Managing Up,Down,and Across the Nursing Home

Abstract

The director of nursing (DON) is an essential member of the top management team in nursing homes and in a key position to improve the quality and value of care. This article describes and examines the roles and responsibilities of DONs as perceived by a convenience sample of current/previous DONs and nursing home administrators (n = 29). Data were collected through in-depth semistructured interviews and analyzed using content analysis and thematic analysis. The findings reveal a broad scope and wide variation in the DON position across settings, with inextricable linkages between clinical care and other aspects of care delivery, such as managing fiscal and human resources (HR). As RN licensure is the only Federal requirement for the DON position, suggesting a clinical focus, the findings highlight a policy-practice gap. Research is needed to address this gap, focusing on the requisite preparation DONs need to effectively and cost-efficiently lead initiatives for quality improvement.

Keywords

directors of nursing nursing home nursing education nursing management

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References

Abedzadeh

Heine

(1992). Roles, responsibilities, and qualifications of nurse administrators in long-term care facilities. Geriatric Nursing, 13, 325-328.

American Association of Long-term Care Nursing. (2009). Position descriptions and related core competencies for long-term care nursing positions in a nursing home. Cincinnati, OH: Author.

American Association of Long Term Care Nursing. (2010). Director of nursing in LTC certification program: DON-CLTC™. Retrieved from http://ltcnursing.org/continuing-education

American Health Care Association. (2001). Competencies for senior nurse leaders in LTC. Retrieved from http://ahca.org/quality/competencies_report.pdf

American Health Care Association. (2011). Report of findings—Nursing facility staffing survey 2010. Retrieved from http://www.ahcancal.org/research_data/staffing/Documents/REPORT%20OF%20FINDINGS%20NURSING%20FACILITY%20STAFFING%20SURVEY%202010.pdf

American Nurses Association. (2009). Nursing administration: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

American Nurses Credentialing Center. (n.d.). ANCC Certification Center: Nurse Executive, Nurse Executive-Advanced. Retrieved from http://www.nursecredentialing.org/

Arkansas Health Care Foundation. (2012). Director of Nursing (DON) training. Retrieved from http://www.arhealthcare.com/Documents/ahcf/DON/DON_Info_August.pdf

Arojan

J. F.

Patsdaughter

C. A.

Wyszynski

M. E.

(2000). DONs in long-term care facilities: Contemporary roles, current credentials, and educational needs. Nursing Economics, 18(3), 149-156.

10.

Ballard

T. M.

(1995). The need for well-prepared nurse administrators in long-term care. Image—Journal of Nursing Scholarship, 27(2), 153-154.

11.

Brannick

M. T.

Levine

E. L.

Morgeson

F. P.

(2007). Job and work analysis: Methods, research, and applications for human resource management (2nd ed.). Thousand Oaks, CA: SAGE.

12.

Castle

N. G.

Lin

(2010). Top management turnover and quality in nursing homes. Health Care Management Review, 35(2), 161-174. doi:10.1097/HMR.0b013e3181c22bcb

13.

Centers for Medicare & Medicaid Services. (2007). National health expenditure projections 2007-2017. Retrieved from http://www.cms.hhs.gov/NationalHealthExpendData/Downloads/proj2007.pdf

14.

Centers for Medicare & Medicaid Services. (2011a). § 483.30 Code of Federal Regulations 42 CFR Ch. IV (10-1-11 Edition). Retrieved from http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/pdf/CFR-2011-title42-vol5-sec483-30.pdf

15.

Centers for Medicare & Medicaid Services. (2011b). § 483.75 Code of Federal Regulations 42 CFR Ch. IV (10-1-11 Edition). Retrieved from http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/pdf/CFR-2011-title42-vol5-sec483-75.pdf

16.

Decker

S. A.

Culp

K. R.

Cacchione

P. Z.

(2009). Evaluation of musculoskeletal pain management practices in rural nursing homes compared with evidence-based criteria. Pain Management Nursing, 10(2), 58-64.

17.

Donabedian

(1980). Explorations in quality assessment and monitoring (Vol 1). Ann Arbor, MI: Health Administration Press.

18.

Fleming

M. L.

Kayser-Jones

(2008). Assuming the mantle of leadership—Issues and challenges for directors of nursing. Journal of Geronological Nursing, 34(11), 18-25.

19.

Forbes-Thompson

Gajewski

Scott-Cawiezell

Dunton

(2006). An exploration of nursing home organizational processes. Western Journal of Nursing Research, 28, 935-954.

20.

Grabowski

D. C.

Stewart

K. A.

Broderick

S. M.

Coots

L. A.

(2008). Predictors of nursing home hospitalization. Medical Care Research and Review, 65(1), 3-39.

21.

Gruneir

Mor

(2008). Nursing home safety: Current issues and barriers to improvement. Annual Review of Public Health, 29, 369-382.

22.

Guion

R. M.

(1998). Assessment, measurement, and prediction for personnel decisions. Mahwah, NJ: Lawrence Erlbaum.

23.

Harrington

Woolhandler

Mullan

Carrillo

Himmelstein

D. U.

(2001). Does investor ownership of nursing homes compromise the quality of care? American Journal of Public Health, 91, 1452-1455.

24.

Kayser-Jones

(2002). Malnutrition, dehydration, and starvation in the midst of plenty: The political impact of qualitative inquiry. Qualitative Health Research, 12, 1391-1405.

25.

Krichbaum

Johnson

Ryden

(1992). Educating nurses in leadership and management. Geriatric Nursing, 13, 170-174.

26.

Lincoln

Y. S.

Denzin

N. K.

(Eds.). (2005). The SAGE handbook of qualitative research (3rd ed.). Thousand Oaks, CA: SAGE.

27.

Lincoln

Y. S.

Guba

E. G.

(1985). Naturalistic inquiry. Beverly Hills, CA: SAGE.

28.

Lodge

M. P.

(1985). Professional practice for nurse administrators / drectors of nursing in long-term care facilities (Phase I). Kansas City, MO: American Nurses’ Foundation.

29.

Long Term Care Professional Leadership Council. (2009). Essential core functions: A guide for the consultant pharmacist, director of nursing, medical director and nursing home administrator in long term care organizations. Retrieved from http://www.achca.org/content/pdf/LTCPLC_Core_Func-R_6-07lw.pdf

30.

Mor

Zinn

Anelelli

Teno

J. M.

Miller

S. C.

(2004). Driven to tiers: Socieoeconomic and racial disparities in the quality of nursing home care. The Milbank Quarterly, 82, 227-256.

31.

Morse

J. M.

Field

P. A.

(1995). Qualitative research methods—Health professionals (2nd ed.). Thousand Oaks, CA: SAGE.

32.

Mueller

C. H.

(1998). LTC Directors of Nursing define educational needs. Nursing Management, 29(11), 39-42.

33.

National Association of Directors of Nursing in Long-term Care. (2013). DON certification exam. Retrieved from https://www.nadona.org/cart/products.php?cat=21

34.

O’Neill

Harrington

Kitchener

Saliba

(2003). Quality of care in nursing homes: An analysis of relationships among profit, quality, and ownership. Medical Care, 41, 1318-1330.

35.

Office of Inspector General. (2008). Memorandum report: Trends in nursing home deficiencies and complaints. Retrieved from http://www.oig.hhs.gov/oei/reports/oei-02-08-00140.pdf

36.

Olson

Zwygart-Stauffacher

(2008). The organizational quality frontier and essential role of the director of nursing. Journal of Nursing Care Quality, 23(1), 11-13.

37.

QSR International. NVivo 9. (2012). Retrieved from http://www.qsrinternational.com/products_nvivo.aspx

38.

Quality Healthcare Foundation. DON/nurse leadership training. Retrieved from http://www.qchf.org/QCHFHome/Schedule/DONNurseLeadership.aspx

39.

Rantz

M. J.

Hicks

Grando

Petroski

G. F.

Madsen

R. W.

Mehr

D. R.

Maas

(2004). Nursing home quality, cost, staffing, and staff mix. The Gerontologist, 44(1), 24-38. doi:10.1093/geront/44.1.24

40.

Redfoot

D. L.

Pandya

S. M.

(2002). Before the boom: Trends in long-term supportive services for older Americans with disabilities. Retrieved from http://assets.aarp.org/rgcenter/health/2002_15_trends.pdf

41.

Siegel

E. O.

Mueller

Anderson

K. L.

Dellefield

M. E.

(2010). The pivotal role of the director of nursing in nursing homes. Nursing Administration Quarterly, 34(2), 110-121.

42.

Simmons

S. F.

Keeler

Zhuo

Hickey

B.A.

Sato

Schnelle

(2008). Prevention of unintentional weight loss in nursing home residents: A controlled trial of feeding assistants. Journal of American Geriatrics Society, 56, 1466-1473.

43.

Society for Industrial and Organizational Psychology. (2003). Principles for the validation and use of personnel selection procedures (4th ed.). Retrieved from http://www.siop.org/_Principles/principlesdefault.aspx

44.

Spillman

B. C.

Black

K. J.

(2006). The urban institute health policy center. The size and characteristics of the residential care population—Evidence from three national surveys. (Report to the Office of Disability, Aging and Long-Term Care Policy Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services). Retrieved from http://www.aspe.hhs.gov/daltcp/reports/2006/3natlsur.pdf

45.

Spradley

J. P.

(1979). The ethnographic interview. Belmont, CA: Wadsworth Group.

46.

Tellis-Nayak

(2005). Who will care for the caregivers? Health Progress, 86, 37-44.

47.

Tellis-Nayak

Duss

(2005). Director of nursing turnover study—Project report. The satisfied but disaffected leader. Retrieved from https://secure.illuminage.com/vhca/members/docs/operation/ReportCover061605.pdf

48.

University of Washington - School of Nursing Continuing Nursing Education. (2012). Nursing leadership & management in long term care. Retrieved from http://www.uwcne.org/specialprograms/details.asp?category=Long-TermCare

49.

Vaughan-Wrobel

Tygart

(1993). Management education needs of nurse administrators in long-term care. Journal of Gerontological Nursing, 19(3), 33-38.

50.

Weech-Maldonado

Neff

Mor

(2003). The relationship between quality of care and financial performance in nursing home. Journal of Health Care Finance, 29(3), 48-61.

51.

Wunderlich

Kohler

P. O.

(Eds.). (2001). Improving the quality of long-term care. Washington, DC: National Academy Press.

52.

Wunderlich

Sloan

Davis

(1996). Nursing staff in hospitals and nursing homes—Is it adequate? Retrieved from http://www.nap.edu/openbook/0309053986/html/R1.html