A director of nursing, or DON, is a registered nurse (RN) who holds responsibility for all nursing services in a facility. As a director of nursing, these RNs address nursing needs and advocate for the nurses employed there. DONs work closely with the highest level of management to act as a liaison for the company’s nursing staff. They share nursing needs and concerns, while also relaying important policy changes from upper management.
Directors of nursing develop new nursing policies as the need arises, and often work with committees of facility nurses to address policy change needs. The DON also has a big say in the nursing budget for their facility. Directors of nursing must have strong leadership skills and experience in management roles to be considered for the job.
Where Do Directors of Nursing Work?
Directors of nursing work on-site at their facility. Health companies that typically hire directors of nursing include:
Insurance companies
Government agencies
Healthcare system corporate offices
Health startups
Hospitals
Long-term care facilities
Outpatient care centers
Skilled rehab facilities
Universities and colleges
A director of nursing job description may vary greatly depending on the type of company they work with. In a smaller outpatient care center, for example, they may be much more involved in the day-to-day running of the facility and may know each of their nurses by name.
In a larger health system, however, the DON will have higher-level responsibilities and will work in a more corporate setting. Directors of nursing who work for an insurance company or health company that does not provide direct care will work more to ensure the medical efficacy of that company’s product and manage any nurses they have on staff, but they may not need to develop patient care policies.
What Does a Director of Nursing Do?
Directors of nursing serve an important administrative role. Depending on what type of facility or health system they work for, the job role can look a little different. But no matter where they work, a DON’s primary responsibility rests with the nursing staff under their charge.
Some common director of nursing responsibilities include:
Adjust staffing schedules and ratios
Advance policies and standard-of-care guidelines to ensure high levels of care
Create or update nursing goals for the facility and a plan to reach them
Develop nursing staff through continuing education opportunities
Evaluate nurse managers’ performance
Keep the facility up to date with state and federal regulations
Manage nurse staffing budgets for each department
Meet and collaborate with CEOs, CFOs, unit managers, and nurses
Monitor expenses, and adjust budgets
Promote recruitment plans for new nursing staff
Occasionally, patients and family members become so unhappy with their care that they need to speak with the director of nursing. This can also happen interpersonally among the staff. The DON is expected to de-escalate issues between any parties and work with them to offer solutions and clarify policies as needed.
A director of nursing also gets involved during emergency situations. As the COVID-19 pandemic gained momentum, DONs all over the country had to make decisions about staff COVID testing, when a nurse should stay home sick vs. coming to work, and vaccination roll-out.
How Do I Become a Director of Nursing?
A director of nursing has years of experience as an RN, then as a nurse manager, and sometimes has higher-level degrees. The first step is to go to nursing school. DON candidates must graduate from an accredited nursing program with their Bachelor of Science in Nursing (BSN).
After graduation, RNs must pass the state licensing exam: the NCLEX-RN. A series of multiple-choice questions, this standardized test shows a nurse’s clinical knowledge and capability to practice in their field.
A director of nursing can gain bedside experience in any field; no one unit will better prepare them for the leadership role. Some nurses’ first step in leadership is to become a charge nurse, who spends their shift assigning admissions, monitoring all patients and staff, and troubleshooting any conflicts or emergencies.
For the next step, nurses may apply to become assistant nurse managers or nurse managers. The nurse manager has charge over their unit: staffing, budget decisions, and policy adherence. The nurse manager’s role looks quite similar to the director of nursing role, but on a smaller scale.
After a nurse has held a nurse manager role for two to three years, they may apply for a director of nursing role. Every facility has differing experience requirements for its DON positions. Some require five years of management experience. Others ask for a higher degree.
A nurse with a Master of Science in Nursing (MSN) or a Master in Healthcare Administration will have a decided leg up on other candidates. Master programs typically take two years to complete, if full-time hours can be devoted to them. Larger facilities or health systems may want their directors of nursing to have a Doctor of Nursing Practice (DNP) in Executive Nursing Administration.
Directors of nursing can also get certifications in their field. The American Nurses Credentialing Center (ANCC) offers Nurse Executive Certification (NE-BC). Eligibility requirements include 2,000 hours of management or administration experience and 30 hours of clinical management experience within the last three years. The ANCC also offers an advanced NE certification, the NEA-BC, for DONs with experience in organization-wide or system-wide operations and outcomes.
The American Association of Directors of Nursing Services (AADNS) offers Director of Nursing Services (DNS-CT) certification. Their requirements state the DON must have the equivalent of two years of full-time acute bedside experience as an RN, with a minimum of one year of experience either as a director of nursing or other relevant nursing leadership experience.
A DON can become a Certified Director of Nursing (CDON) through The National Association of Directors of Nursing Administration in Long-Term Care. To be eligible, the certification candidate must be a licensed RN, have worked 1,000 hours as a director of nursing or similar position, and have completed 75 hours of continuing education.
How Much Does a Director of Nursing Make Per Year?
Because directors of nursing fill executive roles, they can earn quite a bit more than bedside nurses. The US Bureau of Labor Statistics (BLS) does not offer specific salaries for nursing directors. However, according to salary.com, director of nursing salaries average $162,015 per year, as of 2023. This amount can vary depending on the work setting and the cost of living in the area. The low-end average was $123,286, and the high-end was $209,248. Depending on the type of facility, an employer may be able to offer higher or lower compensation.
Other salary reporting organizations put DON salaries much lower, with averages around $87,643 and $95,730. Salaries also vary depending on which state a director of nursing practices. The west coast generally pays nurses the best, but they also have a higher cost of living. San Francisco boasts the highest pay for directors of nursing.
California, Washington, Rhode Island, and New York pay directors of nursing the highest wage, but the cost of living in these areas can also be high. The lowest-paying state is South Dakota.
Certified directors of nursing can be paid more than a DON who is not certified, depending on the facility. In general, the more experience and proof of expertise, the more a director of nursing will be able to earn.
What Are the Benefits of Being a Director of Nursing?
A director of nursing has the power to vastly improve their facility. By developing and implementing policies that attract top-tier nurses, the DON ensures less staffing turnover and better patient care.
A workday as a director of nursing may look quite different from other nursing roles. DONs usually work regular business hours and are not required to work on weekends or holidays. Additionally, director of nursing salaries are much higher than almost any other nursing profession.
Many employers offer significant perks for their director of nursing, including:
Employee assistance programs
Employee discounts
Life and Accidental death and dismemberment (AD&D) insurance
Loan forgiveness
Medical benefits
Relocation assistance
Travel reimbursement
Tuition reimbursement
Are Directors of Nursing in High Demand?
Directors of nursing are in high demand, and the demand is set to grow. According to the Bureau of Labor Statistics, medical and health services manager needs will increase by 32% between 2020 and 2030. Many DONs are nearing retirement age, and that will leave a lot of open positions in the coming years.
Additional Resources About Becoming a Director of Nursing
To learn more about becoming a director of nursing, these additional resources may help:
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