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Director of Nursing Current Job Tenure and Past Experience and Quality of Care in Nursing Homes
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    Directors of nursing (DON) are central to quality of care in nursing homes (NH) because of their role in coordinating and overseeing nursing care. Research is needed to test the association between DON characteristics and quality using large, representative samples of NHs and global measures of quality. One such measure is the quality measure (QM) rating from the Centers for Medicare & Medicaid Services’ Five-Star Quality Rating, which aggregates 10 individual QMs into a single rating.


    This study examined whether DON current job tenure or past experience (1) differed across levels of the QM rating, (2) was associated with QM ratings, and (3) was associated with any of the individual 10 QM scores that comprise QM ratings.


    Data for a nationally representative sample of 1,174 NHs were obtained from the 2004 National Nursing Home Survey, publicly-reported QMs, and an Area Resource File. Wald tests were used to test differences in mean DON current job tenure and past experience across levels of the QM rating. Multinomial logistic and Poisson regression analyses were used to examine the association between DON current job tenure and past experience and QM ratings and QM scores, respectively, controlling for selected market and organizational characteristics.


    NHs with longer DON current job tenure tended to have higher QM ratings. Longer DON current job tenure was associated with higher QM ratings and lower QM scores for several individual QMs, suggesting higher quality. DON past experience did not differ across levels of the QM rating and was neither associated with QM ratings or QM scores.

    Practice Implications

    This study highlights the need for owners and administrators to support DONs as they either transition into the role of the DON for the first time or learn to effectively fulfill their role in a new NH.

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    1UL1RR025011/RR/NCRR NIH HHS/United States
    F31 NR010039-01A1/NR/NINR NIH HHS/United States
    F31 NR010039-02/NR/NINR NIH HHS/United States
    F31 NR010039-03/NR/NINR NIH HHS/United States
    F31NR010039/NR/NINR NIH HHS/United States
    T32 NR007102/NR/NINR NIH HHS/United States
    T32 NR007102-10/NR/NINR NIH HHS/United States
    T32PH10010/PH/PHPPO CDC HHS/United States
    UL1 RR025011/RR/NCRR NIH HHS/United States
    UL1 RR025011-01/RR/NCRR NIH HHS/United States
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