2027 Edition·Coming soon
Knowing It and Doing It
The first year as a nursing home administrator
A practical guide for first-year nursing home administrators: what to do, in what order, and why.
You passed your licensing exams. You got licensed. Now you’re standing in a hallway at seven in the morning, and you don’t know what you’re looking at.
That is the gap this book is about. Not knowledge — you have the knowledge. Every new administrator has sat through the coursework, memorized the regulations, and answered the exam questions correctly.
What nobody teaches is application. How to read a building. When a number is lying to you. Which fights are yours and which ones only look like yours. What a surveyor is actually asking when they ask an innocent question at the entrance conference.
Most administrators learn all of it the hard way, from a preceptor if they are lucky and from a citation if they are not. Whether you get that knowledge has been a lottery. This book is an attempt to make it reliable.
There’s no such thing as a perfect nursing home. And don’t confuse order with care.
Chapter 1 — Your first weekI had a person here every weekend and I called that coverage. What I actually had was a name on a schedule.
Chapter 2 — Reading your buildingYou’re accountable for clinical outcomes you aren’t licensed to produce.
Chapter 3 — You and your DONWhat is inside
Fourteen chapters, ordered by when things actually arrive rather than by topic. Every chapter ends with a short list of what to do Monday.
- Your first week
- Reading your building
- You and your DON
- PPD and labor
- MDS and PDPM
- Your budget and your variance report
- Five-Star, Care Compare, and PBJ
- The tags that come up most
- Survey day and the plan of correction
- Abuse reporting and the first hour of an incident
- Discharges, transfers, and the ombudsman
- Hiring, discipline, and your first termination
- Families, grievances, and protecting your day
- Your regional, and what the first year costs you
Plus the back of the book: a first-year calendar of what comes due when, where to look things up, and a one-page guide for when something is happening right now.
Who it is for
The new administrator
First building, or about to be. The book assumes you are licensed and competent, and that nobody has explained the job.
Administrators in training, and the people precepting them
Preceptors have required hours and no curriculum. This gives the conversation a spine.
Regional directors
If you hand a new administrator a building and hope, this is the thing you hand them instead. It is written to make a new person productive faster, and to be honest enough that they will actually finish it.
Anyone crossing over
Assisted living, hospital, or another setting moving into skilled nursing.
The author
Most books for this audience are written by people who don’t hold the job. Vendors write marketing. Consultants write assessments. Academics write textbooks. Administrators don’t write books, because administrators don’t have time. This one was written by an administrator.
Bryant Sam, LNFA, is a U.S. Army veteran and licensed nursing home administrator who has spent his career leading in places where the stakes are high and the margin for error is small.
The Army taught him leadership: bring people together, set the standard and get it done right. In public relations for Child Protective Services, he learned to speak plainly and carefully about difficult things to families, the public and the press. In leadership roles in corrections, he learned how policy, safety and people meet under pressure every day.
In long-term care, he has helped struggling nursing homes turn around both their regulatory standing and their finances. He has led buildings through Immediate Jeopardy and back into compliance, led five-star buildings, and been recognized for census development and growth. He has also kept buildings steady through multiple changes in senior leadership, often as the one constant while the top of the organization turned over.
He wrote Knowing It and Doing It so new administrators don’t have to learn it all the hard way.
When it’s out
The book is in its final edit. It will come out in paperback, with a companion workbook: every chapter’s Monday list as a checklist you can write in, fill-in pages for occupancy, PPD and your star rating, the PBJ deadlines, a cut-out card for the first hour of an incident, and a twelve-month calendar.
Regional directors and program heads: if you’d like copies for new administrators or a class, email hello@ltcyearone.com.