How to survive bad building and staff syndrome at a SNF-How do you do it-What is your advice....

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Clayton in Romeoville, Illinois

53 months ago

Do not change a thing, Learn what the ownership wants.

Staff can run you out of your facility quicker than anything. I am talking about sabataging your career. Unless you have the complete power to hire, fire, and reward unconditionally, you are a fiqure head. A Director of Nursing is the main power head at any facility.

This is how to survive.
1. Do what the ownership wants first.
2. Get your survey readiness binder up to date.
3. Get out of the facility at 5PM.Nobody likes the administrator there past five P.M. expecially the workers.
4. Think globally, intervene with the department heads only if they goof up on some regulatory isue or not doing their job.
5. The departments heads and lay employees know that Administratores a dime a dozen, so you run amuck on them; they will sabatage you. With that said the ownership will have no choice to fire you. It is cheaper to fire an administrator than clean house due to sick (bad employees who do not do their job) building syndrome.
6. Keep head low, do what the ownership wants, don't make friends with staff, keep positive and up-beat in persona.
7.At all costs-do not micro-manage. That is a kiss of death to your career. The staff will rebel. They can add two years at a place and know they can bamboozzle an administrator for the sake of their job security.
8. If you give a directive to a department head. Give them a deadline of a week to complete it. Follow up. If they employee does not do it. Express your disappointment and state to them the reason it should have been done, it is unacceptable that the task was not done, and that it may lead to disciplinary action in the future. But first ask them why it wasn't done and why you were not informed.
9. Do not push your employees, The workers and department heads are going to do whatever they want to do no matter how you direct them.
10.Concentrate on keeping the budget in line, cost control, overtime control, and marketing.
11. Census is a must.

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Clayton in Romeoville, Illinois

53 months ago

your comments please...

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Stm 101 in Yuma, Arizona

53 months ago

All of your comments are right on. I've been administrator of 9 buildings, 59 beds to 350 beds. First and foremost, the administrator must be a marketing wizard. Census is NUMBER ONE at every company. Number two is survey. It doesn't have to be perfect, but the POC must be implemented perfectly. Learning how to write a vague, but acceptable, POC is an art unto itself. And, as you said, do not push the staff. Staff, good or bad, is difficult to come by. DON? I know I must have one, personally I find them sort of useless. But, that's just me.

My opinion is that administrator is generally nothing more than the punching bag for everyone that walks through the door. Everyone knows how to do the job better, faster and cheaper than the guy doing the job and they are not shy at relaying that information to you. I just smile when I read about all these folks that want to become NHA's. Good luck with that career choice. They have no idea.

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Clayton in Romeoville, Illinois

53 months ago

Yes. Thank you for your reply.

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no name in Cadillac, Michigan

52 months ago

Clayton in Romeoville, Illinois said: Do not change a thing, Learn what the ownership wants.

Staff can run you out of your facility quicker than anything. I am talking about sabataging your career. Unless you have the complete power to hire, fire, and reward unconditionally, you are a fiqure head. A Director of Nursing is the main power head at any facility.

This is how to survive.
1. Do what the ownership wants first.
2. Get your survey readiness binder up to date.
3. Get out of the facility at 5PM.Nobody likes the administrator there past five P.M. expecially the workers.
4. Think globally, intervene with the department heads only if they goof up on some regulatory isue or not doing their job.
5. The departments heads and lay employees know that Administratores a dime a dozen, so you run amuck on them; they will sabatage you. With that said the ownership will have no choice to fire you. It is cheaper to fire an administrator than clean house due to sick (bad employees who do not do their job) building syndrome.
6. Keep head low, do what the ownership wants, don't make friends with staff, keep positive and up-beat in persona.
7.At all costs-do not micro-manage. That is a kiss of death to your career. The staff will rebel. They can add two years at a place and know they can bamboozzle an administrator for the sake of their job security.
8. If you give a directive to a department head. Give them a deadline of a week to complete it. Follow up. If they employee does not do it. Express your disappointment and state to them the reason it should have been done, it is unacceptable that the task was not done, and that it may lead to disciplinary action in the future. But first ask them why it wasn't done and why you were not informed.
9. Do not push your employees, The workers and department heads are going to do whatever they want to do no matter how you direct them.
10.Concentrate on keeping the budget in line, cost control, overtime contr

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no name in Cadillac, Michigan

52 months ago

no name in Cadillac, Michigan said:

Oh gosh, I could have written this! My last assignment lasted for three years, and as the administrator I suffered quite a bit at the hands of very long term staff that sabatoged everything I did in order to preserve their standing with a very aggressive corporation that acquired us; but, what's worse is that someone always took credit for the things I implemented.

I have a lot of experience, but your message speaks volumns, and will print it out and keep it in my pocket to read everyday.

Thanks.

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Clayton in Romeoville, Illinois

52 months ago

Zapping Conflict in the Health Care Workplace by Dr. Judith Briles ...is a wonderful book to inform you what goes on with employment and job sabotage from fellow workers on all spectrums of interdepartment relationships. It even suggests what to do about it.
I hope this helps.

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Clayton in Romeoville, Illinois

52 months ago

Another book to assist you in protection yourself is called
1,001 ways to inspire by David Rye.

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no name in Mattawan, Michigan

52 months ago

Thanks Clayton, I will find these books!

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Jill

52 months ago

Some good advice there.

Any advice on how to survive a bad owner?

Also how much information do other administrators get regarding the budget? I find that a lot of bills and accounts receivable go directly to the corporate office. The corporate office always wants the bills lower, but there is no information as to bench marks, what is typical, and if the facility is actually making a profit or is the owner claiming poverty (while buying new cars, boats, flying around in their own planes, making extensive renovations on their homes, going on several vactions, etc)just to make irresponsible extreme cuts. Also when looking at some of the costs attributed to the nursing home, they are not actually from the nursing home but from another division of the corporation. Such as a corporate office employee that doesn't do any work for the nursing home.

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stm101 in Westminster, California

52 months ago

If you work for a big corp..Golden Living, Mariner, Country Villa in California, forget it. They are in control of all numbers. Real, not real, its all the same. I don't feel the numbers I get from the corporate masters have anything to do with reality, espically in the area of expense allocation. Those numbers can be massaged any which way and as administrator you have no say in the matter. The monthly reports, just like the budget, is nothing more than an smoke and mirrors operation.

It's been my experience than none of the companies pay their bill on time. I've given up making excuses. I now tell the vendor if they want to get paid they must cut me off. Just tell me "no more for you, starting right now" and they will get paid. We've burned every vendor there is.

Of course the corp office wants the bills lower and the census higher, that's the game. Then when the census is high they demand a better payor mix. What's your rehab goal for this month and what is your action plan to get there? How many times have I heard that one? What's your marketing plan? There are only two marketing plans used in LTC. Cookies to the case managers and the free lunch to ever can help you and will take the free lunch. Neither of these work.

Its never been different at any facility I've run. My last place, I didn't even see the financial's and it didn't matter. Census was full, employees were cut to the bone, except for nursing, which no one can control, food cost what it cost, supplies cost what they cost, shop it or don't, save a few pennies or don't and what else is there?

In the end you still have to have the lowest paid people giving the best possible care. Now that's a tough one.

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Jill

52 months ago

I've worked for a smaller corporation and its not that different from how you describe the larger corporation except that I don't get any numbers from them. They look at our nursing supplies, food supplies, etc. and demand lower costs. But there is no definitive way of determining what is actually reasonable. Some costs are top secret and some attributed to your nursing home is just an outright lie. And they lie so easily.

I spoke to the consultant dietician about our food costs - she stated that our costs were less than the prison in the next town over. (She is also a consultant there.) She also recommended changing vendors. I think the corporate office is reluctant to change vendors because then they would have to pay their bill. We changed therapy companies and were sued by the previous company for unpaid invoices. All of our vendors are pre-approved by the corporate office so it is really on them to reduce costs by changing vendors. Also they don't really pay their bills anyway, so whats the difference?

In regard to case mix I find that the corporate office is asinine. They run off your talented staff with their constant scheming to save a hundred bucks here and there. You are left with incompetent people who don't have the training and ability to operate a SNF. The company then loses thousands of dollars each month all because they wanted to save a few hundred. Its totally stupid.

So now the company is left with huge fines from survey because they refused to provide the support and funds to operate the nursing home. They have an new incompetent and unscrupulous nursing team. They are too stupid to realize the need for additional training. Then they pass the blame on to the administrator rather than changing their way of doing business. They continue to scrimp on the nursing home needs effectly denying the residents a safe and comfortable home. Apparently the fine was much too low.

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stm101 in Westminster, California

52 months ago

You have said everything I didn't. Whatever we just said take them both, mix it together and we have one cohesive post. What you said about rehab companies...totally true. Rotate em like underwear. Same with pharmacies, don't pay the bill and the next one lines up for the burn, and they will get burned, just like the last five.

The overall problem is that the margins are so thin that there is no way to make money, except to not pay the bills. I understand what the corporations are doing, but the fallout comes down on the administrator. I do my part which is census and regulatory. If it all falls down there is not much I can do except be blamed, which is the administrators primary job.

I start tomorrow getting an RCFE license. In California, if you have a SNF admin. license, it only takes 12 hours of classes and no test to get the RCFE license. Start tomorrow and done by Thursday, new license. Maybe that will be different.

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Alyssa in Newaygo, Michigan

52 months ago

It is extremly important to recognize the leadership style and center culture in order to be successful in your career. Transactional leadership is valuable in organizational cultures centered upon such beliefs, conversly transformational leadership is essential for other centers.

It has been my experience that you do not try to fill someone elses' shoes when you enter a new building. Bring your "own shoes", identify the fundamental culture of the center and implement strategies to incorporate yourself into the center.

Do not be afraid to work alongside the staff. This builds commarderie and respect. Be available, open door policy and work all shifts to identify performance and mentoring opportunities.

My experience has resulted in higher than ever satisfaction ratings from patients and staff and improved operations.

Good luck!

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stm101 in Westminster, California

52 months ago

MCWS in Des Moines, Iowa said: As a rookie Administrator who jumped from being a C.N.A. to an Administrator and with one day of orientation, I had the idealistic notion to change the world of the nursing home I was at. I wanted it to be the best in the area with the utmost best customer service. Well, the advice Clayton gave sums up what happened to me. I was sabatoged and am now seeking new employment

Let me understand this...you were a CNA one day and the next day you were administrator? There has to be more to this story. No college? No state and federal exam? No license? I'd sabotage you too if I was still a CNA and you were now the administrator.

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stm101 in Westminster, California

52 months ago

Now, with the rest of the story out there, you deserve nothing less than high kudo's for pulling yourself up from CNA to administrator. CNA's should all look to you as an example of what can be accomplished with the right attitude and some very hard work. It is time to move on to a new place where you are looked at as the administrator from the second you walk in the door. Congratulations and good luck.

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clementine2 in Mount Pleasant, South Carolina

52 months ago

I must agree with everything that Clayton says...Census and Surveys...Make your staff happy..You will never make your surveys if your staff rebels, they will bring you down.

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wonderment in Indianapolis, Indiana

51 months ago

I have been the Executive Director for one year, in a small building. At first I was hesitant to step on any one's toes; which only lead the staff to believe they could do as they damn well pleased.Sabatoge? Yup, that too. I have however "put my foot down".I no longer tolerate "passive/aggressive" insubordination. All I ask is that each employee do his or her job. Can't be a team member? Hit the road! State likes it. My patient care is better for my newly found attitude. My surveys are all passed, my CMI is increased and family members and my own boss are happy!. My biggest problem right now is the budget. With the new CIS survey and the MDS 3 I feel that I must build a wall of staffing to meet the new requirements; which means budget cuts elsewhere. I am friendly, I interact with residents and with staff. I do my walking rounds.I hold staff members accountable. Do I micro manage? Yes,I am the personal PIA for all department heads. ( I am also a nurse). Yes I do micro manage because my licensure depends on it!

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restlessintexas in Athens, Tennessee

48 months ago

I have really liked reading these posts. Sometimes I feel like I'm the only one who has had issues relating to sabotage, corporate control, etc. Its a tough road when you are asked to leave a position because the "staff said you spend too much time with a resident", "she gave away 30 year old tables", and because I was discovering serious issues within the nursing department. I also agree with the post who said DONs are not needed. They sit in their offices and gossip and never get out on the floor. After 21 years and many jobs I don't know what else to do. Its very rustrating. I found comfort reading today.

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Clayton in Romeoville, Illinois

48 months ago

restlessintexas in Athens, Tennessee said: I have really liked reading these posts. Sometimes I feel like I'm the only one who has had issues relating to sabotage, corporate control, etc. Its a tough road when you are asked to leave a position because the "staff said you spend too much time with a resident", "she gave away 30 year old tables", and because I was discovering serious issues within the nursing department. I also agree with the post who said DONs are not needed. They sit in their offices and gossip and never get out on the floor. After 21 years and many jobs I don't know what else to do. Its very rustrating. I found comfort reading today.

Hang in there. You will find a job. To do well we should ingratiate the staff and enlist their help. Work on our interpersonal and emotional intelligence skills then add them to our already honed leadership abilities. I still think being altruistic to give it all to the seniors entrusted to our care. We as administrators need to keep driving love, care, and service to our subordinates so we all give excelent care to our senior citizens.

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restlessintexas in Etowah, Tennessee

48 months ago

Clayton in Romeoville, Illinois said: Hang in there. You will find a job. To do well we should ingratiate the staff and enlist their help. Work on our interpersonal and emotional intelligence skills then add them to our already honed leadership abilities. I still think being altruistic to give it all to the seniors entrusted to our care. We as administrators need to keep driving love, care, and service to our subordinates so we all give excelent care to our senior citizens.

Its tough to 'hang in there'. After 21 years of dedicaton its discouraging to know that staff have so much control over your life, your livlihood, your ability to pay bills and find employment. I've had a history of turning poor performing operations into making a profit, excellent surveys, employee morale boosting programs, no complaint surveys, etc. This last facility had five administrators in less than 2 years. I was #6. The entire 30 year history they had 2 then one guy got promoted and when he left that's when the 6 came in. I'll have a hard time getting hired because I'm seen as ajob hopper. They can't seem to concentrate on the good things I've done only that I've moved around a lot. (for some good reason, not because I've been fired).

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Runnerkenn in Dayton, Ohio

47 months ago

From all of your comments it certainly is apparent why the public hates nursing homes. None of you mentioned the consumer. Shame on you.

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restlessintexas in Athens, Tennessee

47 months ago

Runnerkenn in Dayton, Ohio said: From all of your comments it certainly is apparent why the public hates nursing homes. None of you mentioned the consumer. Shame on you.

What the heck does that comment mean? The consumer (the resident) is the reason I got in this business. To give them a bit of quality of life makes me proud and comfort knowing I'm doing God's work. Its the staff who will work against you if they don't get their way, if you try to hold them responsible or resist any kind of change. No, not shame on me. Or the greedy companies who spend thousands of dollars on useless consultants who come to the building and don't do anything!! I feel blessed that I have devoted over 20 years in serving the elderly and their families. Plus I've been there with my own parents in the nursing home and can see things from all sides. My aunt is in a facility in Atlanta. Her airconditioner was broke for over 2 weeks. The building is falling apart and they have one maintenance man. So in the meantime she suffers because the company could not afford one other person to help these people. Now that's a shame to let someone suffer in 100 degree heat. Never point fingers its not nice.

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Curious in Loudon, Tennessee

42 months ago

I have been reading these posts as a means to explore the NHA as a career choice. I have been in healthcare for over 20 years and feel it is time to use my leadership skills gained in rehab as a NHA. After reading many of these posts I am beginning to think I should go in another direction. This sounds like an awful career.

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lumin in fort worth, Texas

39 months ago

Curious in Loudon, Tennessee said: I have been reading these posts as a means to explore the NHA as a career choice. I have been in healthcare for over 20 years and feel it is time to use my leadership skills gained in rehab as a NHA. After reading many of these posts I am beginning to think I should go in another direction. This sounds like an awful career.

I am considering a career as an NHA in TX. I've called and spoken to several NHAs in my area and none of them were half so miserable as everyone on here seems to be. It's very discouraging. I don't know if this is an accurate representation of how all NHAs really feel or if it's just a case of folks who are frustrated being the ones to post. Any chance things are different state by state?

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NHA in Brea, California

39 months ago

So let me understand this, you spoke to a few NHA's in Texas? What does that mean? Quick phone call? In depth face time? What does that mean? Texas has nothing to do with the question. NHA jobs are the same, the same problems, the same staff, the same corporate office, the same surveyors, the same family members, the same residents. I've run 8 facilities, nothing changes.

It's a hard, frustrating job, with never ending demands from all sides. The NHA is the whipping boy for everyone that is unhappy. Lost socks? My fault. Sub-optimal case mix? My fault. Overtime? My fault. Missed that 3.2 again due to staff call-offs on the weekend? My fault. Profits down? My fault. Had to spend $20,000.00 on a new septic system? My fault. Surveyor problems? My fault. Litigation because grandma fell and broke a hip? My fault. Everyone knows how to do the job better than the licensed guy doing the job.

You need to go have a longer conversation.

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no name in Ovid, Michigan

39 months ago

I agree with the last comment ~ everything is the administrators fault, and we suffer greatly because of that, as the RDO will not assume any responsibility.

Also, it's unfortunate that the administrator in the larger corporations have no authority to terminate staff (in particular nurses, whether they are just adequate, or downright dangerous) without corporate intervention by people who do not practically live at the center... believe me, if your license is on the wall, and you are on a sick day, or on vacation ~ CALL THE CENTER 3-5 times a day, speak to various staffers, and ask hard questions... go down the line of all potentially reportable events to see if any of them could be remotely construed as such! As the LNHA, you are ultimately responsible for everything that happens under that roof, and around the grounds!

After nearly one year of being asked to leave due to something the DON neglected to tell me, I am finding it quite difficult to find work again. Now, that same DON is facing a situation that mirrors what she did to me; however, I will bet that she does not loose her job: because she is a nurse - a dangerous, gossiping, uncaring, neglectful, lying, attention seeking, back stabber who no one should trust.

I am looking at employing my skills in other venues after more than 40 years in health care ~ I started as a nurse aide in a nursing home when I was 15, and have seen SNF’s morph into what they are today… feeding the owners, and shareholders meal tickets: and, supplying them with the funds to have multi-million dollar copper roofs on their homes, off of the backs of some of the most hard working people imaginable.

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lumin in fort worth, Texas

39 months ago

If it is truly so awful to be an NHA in any facility, in any state then I can only imagine people continue to enter the business because they are totally unaware of the conditions they are about to be surrounded by. Are things any better for AL Managers or in CCRCs? If an individual is interested in this industry what is the best path?

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Suzanne in Hazel Park, Michigan

39 months ago

I have been in the Long Term Care setting for 30 years. I am an RN who has worked her way up from ADON, to DON to Administrator. Quite frankly, I find all these comments very disturbing. I have had very good experiences in my facilities for the most part. I think maybe there is a problem with many of you not knowing how to manage people and/or perhaps not knowing anything about the business you are trying to run. If you don't understand the business your staff will know and not have respect for you. I have no problem managing my employees and getting them to do what they need to do to have a great facility. The key in my opinion is team building.
I have managed Assisted Living and Muti-level facilities as well and find them basically all the same. I have worked for large companies and private owners.
Something tells me I wouldn't want to work for any of you either!

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No Name in Ovid, Michigan

39 months ago

Ah, "ass-kissing-yes-man" is the key to success in LTC. I have observed over my decades of working in LTC (SNF's, AL, IL/Retirement, Hospice, etc.) that it's those folks who don't have the guts to stand up for what's right that get on okay in their "setting" ~ instead, they take their frustration to the local pub, or home, bridge games, Tupperware and Mary Kay parties, or to confession, to unload. It has nothing to do with how well one manages employees, or what we know about the business; unfortunately, we do know TOO much about the business and where the profits go... not to the residents well being unless citations mandate, not to staff pay increases after 2-3 years of waiting for one, not to better food... I could go on and on. And, I too have worked for large and small organizations ~ and Suzanne, you are correct they are all "the same." Plus your comment "I have had very good experiences in my facilities for the most part," implies that your experiences have not been all a bed of roses "for the most part." Additionally, running "assisted living ~ large and midsized" is not the same as a SNF, as you have made no mention of being a SNF administrator (a entirely different animal). Good luck in your ivory tower, you just haven't had your nose-bleedin' yet!

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restlessintexas in Collierville, Tennessee

39 months ago

I agree. The strangest thing for me is how 'weird' the upper management acts. It is impossible to be yourself because you never know from one day to the other if you will be fired because of something you said, or what someone THOUGHT you said or if your head will be on the chopping block because of census or spending. Yet, I stay because I do love caring for the residents and helping families. I hope someone will do the same for me when I get there (it's not that far away)

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No Name in Ovid, Michigan

39 months ago

I think "upper management" feels similar to the way we do ~ afraid that if a hair is out of place they will be eliminated.

I have tried other health care settings to manage, but I keep coming back to LTC... the residents and families; as well as, the employees ~ that's where my smiles come from.

RestlessinTexas ~ are you looking for work?

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Curious in Loudon, Tennessee

39 months ago

I agree. The SNF environment is totally different than an ALF. Anyone who hasn't experienced frustration of managing within an LTC center isn't being honest, especially with themselves.

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runforthehills in Morristown, New Jersey

38 months ago

I was an LNHA for several yrs in many facilities (large and small, corporate and private). The over-regulation, greedy owners, labor unions, low-paid and often uncaring staff make this one of the hardest and most thankless job there is. Standard business and management skills do not work in this environment. Trying to use them will frustrate you. Unless you are truly dedicated and impervious to constant lack of respect and criticism you will not be happy. There is no shortage of sad stories and stress. If you stay in this profession too long you paint your career into a corner and never be able to transition out. So sad for all the frail elderly who need good care and truly dedicated and caring staff that serves them. I got out and have no regrets.

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Mark Stevenson in Bullard, Texas

33 months ago

I work in Tyler,Texas as a Marketer/Admissions for a large SNF company based in Ft.Worth. Primary focus is Census, with Medicare cuts, you have to get more bodies in beds. My Administrator is good, she does not get rattled by all the screaming for census from Corp or Regional folks...we all know census is cyclic.
I am becoming a LNFA for the challenege and the opp for more money. I know its a 24hr a day job.duh...I love to lead and see it all come together..when your fair and firm with people and dont allow yourself to be held hostage by staff..you will be OK. Of course protect your license and trust a few fellow LNFA's to advise you when needed..And dont ever kiss butt..respect goes out the window and your doomed. ALl LNFA's will be fired, its inevitable,

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Clayton in Romeoville, Illinois

33 months ago

Hi,

Thank you for following this string. Good luck to you. It is rewarding but frustrating, and we have to have nerves of steel.

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Clayton in Romeoville, Illinois

33 months ago

I have an idea,
Instead of being a NHA there is another job out there. Usually requires a B.A. in business, or another type of degree. It is called Practice Administrator. This position is where you would oversee a large medical clinic of physicians and nursing staff. Some large medical practices require you to be an R.N. but many it's not required. More women get this type of position. It also could mean I don't have the credentials.

It seems that one would would have to get ICD9, medical office billing, insurance, experience,with some managerial background, a little business savvy and high emotional intelligence which we all have in our profession. If you have those, it would be a good fit for the Practice Administrator position.

I think if I had an B.A. in business or M.B.A. and the ICD9, billing and claims experience I could compete for such a position. I know the pay is real good for this position. Job security seems better too.

I just think the job of Practice Administrator or Director would be a good alternative. just throwing the idea out there.

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Kiara C in Norfolk, Virginia

32 months ago

lumin in fort worth, Texas said: I am considering a career as an NHA in TX. I've called and spoken to several NHAs in my area and none of them were half so miserable as everyone on here seems to be. It's very discouraging. I don't know if this is an accurate representation of how all NHAs really feel or if it's just a case of folks who are frustrated being the ones to post. Any chance things are different state by state?

I know it seems this way because we always write or comment on the negative. Postive attributes are rarely highlighted the way they should be. The title of this post should have told you it would be a depressing forum. I look at these post as practical advice for when I do become an administrator. If I feel like reading inspirational posts, I try to avoid topics like these.

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Steve in Brea, California

32 months ago

I've run eight facilities and enjoy all aspects of the job EXCEPT for the endless calls from corporate wanting to know what my Medicare census is at that minute, what the case mix is and why am I taking so many g-tubes (easy money smaller reimbursement)and what my marketing plan is to increase the Medicare patients and find patients with higher RUG levels. Those calls are ENDLESS AND A PAIN IN THE A--. Other than that the job has its issues like any other job, but for the most part is enjoyable. Don't be discouraged. Like the poster above said, we tend not to talk up the positive.

This may not be a good forum for those thinking about the profession.

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Mark Stevenson in Tyler, Texas

32 months ago

All LNFA's today have the challenge of census biting at their heels constantly. The whiplash of cuts digs into profits which force buildings to take higher acuity pts or figure out a niche to attract referrals from the hospitals. Some say doing vents is money, but the risk is high..here in Tyler, many folks are remodeling their buildings for memory care wings..and buildings need to have RN's that can do TPN, simply doing PEG tube is not enough. Also taking bariatric pts is becoming a need. The landscape is changing. If you are a new LNFA, try to get in a large building and be an assistant and learn, and then get a building by yourself, so Ive been told. All in all, I love this business, and I know it can be a b__tch, but, I will take stress and a good paycheck over unemployment anyday.

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Kam in Longview, Texas

32 months ago

To me this seems this forum is a place for frustrated administrators to vent to other admins or ppl from a similar backgrounds that can actually understand and relate. I am a new NHA, having very recently passed my NAB exam. There was a reason I chose this field, and yes, at the expense of sounding very naive, I will say it is about the people. Its the residents and staff. Some of the people I have come to know during my AIT are the most amazing and loving ppl I have ever met. In my opinion working in a nursing home requires intrinsic motivation, you have to have a higher purpose otherwise you will hate every second of it. Anyway those were my 2 cents. I have benefited greatly from you all's insights.

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duney99 in Bend, Oregon

32 months ago

Being an NHA is just plain hard work and not for everyone and yes many of the companies are bad. A few of my own points:
1- If you are running a building and do not have the power to hire and fire why are you working there? The staff will make or break you and during your interview it should be very clear that you must have that authority, otherwise you set yourself up to fail. I do not understand why you would not have control of the most critical component of your work in any field. Every company has their policy on how to hire and fire and we have to work with in those boundaries.

2- Nothing gets corporate, regional and anyone else off your back like success. Yes it is all about census now make it happen! Mother Teresa even said, no margin no mission. We are not social workers, we run multi-million dollar business!
BTW the way the best marketing program you can develop to boost census is to ensure outstanding care and service to your residents.

3- I have seen far too many administrators who are afraid to act. I have turned around several buildings using the same budget and other resources that the previous person had at there use. Victory goes to the bold start begging forgiveness rather than asking permission.

4- Sitting in your office trying not to tick off the staff is not leadership and never creates a successful business. Get out there and lead, or get a new job. Are you driving the culture of your building or are you allowing someone (DON) to do it? The team needs to know you have a compelling vision and that you are willing to work hard to bring it to reality... This means long hours and hard work including staying at the building past 5pm. Reading that statement helps me to understand why the staff finds it so amazing that I am at work late. BTW they bring me food, drink and offer to help me.
5- Most importantly develop your people! It is the most important thing that we do and produces the biggest results.

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jillpense in Chatsworth, California

26 months ago

I have read every single comment and have found many helpful tips on how to be a successful administrator. I want to thank each and everyone for their insightful comments. I have one question. I am a newly LNHA. The only experience I have is my AIT rotation. I am finding it very challenging to find a job. I cannot even get an interview. Does anyone have any suggestions on how I can secure at least an interview and a hopefully a job as an LNHA in California?

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Fla in Woodside, New York

21 months ago

I just wanted to ask I am LNHA, Ive been in this position for more than a year, In your opinions or in the course of your careers was it normal for you to recruit for nurses and physical therapists or was it the DON's job, the reason I ask is because the DON at our facility keeps making it up to me when I personally feel he would be better qualified to recruit for these positions...please I would really like your feedback

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Clayton in Romeoville, Illinois

21 months ago

Dear FLA in Woodside,
Best thing to do is partner with your DON to recruit for nurses and therapist. You will need to place the advertisement for the staff, thus sign off on the cost and the company you work for will pay for the recruitment. Then as applicants come in your DON would interview them first, then you would interview, or conduct a group interview. As the Administrator you have veto power to assist in the selection and not select the candidate of the DON's choice. I usually leave the hiring decision to the DON for nurses. I never had gotten involved with the DON's choice of a nurse. The DON who has a wealth of experience in nursing should make the decision because she is best to choose the candidate for what the facility needs are. I hope you DON is good judge of labor. If not enlist the help of your nurse consultant for ideas.

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