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education, nursing home ownership, retention, top management, turnover



  1. Decker, Frederic H.
  2. Castle, Nicholas G.


Background: Research indicates that the length of time a nursing home administrator (NHA) or director of nursing (DON) has worked in a nursing home may have a positive relationship to quality of care. Few studies, however, have focused on factors associated with the job tenure of NHAs and DONs. One important factor may be education level.


Purpose: This study used a nationally representative sample of nursing homes to examine the influence of education level on the current job tenure of NHAs and DONs.


Methodology/Approach: The data sources were the 2004 National Nursing Home Survey and the Area Resource File. Control variables for facility characteristics (e.g., ownership type), market characteristics (e.g., unemployment rate), and career experience were included. Data on NHAs, DONs, and nursing facility characteristics came from the National Nursing Home Survey. Market characteristics came from the Area Resource File. The analysis on NHA tenure included 1,082 cases with usable data from the 1,174 sampled facilities in the National Nursing Home Survey. The analysis on DON tenure included 1,048 cases. Job tenure was measured in number of months. Regression models on NHA and DON tenure were analyzed.


Findings: Among NHAs, and to a lesser extent among DONs, higher education was significantly associated with shorter tenure rather than longer tenure. Ownership status was a notable predictor.


Practice Implications: For owners of nursing homes, our findings may raise a hiring dilemma. Hiring the best educated NHA and DON may be advantageous, but the retention for these same top managers may be the shortest. Initiatives to hire NHAs and DONs with better educational training may need to be coupled with initiatives designed to promote greater retention.