunched the numbers and found striking correlations between the tenure of nursing center administrators and directors of nursing and the number, and severity, of survey deficiencies. The cross-sectional analysis linked nationwide deficiency data with nursing center leadership data.
 
Those centers where the administrator had been on the job for a year or less were more than twice as likely to have a survey deficiency than homes where the administrator had been on the job for 15 or more years, the research team found. Homes with short-tenured directors of nursing were nearly four times more likely to have severe deficiencies than those homes with long-tenured nursing directors.

Worse, the odds didn’t change even if the administrator or director of nursing in question had years of experience somewhere else, lead researcher and University of Maryland Professor Nancy Lerner writes for the team.
 
“To address widespread or systematic weaknesses, [directors of nursing] and [administrators] need time in their position to learn the strengths and weaknesses of the staff and facility,” Lerner says in the latest issue of the Journal of Nursing Regulation. “Refining management practices to improve communications and interaction to achieve better resident outcomes is a complex process, but one that can improve care quality in nursing homes.”
 
This is not Lerner and team’s first foray into the vexing problem of turnover. In February, Lerner and her colleagues published findings linking high nursing center staff turnover to survey deficiencies.
 
At the time, some of their assumptions were challenged by Baltimore geriatrician and multifacility medical director Steven Levenson, who argued that regulatory deficiencies aren’t the same thing as quality, and that the current regulatory regime was focused almost entirely on long term care residents, when, in fact, many more people who spend time in nursing homes are there for short-term rehab.
 
Nonetheless, Lerner and company’s latest report has the attention of David Gifford, MD, senior vice president of quality and regulatory affairs for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).
 
“High turnover at all levels, but especially at the leadership level, makes it hard to operate at peak efficiency and effectiveness,” he says. “This study is consistent with many other studies showing a relationship between turnover and quality. This is why AHCA made turnover one of our four quality initiative goals.”
 
Leadership turnover, by the numbers, shows that:
 
·         The average tenure of an administrator or nursing director is less than three years.
·         About 40 percent of administrators and nursing directors quit or are fired every year.
·         Of those nursing directors studied, about 30 percent had been on the job for less than a year; about 9 percent had been on the job for a decade or more.
·         About one-quarter of the nursing directors in the study had at least 10 years’ experience somewhere else.
·         Of the administrators studied, 23 percent had been on the job for less than year, and 42 percent had been on the job for between one to four years. Twenty-five percent had been on the job for between five and 14 years, and 10 percent had been in their jobs for 15 years or more.
·         Those administrators were more likely to have at least a little experience somewhere else, however: Only 5 percent had less than a year’s experience, 43 percent had between one and nine years on the job, 15 percent had between 10 and 14 years, and 36 percent had at least 15 years’ total experience.
—Source: “Nursing Home Leadership Tenure and Resident Care Outcomes”
 
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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