title: Securing and Managing Nursing Home Resources: Director of Nursing Tactics.
abstract: OBJECTIVE
  Shrinking resources and increasing demands pose managerial challenges to nursing homes. Little is known about how directors of nursing (DON) navigate resource conditions and potential budget-related challenges. This paper describes the demands-resources tensions that DONs face on a day-to-day basis and the tactics they use to secure and manage resources for the nursing department.
  
  
  METHODS
  We conducted a secondary analysis of data from a parent study that used a qualitative approach to understand the DON position. A convenience sample of 29 current and previous DONs and administrators from more than 15 states participated in semistructured interviews for the parent study. Data analysis included open coding and thematic analysis.
  
  
  RESULTS
  DONs address nursing service demands-resources tensions in various ways, including tactics to generate new sources of revenue, increase budget allocations, and enhance cost efficiencies.
  
  
  CONCLUSIONS
  The findings provide a rare glimpse into the operational tensions that can arise between resource allocations and demands for nursing services and the tactics some DONs employ to address these tensions. This study highlights the DON's critical role, at the daily, tactical level of adjusting and problem-solving within existing resource conditions. How DONs develop these skills and the extent to which these skills may improve nursing home quality and value are important questions for further practice-, education-, and policy-level investigation.
authors.affiliation: Betty Irene Moore School of Nursing at UC Davis, Sacramento, California. elena.siegel@ucdmc.ucdavis.edu.
authors.forename: Elena O
authors.initials: EO
authors.lastname: Siegel
authors.affiliation: Betty Irene Moore School of Nursing at UC Davis, Sacramento, California.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Young
authors.affiliation: Betty Irene Moore School of Nursing at UC Davis, Sacramento, California. Department of Psychology, Tel Hai College, Upper Galilee, Israel.
authors.forename: Leehu
authors.initials: L
authors.lastname: Zysberg
authors.affiliation: Betty Irene Moore School of Nursing at UC Davis, Sacramento, California.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Santillan
mesh_terms: D000368:Aged; D006295:Health Resources; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008297:Male; D009718:Nurse Administrators; D024802:Nurse's Role; D009735:Nursing Homes / Q000458:organization & administration*; D009739:Nursing Services / Q000458:organization & administration*; D011361:Professional Competence; D011787:Quality of Health Care; D014481:United States
keywords: Leadership; Long Term Care; Management; Nursing