How to Become a Nursing Home Administrator in California

Receive a master’s degree in nursing home administration. The most direct route to completing your educational requirements prior to taking the NHA qualifying exams is to earn a bachelor’s degree in nursing, nursing home administration, or other related fields. Then, complete a graduate program in health care administration, long term care facility administration, or other related fields. You will be eligible to apply for the licensing exam directly following completion of your graduate work.^[1]

• You can find lists of state and federal programs online through the Commission on Accreditation of Healthcare Management Education (CAHME).
• The NAB is building a list of accredited programs across the US, and as this list continues to grow, these programs will likely set the standard for NHA education. This may be a good point of reference when looking for a program.^[2]
• Ask other NHAs you know about their educational backgrounds. This can be a great way to hear the behind the scenes stories about educational programs, and select a school that works for you.

Take part in an internship. During your graduate studies at accredited universities in the state of California, you are required to complete 480 hours of hands-on training by interning or working in a nursing home. You can find internships in your area by talking to your professors, searching California’s NHAP site, or directly contacting long term care facilities in your area.^[3]

• You can attend any university in the US and some international programs to earn admittance to the state and federal NHA exams, but they may have different internship requirements. In these situations, you may need to complete an Administrator in Training program.

Earn a bachelor’s degree in nursing home administration. If you have an undergraduate degree in nursing, nursing home administration, aging care, or related fields, you may be able to combine your education with experience to earn approval to take the NHA licensing exam. If you have a bachelor’s degree, you'll need to apply for a 1000 hour Administrator in Training (AIT) program. If you are accepted into this program, you will qualify to take the federal and state licensing exams upon completion of the AIT.

Qualify with job experience. If you’ve worked as a nurse or supervisor within a long term care facility for at least ten years, you may be able to qualify to take the NHA licensing exams by completing the same 1000 hour AIT program that those with bachelor’s degrees complete. At least the most recent five years of your experience will need to be in a supervisory role.

Complete the Administrator in Training (AIT) program. The first step in completing this program is to find a preceptor. If you are qualifying based on work experience, you may want to start by asking the NHA in your long term care facility to be your preceptor. If you are applying with a bachelor’s degree, and don’t currently work in a long term treatment facility, you may need to look a little further to find a qualified preceptor.

• You can contact California’s NHAP for a list of qualified preceptors in your area.
• You must receive approval from the NHAP exam board before beginning an AIT. You’ll receive approval by submitting your preceptor’s qualifications, an outline of the 1000 hours of training, an application form, and the necessary fees.
• You have one year from the time your AIT is approved to complete the program.

Establish proof you met educational requirements. You will need to provide transcripts from all of your course work to the NAB. These should be requested from your university and sent directly to the NAB. Additionally, you’ll need to provide documentation of your internship hours or your AIT curriculum.

• Internships completed as part of your graduate education will be verifiable via your transcript.
• If you complete an AIT program, your preceptor will need to complete and submit an evaluation form as part of your verification documentation.

Apply to wave educational requirements. If you are working within a long term care facility run by a religious organization that for some reason hinders your ability to complete traditional education, you can apply to waive your educational requirements. However, you will still need to hold a high school diploma or GED, and complete an AIT program.

• You need to provide adequate documentation to demonstrate that you are unable to attend traditional college or university training due to your religious practices or beliefs. This can include religious texts, letters from leaders within your religious organization, and historical documentation showing that other NHAs in your facility have not completed conventional educational training.
• You will also need to provide information proving that the nursing facility you would be working for is a 501(3)(c) non-profit organization approved by the Internal Revenue Service.
• You should complete your AIT within a nursing home run by your religious organization.
• If you are granted an educational waiver, you may only be hired to work for long term care facilities within your religion.

Maintain continuing education requirements. All NHAs in the state of California are required to complete at least 40 hours of advanced training every two years. This helps to ensure you’ll be exposed to any changes in policies and new administrative criteria.

• Reach out to state and national NHA organizations to find out about seminars, webinars, courses, and other continuing education opportunities in your area.
• College courses taken by semester earn 15 hours of credit, and courses taken by quarter receive 10 hours of continuing education credit.
• If you offer seminars or teach courses to other NHAs, you’ll be able to use 16 hours of that time toward your own continuing education hours.
• Preceptors may record 20 hours of their time training NHA candidates toward their own continuing education hours.

Study for the national and state licensing exams. Your education, internship, AIT program, and real world experiences will likely prepare you to know and understand the topics covered by your state and national licensing exams. However, it’s important to take time to review the various subjects covered by each test. Additionally, taking practice exams will prepare you for the types of questions you’ll be presented with.

• The federal exam is comprised of 150 multiple choice questions. 38% of these related to resident centered care, 13% relate to human resources, 13% to finance, 15% to environment, and 21% to leadership and management.
• You can find recommended reading, practice exams, and more at https://www.nabweb.org/exam-references.
• The California exam is 100 multiple choice questions. It covers the Omnibus Budget Reconciliation Act (OBRA), the California Code of Regulations, Title 22, Division 5, and other aspects of nursing home administration performance and requirements specific to the state of California.

Apply to take the National Nursing Home Administration Examination. Once you’ve complied with basic requirements and completed your educational prerequisites, it’s time to apply for the National Nursing Home Administration Exam. You must meet all of these requirements prior to taking the exam and will need to provide documentation showing proof of your education and training in order to be accepted to sit for the national exam. The entire application process is completed online.

• Once you apply, the associated credit or debit card is validated and the examination fee is charged. As of December 2016, the fee was $375.
• You will receive an email verifying your application and the fee.
• The California state board will be notified of your application, and they will notify you and the NAB within four months confirming or denying your eligibility to sit for the exam.
• Upon approval from the California board, you will receive an email from the NAB that includes an Authorization-to-Test letter.
• Once you’ve received the Authorization-to-Test letter from the NAB, you will have sixty days in which to schedule and complete the exam.^[4]

Pass the federal exam upon approval. You need to achieve at least 75% on all aspects of the NAB exam to be considered eligible to sit for the state of California NHA test. You will be able to take the test three times within one year of acceptance of your initial examination application. If you do not satisfactorily complete the exam within the first year, you will need to restart the application process.^[5]

Sign up for the California Nursing Home State Examination. Once you have taken and passed your federal examination, you’re automatically eligible to sit for the California exam. State tests are offered four times each year. The examination dates are posted well in advance, and available through the California Department of Public Health, which is the regulating body for the state exam.

• You will need to complete an application form. The application is only one page in length and indicates to the California state exam board that you meet all of the basic and educational requirements to sit for the exam.
• If you earn at least a 75% on all aspects of the state exam, you will receive notification of your eligibility to apply for NHA licensing in the state of California via email.

Apply for your NHA license. Once you’ve received your approval and proof of completion of your federal and state exams, you still need to complete the application process to receive your license. The one page form is available online through the California Department of Public Health’s NHAP page. The document itself is almost identical to the application for the state examination. The only difference will be in the amount of the fee. You will need to fill the fee field in based on the current fee schedule at the time of your application. As of July 2016, the license fee was $350.

Prepare your resume. As you begin the job application process, you’ll need to create an adaptable document that lists your education, training, job experience, awards, and other information valuable to employers. Start with a basic list of each topic with date ranges. You may also want to provide wages with your job experience. Once you have this basic outline, you should be able to easily adapt your resume for the NHA job postings of a specific long term care facility.

• If you are applying for a position within a nursing home that caters to more active seniors, you may want to emphasize your past experience in planning and implementing activities and events within long term care communities or at other points in your life. Planning an event for a college sorority takes many of the same budgeting, organization, and other skills that planning events for seniors requires.
• If you apply for a job where the position asks for someone who can implement employee performance reviews, training, and educational practices, emphasize any experience you have with human resources.
• Most importantly, try to use the same terminology the job posting uses. If you show you can speak the language of the long term care facility you hope to work for, those reviewing your application materials are more likely to interpret your resume positively.

Ask for references. Writing a good, accurate resume that is geared toward a specific job posting is your opportunity to tell a company why they should hire you. Most long term care facilities will call your past employers to verify work history, but your past employer’s aren’t able to disclose much information to your potential employers without your prior consent. Ask your current supervisors, your AIT preceptor, and some of your coworkers if they would be willing to be contacted by and speak with potential employers.

• Update your references anytime you apply for a position to let them know they may be contacted. A quick email or phone call will usually suffice. Say something like, "I sent in an application to a new long term care facility. Would you still be willing to be contacted as a reference for me?"
• Ask for letters of reference that verify the information you convey in your resume. If you claim to have managed a large budget in your role as nursing home director, ask your administrator something like, "Would you be able to write a letter of reference offering your opinion of my performance. Specifically, could you explain how I managed the supply budgets for the past several years, and what that entailed?"

Join state of California or national NHA professional organizations. Networking is one of the main benefits of joining these organization. You’ll be able to meet others who work in your field, and in many cases, these organizations are where potential employers begin their search for new NHAs.

• The California Association of Health Facilities is an excellent resource for career opportunities, networking, and continuing education in the state of California.
• You can also join the NAB. As a member of the NAB, you will have access to a variety of nation-wide training resources, up-to-date information about the NHA community, and current job opportunities.^[6]

Search job postings. In addition to searching professional organization careers pages, you can also use LinkedIn, Monster.com, Indeed, and other general career resources to look for available positions. Additionally, these sites often offer faster means of application by storing your education and job experience and auto completing applications for you throughout the job search process.

Apply through professional job placement agencies. Healthcare staffing services are available throughout California. These Employment agencies have team members who do the leg work to find the right long term care facility for you. There are a number of options available, but three of the largest healthcare staffing agencies in California are Flexcare Medical Staffing, Maxim Staffing Solutions, and 365 Healthcare Staffing Services. These agencies have done the research on current salaries, workplace benefits, and they have relationships with many of the long term care facilities throughout the state.

• Ask other NHAs you know if they used a staffing agency, and what their thoughts are.
• Before signing up to work with a staffing agency, ask for a detailed explanation of any placement or service fees associated with their company. In most cases, the employer pays these, but this is not always the case.

Prepare for your interviews. Research any nursing homes that offer you a position so you understand what their organizations are like and what their current states of affair are. Explore the facility’s website, read reviews online from residents and their families, and check on the facility’s standing with the Better Business Bureau and similar organizations. Check sites like Glassdoor to find out about current and past employee experiences.

• During your interview, ask questions based on information from their website, especially if the facility seems proud of a specific event or service.
• If you find any issues that concern you when exploring resident reviews, the Better Business Bureau, Glassdoor, and other sites, don’t hesitate to ask about them. If you’re going to work for a long term care facility in an administrative role, you’ll need to have a complete understanding of these concerns going in to do an effective job.
• Unless a job ad specifies otherwise, wait 2 weeks before following up on your job application and interview. Administrators are often overwhelmed with work and job applicants and need time to review your qualifications.