A day as a Director of Nursing
As a director of nursing, you own every nursing decision in the building, including the ones made in the middle of the night while you were asleep. This guide follows a DON through a weekday in a skilled nursing facility, where most of these jobs sit. Hospital nursing directors run a service line instead, and their days look closer to a middle manager's.
Inside one weekday at a skilled nursing facility
Night report and the call-off list
You get in before day shift and read the overnight report: a fall on the memory care hall, a resident sent out to the ER with low oxygen, a new admission who arrived late from the hospital with half a med list. Then you check the schedule. A couple of CNAs called off, and the staffing coordinator has already texted the per diem pool. You decide whether to pull the unit manager onto the floor or ask a night nurse to stay a few hours on overtime.
Stand-up with the interdisciplinary team
The morning meeting runs through every change in condition, new admission and planned discharge. You'll sit with the administrator, the MDS coordinator, therapy, social services and dietary. Your job here is to catch what isn't being said: the weight loss nobody charted a plan for, the antipsychotic that's been on the order sheet too long, the wound that's gotten worse since Friday.
The plan breaks: a family and a state complaint
A resident's daughter calls, angry that her mother sat in a wet brief for hours last night. She's already filed a complaint with the state. Now your morning is gone. You pull the call light log, interview the aide and the nurse, check the care plan, and write up an investigation that has to hold up if a surveyor walks in tomorrow. You'll also call the daughter back yourself, because she wants to hear it from the person in charge.
Audits, QAPI and the survey binder
Afternoons are for the work that keeps the building out of trouble. You review PointClickCare reports for missed meds and late assessments, check that infection control logs are current, and prep for the monthly QAPI meeting with the medical director. You're also tracking your star rating and the quality measures that feed it, since the administrator will ask about them.
Evening shift handoff and the phone that stays on
Before you leave, you round the halls, talk to the evening supervisor, and sign off on the next day's schedule. The on-call phone comes home with you most nights. Expect a text about a pharmacy delivery that didn't show up, or a nurse asking whether a resident's change in condition needs a call to the doctor.
What wears DONs down
The clinical side is rarely the problem. What grinds people out of this job is staffing that never feels finished and the weight of the annual state survey. You're the name on the plan of correction when a deficiency gets cited, even if the mistake happened on a shift you never saw. Turnover in the role is high, and plenty of DONs step back to an assistant director or MDS job after a few rough surveys. The ones who last tend to build a strong unit manager team and delegate early, rather than covering every gap with their own hours.
Three common ways people land the DON chair
Unit manager to assistant director, then DON
This is the most common route. You run a hall or a unit, move up to assistant director of nursing, and learn survey, staffing and QAPI from the DON above you. When that person leaves, you're often the obvious pick.
MDS or infection preventionist into leadership
Nurses who've run the MDS process or the infection control program already understand the regulations and the reimbursement side. That makes them strong candidates, especially in buildings that struggle with documentation.
Hospital charge nurse or nurse manager crossing over
Some DONs come from acute care, bringing strong clinical skills and experience leading a team. Expect a steep learning curve on long-term care regulations and the MDS, since hospitals run on a different rulebook.
What Director of Nursing postings ask for
Hiring the most
- dstaff19
- TrinityHealthcare5
- Freseniusmedicalcare4
- SpectrumRetirementCommunities4
- Clearskyhealth3
Remote
1% of openings are fully remote.
Posted pay
$125,100 – $164,000
Typical range in the 12 of the newest 60 postings that list pay.
Questions people ask
Do you need to be an RN to be a director of nursing?
In skilled nursing facilities, yes. Federal rules require the DON to be a registered nurse, which means passing the NCLEX-RN and holding an active state license. Some states add their own requirements on top of that, so check with your state board of nursing and the state health department before you apply. Assisted living and home health roles may have different rules.
Is a BSN or MSN required?
It depends on the employer. Plenty of long-term care DONs hold an associate degree, and some buildings will hire you on experience alone. Hospitals and larger health systems usually want a BSN at minimum and often prefer an MSN for director-level roles. If you're aiming at a hospital, the degree matters more than it does in a nursing home.
How is a DON different from a chief nursing officer?
A DON usually runs nursing for one building and is close enough to the floor to know every resident's name. A chief nursing officer sits above several directors, often across a hospital or a system, and spends most of the day on budgets, strategy and executive meetings. Many CNOs started as DONs or nursing directors.
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