title: Leadership education, certification and resident outcomes in US nursing homes: cross-sectional secondary data analysis.
abstract: BACKGROUND
  Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited.
  
  
  OBJECTIVE
  To examine associations of education and certification among NHAs and DONs with resident outcomes.
  
  
  METHODS
  Cross-sectional secondary data analysis.
  
  
  METHODS
  This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use).
  
  
  METHODS
  1142 nursing homes in the survey which represented 16628 nursing homes in the US.
  
  
  METHODS
  Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status.
  
  
  RESULTS
  Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education.
  
  
  CONCLUSIONS
  Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.
authors.affiliation: School of Nursing, University of Maryland, Baltimore, MD, USA. Electronic address: trinkoff@son.umaryland.edu.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Trinkoff
authors.affiliation: School of Nursing, University of Maryland, Baltimore, MD, USA.
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Lerner
authors.affiliation: School of Nursing, University of Maryland, Baltimore, MD, USA.
authors.forename: Carla L
authors.initials: CL
authors.lastname: Storr
authors.affiliation: Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
authors.forename: Kihye
authors.initials: K
authors.lastname: Han
authors.affiliation: School of Nursing, University of Maryland, Baltimore, MD, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Johantgen
authors.affiliation: School of Nursing, University of Maryland, Baltimore, MD, USA.
authors.forename: Kyungsook
authors.initials: K
authors.lastname: Gartrell
mesh_terms: D003430:Cross-Sectional Studies; D004496:Education, Continuing / Q000458:organization & administration*; D007857:Leadership; D009735:Nursing Homes / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D014481:United States
keywords: Certification; Director of nursing; Education; Leadership; Nursing home; Nursing home administrator