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Becoming a Director of Nursing for a Skilled Nursing Facility


Updated April 22, 2014

Becoming a Director of Nursing for a Skilled Nursing Facility

Multi-tasking is one skill a DON definitely needs!

@Seth Joel, Getty Images


The Director of Nursing Services (DON) works in concert with the Administrator and directs the Nursing Department to maintain quality standards of care in accordance with Federal, State and facility standards, guidelines and regulations.

Reporting Responsibility:

The director of nursing is the senior nursing management position in an organization and often may also have titles such Chief Nursing Officer (CNO), Chief Nurse Executive, or Vice-President of Nursing. They typically report to the CEO or COO.

Though less common, some large healthcare organizations also have service directors. These directors have oversight of a particular service within the facility.

Scope of Responsibilities:

The scope of responsibilities for the DON are diverse and include:
  • Assumes the responsibility for facility operations in the absence of the Administrator.
  • Conducts the nursing process' assessment, planning, implementation and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure.
  • Develops, implements, and evaluates programs to measure, assess, and improve the quality of nursing care delivered to patients.
  • Ensures optimal quality of care is provided in a safe environment.
  • Participates in facility surveys.
  • Manages programs that promote the recruitment, retention and continuing education of nursing staff.
  • Ensures that adequate nursing staff are available, based on census and facility requirements.
  • Complies with federal, state and local regulations as well as company policies and procedures.
  • Plans and facilitates meetings and committees, and coordinates with other departments to address resident care issues.
  • Sets goals and establishes priorities, then coordinates and manages the policies and resources needed to meet those goals.
  • Administers nursing services budget and expense control system.
  • Oversees nursing employee conduct.
  • May be called to be a witness at a trial in the event of litigation.
  • Is knowledgeable of incidents at the facility.
  • Assesses the health needs of each resident.
  • Communicating the needs of the residents of the facility to the physicians.


  • Bachelors degree in Nursing; Masters preferred with postgraduate education in nursing or management.
  • Knowledge of professional nursing principals and practices.
  • Must have verbal, interpersonal and quantitative skills.
  • RN licensure required.
  • Minimum of three years of progressive healthcare management experience.
  • Has supervisory experience in long-term care.

Salary Guide:

A nursing home DON median salary is $85,507 per year, but can range as low as $71,000 to $104,000 annually. Income varies, depending on:

  • credentials
  • location
  • type of facility
  • years of experience

Education and Training:

In addition to the requirements above, the National Association Directors of Nursing Administration in Long Term Care(NADONA/LTC) certifies Directors of Nursing and Assistant Directors of Nursing in Long Term Care facilities. Over 1800 DON's have been certified through this program.

To qualify for certification you must hold an active license as a RN and have at least 2 years of full-time experience as a DON or ADON. Re-certification is required every 5 years. To become recertified, the nurse must:

  • Have been employed or served as a volunteer or in another capacity at least half time (1000 hours) as a DON or consultant in the long-term care specialty within the last 5 years.
  • Provide evidence of at least 75 hours of continuing education or retake the examination.

Certification indicates that the DON and ADON in long term care possess a specific core of knowledge in their profession. Their profession is unique in the nursing field, and becoming certified validates the uniqueness. The certification program, the rules and regulations and the test itself, have all been developed by DONs in long term care.

In addition, the American Health Care Association is advocating for Gerontological Nurse Certification.

Gero Prep equips RNs to pass the national Gerontological Certification exam and was created expressly to expand the knowledge, skills, competencies, personal and professional growth of registered nurses (RNs) in long-term care facilities.

National certification is a badge of quality. It signifies the highest standard of clinical and leadership excellence. And it assures employers, residents and families of quality nursing care. Facilities employing certified RNs, key quality indicators — including patient outcomes, patient satisfaction and RN satisfaction — have shown marked improvement.

Career Advancement:

The DON position does not have to signify the peak achievement in your profession. With additional training and certification, DONs can become administrators. Or they can move from single facility responsibility to working for a health system.

And careers outside of long-term care that could still impact the care of elders are varied and could include:

  • Certified Registered Nurse Anesthetist
  • Nurse Researcher
  • Nurse Practitioner
  • Clinical Quality Specialist
  • Legal Nurse Consultant
  • Nurse Consultant

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