Objectives: Nursing homes are an integral component of the US healthcare system acting as a safety net for older adults and people with disabilities. Nursing home administrators (NHAs) are responsible for supervising the day-to-day operations of their facilities and determining its strategic direction. However, nursing homes have experienced persistent challenges with high NHA turnover rates, and research has established a strong association between turnover rates and poor organizational performance. The purpose of this study was two-fold: first, to examine the relationship between NHA turnover and quality; second, to understand if the association between NHA turnover and quality is mediated by registered nurse (RN) turnover. Research Design and
Methods: Our conceptual framework is an integrated perspective based on tenets from the structure-process-outcome model and the knowledge-based view of the firm. The study uses multiple secondary data sources including the Care Compare: Skilled Nursing Facility Quality Reporting Program (SNF QRP) and Long-Term Care Focus (LTCFocus)
Results: Our final analytic data file comprised of 19,645 nursing homes for the study years 2020-2022) Our results support our hypotheses: NHA turnover associated with lower quality of care. Significantly, this effect is fully mediated by RN turnover. Discussion and Implications: Quality improvement initiatives in nursing homes have privileged nurse staffing with administrators an afterthought. Our results highlight the synergistic relationship between administrators and caregivers. While nursing homes must improve compensation and non-monetary benefits to encourage NHA retention, government intervention may still be necessary especially considering the resource-constrained environment the industry operates in.