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10 Pros and Cons of Being a Director of Nursing + Salary + Steps to Become
Written By: Pattie Trumble, MPP, MPH
What is a director of nursing (DON)? Nursing directors are administrators who oversee the functions and operations of a single nursing unit within a hospital, nursing home, home health agency, hospice or other facility that provides healthcare to patients. The director of nursing manages the unit’s non-clinical work; this work may include scheduling, preparing budgets, formulating clinical policies, ensuring compliance with government and facility regulations, and strategizing employee development. Nursing directors typically report to a facility’s chief nursing officer. Interested in becoming a nursing director?
This article will provide you with the in-depth information you’re looking for about the role of the director of nursing – what is it, the steps to become, pros & cons, and salary.
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Table Of Contents
WHAT DOES A DIRECTOR OF NURSING DO? – 12 KEY DUTIES AND RESPONSIBILITIES
While the Director of Nursing is not a clinical position, the individual occupying this role is ultimately accountable for all the clinical nursing care that’s provided to patients on his or her unit. What does a director of nursing do? Specific duties vary greatly according to the size of the facility and the types of care being offered but most often include:
1. Policies and procedures:
As a director of nursing, you will help draft the departmental policies and procedures that guide day-to-day nursing activities. Not only do such policies promote consistent patient care and reduce errors, but they also minimize legal liability by demonstrating that your facility has procedures in place that are designed to optimize patient safety.
2. Budget development:
As a nursing director, you’ll be in charge of your nursing department’s operating budget. You’ll use information you collect about your department’s payer mix, patient mix, staff mix and standards of care to determine what services your department should be offering and how much the resources for delivering those services will cost. You may also make long-term decisions about asset acquisition and other capital improvements.
3. Managing inventory:
Inventory management is related to budget planning because inventory must be replaced, and that takes money. Nursing directors are tasked with placing the orders that replenish used supplies and making sure that supplies are available to the professionals who use them. That means they are charged with tracking inventory usage.
4. Monitoring and ensuring compliance:
One of the most important duties of a director of nursing is making sure his or her department complies with government regulations. Healthcare is one of the most heavily regulated of all American industries
because it’s one of the industries that has the most impact on people’s lives. Healthcare regulations are implemented by federal, state and local governments as well as by private organizations such as professional associations. Individual healthcare facilities may impose regulations as well, which they expect clinical staff to comply with.
5. Employee development:
You’ll be in charge of maintaining an adequate workforce when you’re a nursing director. That means you’ll have the final say on hiring and firing decisions, and you’ll oversee staff professional development, including training and other performance improvement activities. You may collaborate with the Director of Staff Development on training and education.
6. Performance reviews:
Directors of nursing are also involved in the performance review process. Clinical nurse managers generally take the lead in this process, but you’ll be expected to sign off on evaluations and attend reviews occasionally.
7. Staffing decisions:
As DON, you won’t be responsible for staffing each shift, but you will be responsible for making the monthly projections that will determine how much staff each shift needs. This means you will have to track the shift-to-shift ratio of nurses to patients based on historical patient census numbers.
8. Disciplinary actions:
As director of nursing, you will be in charge of all disciplinary actions on your unit taken against nurses whose practice and/or conduct does not comply with the terms of your state’s Nurse Practice Act or your facility’s expectations of professional performance.
9. Conflict resolution: Nursing directors set the tone for conflict resolution in the departments they run
. They do this by identifying potential conflicts, engaging in dialogue, coaching, and educating and training staff nurses in conflict resolution techniques.
10. Representing nurses:
Every healthcare facility has interdisciplinary committees on which representatives of the facility’s various stakeholders sit to discuss issues facing the facility. These committees tackle everything from evaluating and selecting new patient care services to technology assessment and capital expenditures planning. DONs sit on committees to give the nursing department’s viewpoint.
11. Goal setting:
Short-term departmental goals address immediate needs for improved quality and patient safety while long-term departmental goals speak to building a framework in which nursing excellence can prosper. A talented director of nursing pays attention to both types of goals.
12. Reports: Hospitals and similar healthcare providers typically use a stratified nursing hierarchy to impose organizational structure
. As director of nursing, you will report to your facility’s chief nursing officer. In turn, the clinical nurse managers in your department or unit will report to you.
WHERE DOES A DIRECTOR OF NURSING WORK?
Nearly 65,000 directors of nursing are employed throughout the U.S. Eleven percent of DONs work in healthcare organizations with 10,000 or more employees
; 43 percent work in healthcare organizations with between 1,000 and 10,000 employees; and 18 percent work in healthcare organizations with between 500 and 1,000 employees. Nursing directors manage day-to-day nursing operations in a variety of practice settings, including:
• Healthcare systems:
A healthcare system is a unit consisting of at least one hospital and one physician practice group working together to deliver patient care. Within a large healthcare system, each hospital and outpatient care center may have its own director of nursing.
• Hospitals and medical centers:
A hospital’s director of nursing oversees all nursing services and operations at that hospital.
• Outpatient care centers:
As the DON of an ambulatory care center, an urgent care clinic, an outsourced emergency room or some other outpatient care practice setting, you’ll be responsible for the provision of high-quality patient care to all patients who present to these outpatient care settings.
At specialty clinics, nursing directors typically oversee all staff members who provide direct patient care, including registered nurses (RNs), licensed vocational nurses (LVNs), licensed practical nurses (LPNs), and nursing assistants.
• Skilled nursing facilities:
If you become a director of nursing at a rehabilitative center or some other skilled nursing facility, you’ll be the primary administrator for RNs, LPNs, nursing assistants, and other clinicians delivering hands-on patient care.
• Physician practices:
Physician practices that employ five or more nurses may find it cost-effective to hire a dedicated nursing director to keep up with professional development and compliance needs.
• Home healthcare agencies:
As a director of nursing at a home healthcare agency, you will oversee all nursing personnel, and you will coordinate orders for home healthcare (made when patients are discharged from a hospital) with available nurse resources.
WHAT ARE THE TYPICAL WORKING HOURS OF A DIRECTOR OF NURSING?
Nursing directors are primarily salaried employees assigned to work standard, nine-to-five, 40-hour workweeks. Since DONs are on the frontline where crisis management is concerned, however, they frequently end up working more than 40 hours a week. Essentially, directors of nursing must be on call at practically all times in case an emergency arises at the workplace. In some healthcare facilities, DONs work 12-hour rather than 8-hour shifts.
8 MUST-HAVE PERSONALITY TRAITS NEEDED TO BE A SUCCESSFUL DIRECTOR OF NURSING
Every director of nursing position has slightly different requirements depending upon the needs and the organizational culture of the prospective employer. In general, though, ideal candidates for this position share personality traits in common:
1. Patience: Nursing directors need to be able to function optimally in a stressful environment without getting flustered, and the key to that is patience. DONs who stay calm and consistent when dealing with frustrated nurses and patients can help ensure good outcomes in problematic situations.
2. Flexibility: Healthcare practice settings can change quickly. As the director of nursing, you need to be flexible enough to catch any ball that’s thrown your way.
3. Critical thinking: Critical thinking is the ability to reason objectively while keeping personal bias at a minimum. As a director of nursing, you’ll need to be able to evaluate situations without allowing emotions to influence your decisions unduly.
4. Attention to detail: As a nursing director, you’ll need to know how to concentrate so that tasks you undertake are completed consistently, accurately, and thoroughly.
5. Stamina: Becoming a director of nursing can mean dealing with high levels of stress due to the immense level of responsibility associated with this job. To keep from succumbing to exhaustion and other signals of burnout, you’ll need to cultivate high levels of physical fortitude.
6. Self-discipline: You won’t be able to react impulsively when you become a director of nursing. After all, you are the nursing unit leader! Instead, you’ll need to be disciplined enough to arrive at conclusions based on a preponderance of the evidence.
7. Emotional intelligence: Emotional intelligence is the ability to manage one’s own feelings and to handle interpersonal relationships with sensitivity and empathy. Healthcare facilities are settings where emotions—both positive and negative—run high. As a nursing director, you need to understand the ways that emotions impact your own behavior and the behavior of others.
8. Accountability: Directors of nursing must be willing to accept responsibility for their actions and decisions. This will better enable you to hold the nurses you supervise accountable for their actions and decisions.
8 MOST IMPORTANT SKILLS NEEDED TO BE A SUCCESSFUL DIRECTOR OF NURSING
Running a hospital nursing department calls for excellent communication and organizational skills. Although the nursing director role is not a clinical position, you need a strong clinical background so that you can accurately assess that the high standards you set for nursing care are being met. Here are some of the other skills needed to be a director of nursing:
1. High executive functioning:
Executive functioning is that set of mental skills that include working memory, attention to detail, adaptive reactions, and self-control. These are skills that are very useful to administrators like nursing directors who are charged with leading and supervising a nursing unit.
2. Time management:
Nursing units are hectic places where the pace of work is constantly being interrupted by emerging crises that need to be dealt with. As a nursing director, you’ll have to learn how to manage your time most efficiently by prioritizing, staying focused, and structuring your schedule.
Directors of nursing draft the preliminary budgets used to allocate resources in the hospital departments and units they manage. As a DON, you must know how to forecast resource use.
4. Staff management:
Personnel management is a skill set nursing directors learn over time through effort and attention. Giving positive feedback and reinforcement to employees, and understanding when to delegate, will help a nursing department run more smoothly.
5. Quality assurance and legal compliance:
As a director of nursing, you must understand the rules, regulations and laws that relate to healthcare practices and make sure that they’re followed in the department you supervise. Additionally, you must make sure unit policies and initiatives are regularly updated to reflect regulatory changes and patient expectations.
When you become a director of nursing, you’ll need to learn how to assess the relative importance of the tasks you’re responsible for completing so that the most important tasks are performed first. Nurse leaders nationwide have identified patient safety and the stabilization of the nurse workforce as two of their most important priorities.
7. Conflict resolution: In high-pressure workplaces like hospitals, conflicts are commonplace
and can affect patient health outcomes if they are not successfully resolved. To be successful, DONs must become familiar with conflict resolution techniques like accommodation, avoidance, compromise, and collaboration.
The ability to communicate well is an essential skill for directors of nursing and other nurse managers. Superior oral, written and presentation skills will enable you to interact with nursing staff, patients and other healthcare colleagues most effectively.
ARE YOU A GOOD FIT FOR A CHIEF NURSING OFFICER POSITION? – 10 QUESTIONS TO ASK YOURSELF
Careers in nurse management only appeal to 11 percent of all nurses
according to a 2021 survey released by the healthcare workplace management platform Trusted Health. If you’re one of those RNs, there are still some questions you should ask yourself to determine whether becoming a director of nursing is a good fit for your personality and skill set. If your answer is, “No,” to more than three of these 10 questions, you’d probably be better off investigating a different nursing career track.
1. Can you ask for help when you need it?
A director of nursing position is enormously challenging. There’s no way you can possibly do everything that needs to be done without backup. At times, you may need to rely upon your assistant DONs and charge nurses to finish projects you’ve started when another high-priority request comes your way. Make sure you identify a trusted support network early on in your DON tenure.
2. Do you know how to delegate?
Effective delegation is the only way you’ll be able to keep up with your workload as a director of nursing. If you insist on micromanaging, you won’t have time or energy to do the high-level planning and supervision your position demands. Surround yourself with deputies whose leadership and management skills you trust.
3. Do you like working hard?
A director of nursing position involves a lot of hard work on a daily basis. Even during your off-hours, if an emergency arises in your unit, you may have to come in to put out the fire. There are no lazy days. If you’re not comfortable giving your all every moment you’re on the job, this is not the career track for you.
4. Would you be happy stepping away from the clinical side of nursing care?
Nursing directors need to have experience with the clinical aspects of bedside nursing so that they can accurately assess the quality of nursing care delivered in the departments they supervise. The DON role, though, is not a clinical but an administrative role. If your primary job satisfaction is tied to delivering hands-on care and forging close relationships with the patients you care for, it’s unlikely that a director of nursing position will gratify you in the same way.
5. Do you like meetings?
Meetings are the name of the game for nurses in upper management. Care conferences, unit staff meetings, medical rounds, quality assurance meetings, performance review meetings, hospital leadership team meetings—your schedule will be crowded with them. As an executive, you’ll be expected to stay focused and productive throughout no matter how tedious you may find these meetings to be.
6. Are you interested in the business side of healthcare?
As a nurse clinician, one-on-one patient care is your primary concentration when you’re working in a healthcare facility. But healthcare facilities are also businesses, and as a senior nurse administrator, much of your attention will necessarily focus on how to preserve your facility’s bottom line. If the business side of healthcare doesn’t interest you, you’d be better off investigating mid-level nurse management positions where you’ll still be able to concentrate primarily on patient care-related issues.
7. Can you put your emotions aside when you make decisions?
An effective leader can’t afford to play favorites. Good management involves the ability to make evidence-based decisions
. As a director of nursing, you’ll need to rely upon objective rather than subjective methods for analyzing problematic situations and determine what the correct next step should be by critically evaluating objective input.
8. Are you comfortable making unpopular decisions?
Your management position makes you an easy target. As a DON, you’ll be the one informing staff nurses about unpopular hospital administration decisions, and your announcements may be met with anger and resentment. That can hurt your feelings. Keep reminding yourself that your nursing colleagues are not frustrated with you personally.
9. Are you passionate about high-quality patient care?
If you’re like most RNs, you wanted to become a nurse because you dreamed about making a real difference in another person’s life
. As a nursing director, you’re still making that difference—except you’re doing it on a larger, more systemic scale.
10. Do you have the right qualifications and experience?
Nursing director positions are highly sought-after jobs. To stand out from other candidates angling for this job title, you’ll need a Master of Science in Nursing
(MSN) degree with a concentration in healthcare administration or nursing leadership as well as a Bachelor of Science in Nursing
(BSN). Most employers will prefer a candidate who’s pursued a certification such as the Director of Nursing Services–Certified
(DNS-CT) or the Certified Director of Nursing Exam
(CDONA). Successful candidates will also have several years of experience on their resumes as well as a nurse manager, supervisor, or assistant director of nursing.
HOW DO YOU BECOME A DIRECTOR OF NURSING?
What Education Is Required To Become A Director Of Nursing?
Although nearly 50 percent of nursing directors have an Associate Degree in Nursing (ADN) or a diploma from a hospital nursing program
, most of these individuals are nearing retirement age, which means they’re aging out of the executive nurse management pool. These days, most employers prefer to hire DON candidates who have a BSN. Nurses with a BSN typically have more education in such management-related fields as communication, leadership, and critical thinking. Acceptance into a BSN program is predicated on having a high school diploma. If you want to get accepted into a strong college or university nursing program, make sure your high school transcripts include classes in chemistry, biology, and math.
Only 11 percent of directors of nursing currently have MSN degrees, but this percentage is certain to increase in the coming years. According to U.S. News & World Report, five MSN programs with strong executive nurse leadership concentrations are
• Duke University
: Duke University’s Nursing and Healthcare program is offered in a distance learning format with some campus components.
• University of Pennsylvania
: Penn’s Nursing and Healthcare Administration program is a hybrid of online and traditional campus components.
• George Washington University
: Distance format with online courses and some on-campus experiences for testing and training.
• University of Alabama-Birmingham
: Distance learning format.
• University of Iowa
: Distance learning format.
What Licensure Is Required To Become A Director Of Nursing?
There’s no legal stipulation that LVNs or LPNs can’t become nursing directors. But for practical reasons, any nurse manager who’s supervising RNs must be an RN because LVNs and LPNs have far less training, and so, do not have the credentials to evaluate an RN’s work properly.
The first step in attaining RN licensure involves passing the (NCLEX-RN) exam. The NCLEX-RN exam is a standardized test that utilizes computer adaptive testing technologies. The passing score is zero logits, and the fee to take the exam is $200.
Once you pass the NCLEX-RN, you must pursue licensure in the state where you wish to work. RN licensure requirements vary from state to state
. Thirty-four states participate in the Nurse Licensure Compact
, which offers reciprocal licensure.
What Certifications Are Required OR Recommended For A Director Of Nursing?
Certifications are not a legal requirement for director of nursing jobs, but most employers will look more favorably upon candidates who’ve gone the extra mile to prove their ability. Helpful certifications include:
The NE-BC is offered by the American Nurses Credentialing Center
(ANCC). The exam consists of 175 multiple choice questions, and the passing score is 350 or above. The exam is only open to RNs who hold a BSN and an MSN, and who’ve held a full-time nurse executive position for at least 24 months within the last five years. The exam fee is $270 for members of the American Nurses Association
and $395 for non-members.
• Director of Nursing Services Certification (DNS-CT):
The DNS-CT is offered by the American Association of Post-Acute Care Nursing
(AAPACN). To be eligible to earn the credential, you must be a registered nurse with either two years of full-time post-acute care experience or one year of relevant nurse leadership experience. To earn the DNS-CT, you must take 10 continuing education courses through AAPACN on such topics as Leadership & Management for the Nurse Leader, Quality Assurance and Performance Improvement for the Nurse Leader and Essential Business Skills for the Nurse Leader. Once you pass the exams associated with each of the exams with a score of 80 percent or higher, you earn the certification. The cost for the continuing education classes is $700 for AAPACN members and $950 for non-members.
• Certified Director of Nursing Exam (CDONA):
The CDONA, offered by the National Association of Directors of Nursing Administration in Long Term Care
(NADONA), is specifically a certification for nursing directors in long-term care facilities. The passing score is 80 percent or higher. The exam is administered in conjunction with a 14-contact-hour continuing education course. The fee for the course and the certification exam is $350.
What Additional Training And Experience Is Required To Become A Director Of Nursing?
No specific experience is required for a director of nursing, but an ideal candidate is likely to have at least two years of clinical experience and an additional three years of nurse management experience as a charge nurse, a clinical nurse manager, or an assistant director of nursing.
What Are The Continuing Education Requirements For A Director Of Nursing?
Though no continuing education requirements exist specifically for nursing directors, every state has its continuing education requirements for RN licensure renewals
WHAT IS THE STEP-BY-STEP PROCESS TO BECOME A DIRECTOR OF NURSING?
A director of nursing position is a professional option rather than a nursing degree specialty, so there is no set process associated with this career trajectory. If you’re interested in becoming a nursing director, though, here are the main moves you’ll have to plan on making:
1. Get a high school diploma.
You won’t be admitted into an accredited nursing program without one. Focus on taking science and math classes like chemistry, biology, physics, algebra and geometry.
2. Attend nursing school:
If you’re interested in climbing the nurse manager ladder, a BSN will be more useful to you than an ADN. Do your best to be accepted at an accredited nursing program affiliated with a college or a university.
3. Pass the NCLEX-RN exam:
A passing grade on the NCLEX-RN exam is a condition for licensure for all registered nurses throughout the U.S. and Canada.
4. Attain your nursing license.
Remember that the majority of U.S. states require RNs to renew their licenses every two years.
5. Acquire nursing experience:
Most prospective employers hiring for a DON position prefer candidates with at least two years of clinical nurse experience and at least three years of nurse manager experience.
6. Graduate from an MSN program:
At present, just 11 percent of nursing directors hold MSNs
. But you can expect that to change in the near future. RNs who hold MSNs have more leadership training than RNs with BSNs, and they command director of nursing salaries that are more than $100,000 a year higher.
TIME AND COST ASSOCIATED WITH BECOMING A DIRECTOR OF NURSING
How Long Does It Take To Become A Director Of Nursing?
Since “director of nursing” is a type of employment rather than an advanced practice nursing specialization, there is no set time interval associated with achieving this goal. Becoming a nursing director will take you at least nine and a half years: four years to complete your BSN, six months to pass the NCLEX-RN exam and attain licensure, two years spent working as a clinical nurse, and then three years in the lower echelons of nurse management. If you decide to earn an MSN, you can add 18 months to three years onto that figure. To advance more quickly, consider earning certifications such as the DNS-CT offered by AAPACN or the NE-BC offered by ANCC.
A few medical centers offer in-house management training programs for their nurses. If you’re fortunate enough to work for one of these hospitals, take advantage of these programs. Many hospitals prefer to recruit internal candidates for leadership positions since internal candidates are already aware of the way departments operate.
How Much Does It Cost To Become A Director Of Nursing?
The costliest part of the preparations you’ll have to make to obtain a director of nursing position will involve your education. A four-year BSN program can cost anywhere between $40,000 and $100,000; a three-year MSN program can cost anywhere between $35,000 and $75,000. Add to that the cost of the NCLEX-RN exam and prep classes ($700), the cost of continuing education classes (which range from free to thousands of dollars), and the costs of RN licensure and licensure renewals ($200 to $1,000). At a minimum, becoming a nursing director may cost you $42,000; at a maximum, becoming a nursing director may cost you $177,000.
CAREER ADVANCEMENT OPPORTUNITIES FOR DIRECTORS OF NURSING
In most medical facilities, directors of nursing are upper-level managers. The only nursing job with more seniority is the facility’s chief nursing officer. That doesn’t mean that career advancement opportunities don’t exist for nursing directors, however.
As a nursing director of a small unit or department, you can make a horizontal leap to become a nursing director of a larger unit or department within the same medical facility where you currently work. You can also make a vertical leap to become your facility’s chief nursing officer or assistant chief nursing officer.
If you’re working as a DON in a small medical facility, you can also submit your resume to larger medical facilities as positions become available. You can also switch practice settings—move, for example, from a director of nursing at a hospital to a director of nursing at an outpatient care clinic—if your knowledge base and skill set are a match for the new setting.
Consulting is another advancement opportunity to explore. Healthcare providers pay nurse management consultants high fees to analyze existing problems with administrative services and human resource utilization, and to develop more efficient solutions. In addition to working with healthcare providers, nurse consultants with DON experience also work with governmental agencies and with private sector firms like insurance companies.
WHAT ARE THE TOP CONS OF BEING A DIRECTOR OF NURSING?
Becoming a nursing director is not a quick process. You may spend years working as a bedside nurse before you realize you’re more interested in the administrative side of nursing care and embark upon this new professional path. There are other disadvantages to working as a DON as well. Here are 10 of the top cons of being a director of nursing.
1. You have to deal with a lot of paperwork:
Nursing directors divide the majority of their time between doing paperwork and attending meetings. As director of nursing, you’ll be responsible for developing, implementing and evaluating nursing programs and departmental objectives. You’ll prepare reports, fill out forms, write executive summaries, draft PowerPoint decks, maintain records and compose email after email. If you find administrative tasks a thankless chore, a nursing director position is not the right job for you.
2. Your high salary may be eaten up by the high cost of living:
Directors of nursing earn comparatively high salaries. But the best-paying states for DON salaries are often the states with the highest costs of living. California, New Jersey and Washington are the three states where nursing directors earn the highest salaries on average: $128,710; $115,410, and $111,520 respectively. But the cost of living in these three states is 18 percent to 50 percent more than the average cost of living throughout all parts of the U.S.
3. You’ll rack up student loan debt:
You need a good education to become a nursing director. According to the American Association of Colleges of Nursing, 69 percent of nursing students subsidize their nursing education through student loans
. Obviously, the more education you pursue, the greater your student loan debt will be. And if you attend a top-tier college or university, your student debt is likely to be even higher. According to a 2019 Medscape report, 20 percent of nurses over the age of 55 are still paying back student loans
4. You may be held legally liable for other nurses’ errors:
As a director of nursing, you are legally responsible for the overall operation of your department or unit’s nursing team
. If one of your nurses makes a medical error that can be traced back to insufficient training or oversight, your nursing license may be on the line if your state board of nursing concludes you’ve performed your training and supervisory duties in an incompetent manner. Moreover, since the employer of a nurse can be liable for medical malpractice, you may be found liable as that nurse’s supervisor. This may be one of the biggest disadvantages of being a director of nursing.
5. You’ll work longer, more irregular hours:
On paper, a nursing director’s job may look like 40 hours a week, but the reality is very different. You’ll come in early in the morning and work until all your tasks for the day are checked off—and that may not be until late in the evening. Since you’re the one responsible for ensuring all nursing staff members are performing productively and efficiently, you’ll have to check in with RNs on evening, night and weekend shifts from time to time. You’re also the one who puts the fires out, so if an emergency occurs in the department you supervise when you’re not around, you can expect a phone call—and possibly even a trip to work to check the situation out.
6. You must be able to multitask:
You’ll be in charge of so many staff members and so many projects that multitasking must become second nature to you. Multitasking, however, can impair your thought processes by dividing your attention. Studies show that only 2.5 percent of the population have brains that are wired to multitask effectively
. For the rest of the population, multitasking can be extremely stressful, and stress predisposes you to make more errors. You’ll have to figure out a way to prioritize and delegate parts of your workload so that you can stay on top of it.
7. You’ll spend a lot of time sitting:
One of the most unexpected disadvantages of being a director of nursing is that your life will become a lot more sedentary. During the course of an average shift, a floor nurse walks approximately 16,390 steps
(about 7.3 miles.) Director of nursing, though is primarily a desk job. If you want to stay in shape, you’ll have to figure out another way to get your steps once you’re promoted.
8. You’re the cheerleader—even when you don’t want to be:
As a representative of your workplace’s administrative team, you must publicly support your workplace’s policies and procedures even when you have doubts about them. This is another one of the top cons of being a director of nursing because it may make you feel like a hypocrite, particularly if situations arise where your loyalty to the nursing profession clashes with your loyalty to the people who are signing your paycheck.
9. Your friendships will change:
This is one of the cons of being a director of nursing that primarily affects DONs who are promoted internally after some years in their workplace as a staff nurse. Transitioning from being a peer to being a manager is difficult. Your one-time peers may have a hard time recognizing your new authority, and you may find it challenging to evaluate colleagues you once worked beside. In fact, you may struggle to remain objective when dealing with staff members whom you consider friends.
10. You’ll need more education:
Though just under half of nursing directors list ADN degrees and hospital diplomas on their resumes
, the trend these days is toward hiring DONs who have BSN and MSN degrees. In fact, an MSN with a leadership specialty is considered so valuable that many prospective employers consider it an adequate substitute for a year or two of actual administrative experience.
WHAT ARE THE TOP PROS OF BEING A DIRECTOR OF NURSING?
There are many advantages of being a director of nursing, too, of course. For RNs with a flair for administration, this is an opportunity to promote high-quality healthcare on a much larger scale than bedside nursing may provide. Here’s a look at 10 of the top pros of being a director of nursing.
1. You’ll make more money:
On average, nursing directors throughout all parts of the U.S. earn $100,969 annually. A director of nursing salary, in other words, is 54 percent higher than the average annual salary of all RNs throughout all parts of the U.S. ($65,666). DONs who stay in the job for a decade earn $114,840 on average, which is 75 percent higher than the average RN salary.
2. There will be high demand for your services: The Bureau of Labor Statistics projects that the demand for medical and health services managers will increase by 32 percent between 2020 and 2030. Seventy-three percent of nursing directors are over the age of 40
, which means there will be a large number of retirements within this field as well over the next decade, empty positions that will need to be filled.
3. You’ll be satisfied with your job:
Although research specifically addressing job satisfaction among directors of nursing has not been conducted in any significant manner, a lot of research exists that examines the overall job satisfaction of nurse managers. One such study found that 70 percent of nurse managers are satisfied with their career choice, and 68% were either likely or very likely to recommend nursing management as a career choice
4. You’ll have more autonomy:
As a director of nursing, you won’t be assigned to a specific shift. There will be specific responsibilities that you’ll have to fulfill, but you won’t be told how to fulfill them. You can set your own hours—come to work when you please and leave when you please—so long as you accomplish what the chief nursing officer you report to expects you to accomplish. If you like being the one who makes the rules, then a DON position is for you.
5. You’ll be able to work in multiple practice settings:
Nurse management is a skill, and any facility that employs more than five nurses to do patient care is going to need a manager to supervise the care those nurses are delivering. When it’s time to move on from your present job, you’ll be able to work in a variety of practice settings from large urban healthcare systems to smaller rural clinics.
6. You can wear street clothes:
This may not seem as though it should be one of the pros of being a director of nursing, but for many DONs, it is. You won’t have to wear scrubs or a nursing uniform as a nursing director! Suitable attire for you will be a white lab coat over a stylish suit in a classic color. There’s some evidence, in fact, that physicians and other executives within a hospital’s administration treat nurse managers in business casual with more respect than they treat nurse managers in scrubs.
7. You’ll have networking opportunities:
As a staff RN, your primary professional exposure will be to other nurses and the occasional physician. As a director of nursing, you’ll have the opportunity to interact with colleagues from every department within your organization. You’ll also attend meetings and events outside your organization that will expand your Rolodex even further. Networking will help you become more visible and increase your access to career advancement.
8. You’ll play a pivotal role in your unit’s success:
Bedside nurses touch lives, one patient at a time. But as a nursing director, you’ll have the opportunity to touch hundreds of patients’ lives through the actions of the nurses whom you mentor and influence. You will have the opportunity to shape the nursing care your staff delivers according to your own quality standards. This legacy of excellence is one of the top pros of being a director of nursing for many nurse managers.
9. You’ll learn new skills:
The management skills you develop as a nursing director are transferable. Once you learn what it takes to manage a team, you can transition into supervisory positions like project management, program management or business analysis that are outside healthcare if you wish.
10. Your employer wants to keep you contented:
One of the biggest advantages of being a director of nursing is the perks your employer may give you to keep you happy. Healthcare organizations often offer tuition assistance and loan forgiveness to their nursing directors and other upper echelon nursing staff. This can make earning an MSN more plausible.
DIRECTOR OF NURSING SALARY + BENEFITS
What Is The Starting Salary Of A Director Of Nursing?
The starting salary of a director of nursing is $35.17 an hour, $6,100 a month, or $73,150 a year. The base salary of nursing directors and other healthcare executives working in medical practice settings are typically paid “step rates” that ascend according to seniority and the importance of the job. Some hospitals also award cash bonuses at the end of the year. Such bonuses are based on merit.
What Is The Average Salary Of A Director Of Nursing?
The average director of nursing salary is $48.54 an hour, $8,410 a month, or $100,969 annually. Nursing directors typically reach this milestone during their ninth or tenth year in the profession. Average salaries tend to track the overall cost of living within a specific geographic locale, but they also track educational accomplishments. Nursing directors with BSN degrees average $86,893 annually, but nursing directors with MSN degrees average $97,604, and nursing directors with Doctor of Nursing Practice (DNP) degrees average $114,614 annually
How Much Does The Director Of Nursing Salary Grow With Experience?
Nursing directors with one to four years of experience earn $83,670 annually on average, which is 14 percent more than entry-level directors of nursing earn. Nursing directors with five to nine years of experience earn $98,470 annually on average, which is 35 percent more than entry-level directors of nursing earn. Nursing directors with 20 or more years of experience earn $137,690 annually on average, which is 88 percent more than entry-level directors of nursing earn.
Nursing director jobs have high turnover. Only 10 percent of DONs stay in the same position for more than eight years
. Forty percent of all nursing directors leave their jobs within one to two years. However, since the director of nursing is an executive position, most employers credit nursing directors for past experience so that when DONs make lateral employment jumps to a new hospital setting, they’re paid considerably more than entry-level wages at their new place of employment.
| Level of Experience || Annual || Monthly || Hourly |
| Entry-Level ||$35.17 ||$6,100 ||$73,150 |
| 1-4 Years of Experience ||$40.23 ||$6,970 ||$83,670 |
| 5-9 Years of Experience ||$47.34 ||$8,210 ||$98,470 |
| 10-19 Years of Experience ||$55.21 ||$9,570 ||$114,840 |
| 20 Years or More Experience ||$66.20 ||$11,470 ||$137,690 |
What Benefits And Perks Can You Expect As A Director Of Nursing?
Benefits are non-cash perks that employers use to sweeten the deal for prospective employees. Nursing directors are executives, so their employee benefits often contain options that aren’t available to other employees. These options may include:
• Medical, dental and vision insurance for you and your family
• Life insurance, and accidental death and dismemberment insurance (AD&D)
• Relocation assistance
• Travel reimbursement
• Tuition reimbursement
• Employee assistance programs
• Employee discounts
• Flexible scheduling
DIRECTOR OF NURSING SALARY BY STATE
The states where directors of nursing earn the highest salaries are mostly in the northeast and the west coast; the states where directors of nursing earn the lowest salaries are mostly in the southeast. Nursing directors in California, the highest-paying state for DONs, earn $128,710 a year, which is 46 percent more than what nursing directors in Alabama earn ($87,990 a year). Alabama is the lowest-paying state for DONs.
This differential can be deceiving, though, because it doesn’t address purchasing power. The average cost of living in California is 50 percent higher
than the average cost of living in the U.S. as a whole while the average cost of living in Alabama is 18 percent lower
. This difference in the cost of living means that Alabama DON salaries have more purchasing power than California DON salaries.
| State || Hourly || Monthly || Annual |
| Alabama || $42.30 || $7,330 || $87,990 |
| Alaska || $46.75 || $8,100 || $97,230 |
| Arizona || $49.80 || $8,630 || $103,590 |
| Arkansas || $45.02 || $7,800 || $93,650 |
| California || $61.88 || $10,730 || $128,710 |
| Colorado || $46.53 || $8,070 || $96,780 |
| Connecticut || $49.50 || $8,580 || $102,970 |
| Delaware || $47.58 || $8,250 || $98,960 |
| Florida || $42.84 || $7,430 || $89,110 |
| Georgia || $45.03 || $7,810 || $93,660 |
| Hawaii || $50.35 || $8,730 || $104,730 |
| Idaho || $48.28 || $8,370 || $100,420 |
| Illinois || $47.50 || $8,230 || $98,810 |
| Indiana || $46.61 || $8,080 || $96,940 |
| Iowa || $45.75 || $7,930 || $95,150 |
| Kansas || $44.31 || $7,680 || $92,170 |
| Kentucky || $43.43 || $7,530 || $90,340 |
| Louisiana || $47.43 || $8,220 || $98,650 |
| Maine || $47.30 || $8,200 || $98,390 |
| Maryland || $48.85 || $8,470 || $101,610 |
| Massachusetts || $53.43 || $9,260 || $111,140 |
| Michigan || $46.27 || $8,020 || $96,240 |
| Minnesota || $50.40 || $8,740 || $104,840 |
| Mississippi || $46.44 || $8,050 || $96,600 |
| Missouri || $45.30 || $7,850 || $94,230 |
| Montana || $48.49 || $8,400 || $100,850 |
| Nebraska || $45.50 || $7,890 || $94,640 |
| Nevada || $50.82 || $8,810 || $105,710 |
| New Hampshire || $47.67 || $8,260 || $99,160 |
| New Jersey || $55.49 || $9,620 || $115,410 |
| New Mexico || $49.62 || $8,600 || $103,210 |
| New York || $53.60 || $9,290 || $111,490 |
| North Carolina || $45.94 || $7,960 || $95,560 |
| North Dakota || $47.09 || $8,160 || $97,940 |
| Ohio || $44.78 || $7,760 || $93,140 |
| Oklahoma || $47.80 || $8,290 || $99,420 |
| Oregon || $50.28 || $8,720 || $104,580 |
| Pennsylvania || $47.29 || $8,200 || $98,370 |
| Rhode Island || $49.73 || $8,620 || $103,430 |
| South Carolina || $42.89 || $7,440 || $89,220 |
| South Dakota || $43.70 || $7,570 || $90,890 |
| Tennessee || $42.13 || $7,300 || $87,620 |
| Texas || $49.47 || $8,580 || $102,900 |
| Utah || $48.13 || $8,340 || $100,120 |
| Vermont || $45.90 || $7,960 || $95,480 |
| Virginia || $46.49 || $8,060 || $96,690 |
| Washington || $53.62 || $9,290 || $111,520 |
| West Virginia || $44.61 || $7,730 || $92,780 |
| Wisconsin || $47.91 || $8,310 || $99,660 |
| Wyoming || $50.37 || $8,730 || $104,760 |
DIRECTOR OF NURSING SALARY BY METRO
As noted above, salaries tend to reflect cost of living indices. Cities where the director of nursing salary is highest tend to be cities with notably high costs of living.
There are some exceptions to this, however. The cost of living in Texas is 6 percent lower than the national average
, but nursing director salaries in Houston ($110,930) are 10 percent higher than the national average while nursing director salaries in Dallas ($102,940) are 2 percent higher than the national average. And in Oklahoma, the cost of living is 15 percent less than the national average
, but in Oklahoma City and Tulsa, nursing directors earn just around the national average for nursing director salaries. The reason for this most likely has to do with the fact that Houston, Dallas, Oklahoma City and Tulsa are all regional healthcare hubs.
| Metro || Hourly || Monthly || Annual |
| Akron, OH || $48.51 || $8,410 || $100,910 |
| Albany-Schenectady-Troy, NY || $46.79 || $8,110 || $97,320 |
| Albuquerque, NM || $46.20 || $8,010 || $96,100 |
| Allentown-Bethlehem-Easton, PA-NJ || $47.94 || $8,310 || $99,720 |
| Anchorage, AK || $50.85 || $8,810 || $105,770 |
| Ann Arbor, MI || $47.42 || $8,220 || $98,640 |
| Asheville, NC || $44.29 || $7,680 || $92,120 |
| Atlanta-Sandy Springs-Roswell, GA || $45.40 || $7,870 || $94,430 |
| Austin-Round Rock, TX || $47.30 || $8,200 || $98,390 |
| Baltimore-Columbia-Towson, MD || $49.41 || $8,560 || $102,770 |
| Baton Rouge, LA || $41.53 || $7,200 || $86,380 |
| Birmingham-Hoover, AL || $41.94 || $7,270 || $87,230 |
| Boise City, ID || $53.81 || $9,330 || $111,920 |
| Boston-Cambridge-Nashua, MA-NH || $53.81 || $9,330 || $111,920 |
| Bridgeport-Stamford-Norwalk, CT || $51.15 || $8,870 || $106,390 |
| Buffalo-Cheektowaga-Niagara Falls, NY || $47.46 || $8,230 || $98,710 |
| Cape Coral-Fort Myers, FL || $38.84 || $6,730 || $80,780 |
| Charleston-North Charleston, SC || $44.29 || $7,680 || $92,130 |
| Charlotte-Concord-Gastonia, NC-SC || $45.90 || $7,960 || $95,480 |
| Charlottesville, VA || $45.43 || $7,870 || $94,490 |
| Chattanooga, TN-GA || $42.93 || $7,440 || $89,300 |
| Chicago-Naperville-Elgin, IL-IN-WI || $47.48 || $8,230 || $98,760 |
| Cincinnati, OH-KY-IN || $42.40 || $7,350 || $88,190 |
| Cleveland-Elyria, OH || $43.32 || $7,510 || $90,100 |
| Colorado Springs, CO || $43.15 || $7,480 || $89,750 |
| Columbia, SC || $40.82 || $7,080 || $84,900 |
| Columbus, OH || $43.98 || $7,620 || $91,480 |
| Dallas-Fort Worth-Arlington, TX || $49.49 || $8,580 || $102,940 |
| Dayton, OH || $46.82 || $8,120 || $97,390 |
| Denver-Aurora-Lakewood, CO || $47.73 || $8,270 || $99,280 |
| Des Moines-West Des Moines, IA || $40.79 || $7,070 || $84,840 |
| Detroit-Warren-Dearborn, MI || $47.25 || $8,190 || $98,280 |
| Durham-Chapel Hill, NC || $46.95 || $8,140 || $97,660 |
| El Paso, TX || $47.80 || $8,290 || $99,430 |
| Evansville, IN-KY || $47.56 || $8,240 || $98,930 |
| Fort Wayne, IN || $45.11 || $7,820 || $93,820 |
| Fresno, CA || $58.26 || $10,100 || $121,190 |
| Grand Rapids-Wyoming, MI || $45.42 || $7,870 || $94,470 |
| Greensboro-High Point, NC || $46.80 || $8,110 || $97,350 |
| Greenville-Anderson-Mauldin, SC || $44.29 || $7,680 || $92,130 |
| Gulfport-Biloxi-Pascagoula, MS || $43.71 || $7,580 || $90,920 |
| Hartford-West Hartford-East Hartford, CT || $47.41 || $8,220 || $98,620 |
| Houston-The Woodlands-Sugar Land, TX || $53.33 || $9,240 || $110,930 |
| Huntsville, AL || $42.33 || $7,340 || $88,040 |
| Indianapolis-Carmel-Anderson, IN || $46.65 || $8,090 || $97,040 |
| Jackson, MS || $46.01 || $7,980 || $95,700 |
| Jacksonville, FL || $43.59 || $7,560 || $90,660 |
| Johnson City, TN || $40.65 || $7,050 || $84,560 |
| Jonesboro, AR || $42.61 || $7,390 || $88,620 |
| Kansas City, MO-KS || $46.91 || $8,130 || $97,570 |
| Killeen-Temple, TX || $47.46 || $8,230 || $98,710 |
| Knoxville, TN || $42.20 || $7,320 || $87,780 |
| Lancaster, PA || $44.38 || $7,690 || $92,310 |
| Las Vegas-Henderson-Paradise, NV || $48.97 || $8,490 || $101,860 |
| Lexington-Fayette, KY || $43.28 || $7,500 || $90,030 |
| Little Rock-North Little Rock-Conway, AR || $43.09 || $7,470 || $89,630 |
| Los Angeles-Long Beach-Anaheim, CA || $60.52 || $10,490 || $125,890 |
| Louisville/Jefferson County, KY-IN || $44.87 || $7,780 || $93,320 |
| Madison, WI || $46.80 || $8,110 || $97,350 |
| Memphis, TN-MS-AR || $46.39 || $8,040 || $96,500 |
| Miami-Fort Lauderdale-West Palm Beach, FL || $41.13 || $7,130 || $85,560 |
| Milwaukee-Waukesha-West Allis, WI || $47.44 || $8,220 || $98,680 |
| Minneapolis-St. Paul-Bloomington, MN-WI || $50.87 || $8,820 || $105,810 |
| Nashville-Davidson--Murfreesboro--Franklin, TN || $41.79 || $7,240 || $86,930 |
| New Orleans-Metairie, LA || $47.88 || $8,300 || $99,590 |
| New York-Newark-Jersey City, NY-NJ-PA || $56.54 || $9,800 || $117,610 |
| North Port-Sarasota-Bradenton, FL || $47.24 || $8,190 || $98,260 |
| Oklahoma City, OK || $48.13 || $8,340 || $100,100 |
| Omaha-Council Bluffs, NE-IA || $46.09 || $7,990 || $95,870 |
| Orlando-Kissimmee-Sanford, FL || $46.79 || $8,110 || $97,320 |
| Philadelphia-Camden-Wilmington, PA-NJ-DE-MD || $50.38 || $8,730 || $104,800 |
| Phoenix-Mesa-Scottsdale, AZ || $49.31 || $8,550 || $102,570 |
| Pittsburgh, PA || $46.02 || $7,980 || $95,730 |
| Portland-South Portland, ME || $47.23 || $8,190 || $98,240 |
| Portland-Vancouver-Hillsboro, OR-WA || $50.16 || $8,700 || $104,340 |
| Providence-Warwick, RI-MA || $50.14 || $8,690 || $104,300 |
| Raleigh, NC || $47.16 || $8,180 || $98,100 |
| Richmond, VA || $46.05 || $7,980 || $95,780 |
| Riverside-San Bernardino-Ontario, CA || $61.90 || $10,730 || $128,750 |
| Rochester, NY || $46.75 || $8,100 || $97,250 |
| Sacramento--Roseville--Arden-Arcade, CA || $62.80 || $10,890 || $130,630 |
| Salt Lake City, UT || $49.55 || $8,590 || $103,060 |
| San Antonio-New Braunfels, TX || $46.87 || $8,120 || $97,490 |
| San Diego-Carlsbad, CA || $53.47 || $9,270 || $111,210 |
| San Francisco-Oakland-Hayward, CA || $75.37 || $13,060 || $156,770 |
| San Jose-Sunnyvale-Santa Clara, CA || $64.96 || $11,260 || $135,120 |
| Seattle-Tacoma-Bellevue, WA || $54.67 || $9,480 || $113,710 |
| Springfield, MA-CT || $49.34 || $8,550 || $102,620 |
| Springfield, MO || $38.14 || $6,610 || $79,340 |
| St. Louis, MO-IL || $44.66 || $7,740 || $92,900 |
| Syracuse, NY || $47.02 || $8,150 || $97,800 |
| Tampa-St. Petersburg-Clearwater, FL || $41.86 || $7,260 || $87,070 |
| Toledo, OH || $47.28 || $8,200 || $98,340 |
| Tucson, AZ || $51.19 || $8,870 || $106,480 |
| Tulsa, OK || $48.70 || $8,440 || $101,300 |
| Virginia Beach-Norfolk-Newport News, VA-NC || $43.97 || $7,620 || $91,450 |
| Washington-Arlington-Alexandria, DC-VA-MD-WV || $50.41 || $8,740 || $104,860 |
| Wichita, KS || $41.63 || $7,220 || $86,580 |
| Winston-Salem, NC || $44.27 || $7,670 || $92,090 |
| Youngstown-Warren-Boardman, OH-PA || $47.15 || $8,170 || $98,070 |
HIGHEST PAID DIRECTORS OF NURSING
What Are The 10 Highest Paying States For Directors Of Nursing?
Three of the highest paying states for directors of nursing are also states where the demand for directors of nursing is high: California, New Jersey, and New York. California and New York are among the states where the highest number of nurses are employed
, and nursing teams need nursing directors to manage them. Interestingly, only 4,850 nurses are employed in Wyoming, making the Cowboy State the state with the lowest number of nurses on its payroll. Likely, one of the reasons why nursing director salaries are so comparatively high in Wyoming is to attract nurse managers who can make the most out of smaller teams.
| Rank || State || Average|
| 1 || California || $128,710 |
| 2 || New Jersey || $115,410 |
| 3 || Washington || $111,520 |
| 4 || New York || $111,490 |
| 5 || Massachusetts || $111,140 |
| 6 || Nevada || $105,710 |
| 7 || Minnesota || $104,840 |
| 8 || Wyoming || $104,760 |
| 9 || Hawaii || $104,730 |
| 10 || Oregon || $104,580 |
What Are The 10 Highest Paying Metros For Directors Of Nursing?
Nine of the ten cities in the U.S. that pay the highest salaries to nursing directors are located in California. The cities of Vallejo and Fairfield in the Golden State’s Solano County are the highest paying metros for directors of nursing with salaries that average $165,830 a year. Other high-paying cities for California directors of nursing include the San Francisco Bay Area ($156,770), Salinas ($136,940), and the San Jose Metropolitan Area ($135,120).
One reason why the highest-paid directors of nursing work in California may be that in 1999, the state passed AB 394
, which set minimum nurse-to-patient ratios for all hospitals in the Golden State. Scheduling is a major component of the nursing director role, and one that involves evaluating nurse-to-patient ratios very carefully.
| Rank || Metro || Average|
| 1 || Vallejo-Fairfield, CA || $165,830 |
| 2 || San Francisco-Oakland-Hayward, CA || $156,770 |
| 3 || Salinas, CA || $136,940 |
| 4 || San Jose-Sunnyvale-Santa Clara, CA || $135,120 |
| 5 || Napa, CA || $134,590 |
| 6 || Sacramento--Roseville--Arden-Arcade, CA || $130,630 |
| 7 || New Bedford, MA || $130,070 |
| 8 || Riverside-San Bernardino-Ontario, CA || $128,750 |
| 9 || Santa Maria-Santa Barbara, CA || $128,510 |
| 10 || Yuba City, CA || $127,920 |
What Are The Highest Paying Workplaces For Directors Of Nursing?
No statistics are available that break out director of nursing salaries by practice setting, but it is likely that the highest-paid directors of nursing are employed by large medical systems in densely populated urban centers. In general, the salaries of healthcare workers are positively correlated with institutional size. Large medical systems can take advantage of economies of scale to keep operational costs down. This means they have more money than smaller medical centers or private physician practices to invest in employee salaries and benefits.
5 Tips To Become One Of The Highest Paid Directors Of Nursing
Looking for ways to maximize your earnings as a director of nursing? Here are five tips to consider:
1. Work for an employer that pays annual bonuses:
A nursing director’s compensation package consists of three elements: salary, benefits, and bonuses. Bonuses are often offered as a performance-based incentive, tied into a workforce or departmental goal. If you have the opportunity to earn bonuses, you may make more money.
2. Work for a larger healthcare system:
Directors of nursing employed by large healthcare systems make the highest salaries on average.
3. Earn a degree: According to the career website Zippia, directors of nursing with BSN degrees average $86,893 a year
. In contrast, directors of nursing with MSN degrees average $97,604 a year (12 percent more) while directors of nursing with DNP degrees average $114,614 annually (32 percent more).
4. Get experience:
The more experience you have as a director of nursing, the higher your salary will be. Nursing directors with 10 to 19 years of experience make $114,840 a year on average, which is 57 percent more than entry-level directors of nursing average ($73,150 a year).
Directors of nursing earn different salaries according to the geographical region where they work. The top-paying states for nursing directors are California, New Jersey, Washington, New York, and Massachusetts.
DIRECTOR OF NURSING JOB OUTLOOK
Is There A Demand For Directors Of Nursing?
As noted above, the demand for nurse managers overall—including nursing directors—is high. The Bureau of Labor Statistics projects that the demand for medical and health services managers will increase 32 percent in the decade between 2020 and 2030
What Are The Top 5 Reasons Contributing To The Demand For Directors Of Nursing?
The demand for nursing directors in the next decade will be driven by several factors, including:
1. The Affordable Care Act: The 2010 Affordable Care Act (ACA) expanded healthcare access for some 17.6 million Americans
, many of them low-income individuals. This has resulted in a huge increase in the utilization of healthcare services, particularly those services related to chronic conditions like diabetes, hypertension and heart disease that are correlated with low incomes. Nursing directors are needed to help coordinate the cost-effective delivery of high-quality healthcare services to this larger pool of prospective patients.
2. Aging of the Baby Boomers:
“Never trust anyone over 30!” was the mantra of the Baby Boomers in their youth. But now members of this generation are approaching their 70s and 80s and putting their trust in the American healthcare system. By 2050, the number of Americans over the age of 65 is projected to surpass 83 million
. Older adults utilize far more healthcare services: Though individuals aged 65 or over only account for 12 percent of the population, they account for 26 percent of all physician visits
. It will fall to nursing directors as well as other nurse managers to ensure that increased rates of utilization aren’t accompanied by a decline in quality.
It takes years to qualify for a director of nursing job, so it should come as no surprise that 73 percent of nursing directors are older than 40, and that the average age of a nursing director is 47
. Retirement is on the horizon for many of these individuals—and when that takes place, there must be a fresh pool of nursing director candidates to take their place. And that doesn’t begin to take into consideration all the new nursing director jobs that will be opening up and that will also need to be filled.
4. The looming nursing shortage:
The COVID-19 pandemic accelerated an issue that healthcare analysts have predicted for a long time: a nationwide nursing shortage. Nursing staff shortages throughout the pandemic cost hospitals throughout the U.S. an estimated $24 billion
. Creative nursing directors are needed who can figure out ways to cope with a dwindling nurse workforce without sacrificing high standards in patient care.
5. Cost containment:
The costs associated with healthcare keep escalating because of the rising costs of government programs like Medicare and Medicaid, the rising price of insurance premiums, and the rising cost of drugs. But most hospitals and other healthcare providers teeter at the brink of insolvency. Since 2018, the average operating margin for hospitals in the U.S. has hovered at 2 percent
. Talented nursing directors can help the organizations they work for identify cost savings and improve efficiencies without sacrificing high-quality nursing care.
What Are The 10 States With The Highest Demand For Directors Of Nursing?
The 10 states with the highest demand for nursing directors are New York, California, Texas, Florida, Illinois, Tennessee, Georgia, Ohio, Pennsylvania, and New Jersey. These are also the states with some of the highest percentages of Medicaid enrollees in the U.S. Medicaid expansion has been correlated with increased rates of hospital utilization
, particularly among the elderly and individuals with chronic conditions like diabetes, hypertension, and cardiac disease. Increased rates of hospitalization will lead to an increased demand for talented nursing directors and other nurse managers who understand how to deliver high-quality care even when resources are strained.
| Rank || State |
| 1 || New York |
| 2 || California |
| 3 || Texas |
| 4 || Florida |
| 5 || Illinois |
| 6 || Tennessee |
| 7 || Georgia |
| 8 || Ohio |
| 9 || Pennsylvania |
| 10 || New Jersey |
What Are The 10 Metros With The Highest Demand For Directors Of Nursing?
Unsurprisingly, the cities where the demand for nursing directors is highest are predominantly in the states where the demand for nursing directors is highest. Several nonprofit hospitals in cities like Philadelphia, Chicago and New York City have closed in the last 20 years; these were hospitals that chiefly served the urban poor. By ensuring nursing departments stay on budget, creating staff schedules that avoid overtime and researching lower-cost employee benefits, nursing directors can help struggling hospitals in urban settings conserve financial resources.
| Rank || Metro |
| 1 || New York-Newark-Jersey City, NY-NJ-PA |
| 2 || Boston-Cambridge-Nashua, MA-NH |
| 3 || Chicago-Naperville-Elgin, IL-IN-WI |
| 4 || Atlanta-Sandy Springs-Roswell, GA |
| 5 || Los Angeles-Long Beach-Anaheim, CA |
| 6 || Dallas-Fort Worth-Arlington, TX |
| 7 || Philadelphia-Camden-Wilmington, PA-NJ-DE-MD |
| 8 || Miami-Fort Lauderdale-West Palm Beach, FL |
| 9 || Houston-The Woodlands-Sugar Land, TX |
| 10 || Phoenix-Mesa-Scottsdale, AZ |
MOST COMMON INTERVIEW QUESTIONS AND ANSWERS FOR DIRECTOR OF NURSING JOBS
A job interview is your opportunity to shine when you’re applying for a director of nursing position. Nursing directors have such a varied set of responsibilities that you can anticipate a bunch of hypothetical situational inquiries in addition to standard questions about your education, work experience, and nursing philosophy. Here are five of the top director of nursing interview questions that you should understand how to answer.
Question #1: When you’re hiring new nurses, what techniques do you find most useful in finding the right person for the job?
What the Interviewer Really wants to Know: Your interviewer is essentially asking what you would do if you were in their position—which has the potential to help you establish a rapport. Hiring decisions and staff development are an important part of a nursing director’s job, so this question references a task you’ll probably be doing a lot when you land this position.
If you’ve done your due diligence and researched this healthcare organization, you should have a general idea of how this prospective employer vets new hires. Go with that for your answer here—even if as nursing director, you personally would prefer to use a different method.
Sample Answer: “If I’m hiring an external candidate, I use a different set of methods and techniques than if I’m hiring an internal candidate. The two most important parts of the hiring process with external candidates—once the information in their resume or curriculum vitae is verified—are references and interviews. In fact, I may end up interviewing a candidate’s references at considerable length! As I draft my interview questions, I am looking for ways to tease out information about the four characteristics I believe are essential to nursing success: excellent communication, a capacity for critical thinking, empathy for others, and resilience in oneself.”
Question #2: How do you handle days when your department is short-staffed?
What the Interviewer Really wants to Know: This is one of the most important director of nursing interview questions because it addresses the most pressing issue directors of nursing face: inadequate staffing. In a way, though, it’s a trick question. The easy solution to being short-staffed is to ask nurses to do overtime. This is the wrong answer, though, because overtime is extremely expensive, and the hospital administration is looking for ways to cut costs. They want to hire a director of nursing who respects that stance.
Sample Answer: “Overtime is an option I only use as a last resort because paying a nurse time and a half for eight hours is an expensive solution. What I would do first is look to see what resources might be available to me among nurses who are receiving their standard salaries for eight hours. One of the things I’m interested in doing as a director of nursing is augmenting the department’s per diem pool. Per diem nurses work as needed—so, if we see a bump in the patient census, we can recruit our existing per diems to come in.”
Question #3: How would you handle a conflict with the angry family member of a patient?
What the Interviewer Really wants to Know: Conflict resolution is an important skill for nursing directors. This question gives the interviewer an opportunity to learn about your conflict resolution techniques. It’s also a subtle way for the interviewer to figure out whether you’ve been involved in frequent conflicts at the other hospitals where you’ve worked. The interviewer wants to see that you stayed calm and respectful with the angry family member and offered practical recommendations so that the situation would not occur again.
Sample Answer: “I understand very well that family members feel powerless when their loved ones fall ill, and that many times, this primes them to overreact. They’re projecting their frustrations over their loved one’s plight onto hospital staff to a certain extent. Nevertheless, their concern is real, and I respect that. I listen to what they have to say and ask all the necessary follow-up questions. Once I have a complete picture of the issue that sparked their concerns, I present possible solutions. And I let them know I will give them time to decide which one will work best for them.”
Question #4: How would you handle a staff member who was underperforming and needed disciplinary action?
What the Interviewer Really wants to Know: This question gets to the heart of what a good nursing director is supposed to achieve, which is to guide the nursing team and keep morale strong. The director of nursing is responsible for formulating and enforcing policies at the departmental level. These policies are designed to optimize nursing productivity while maintaining patient safety. A good answer here is one that emphasizes conflict resolution skills, respect for hospital policies, insistence upon patient safety, and a sincere desire to mentor the errant staff member.
Sample Answer: “This is an issue that should be handled initially by nurse managers who work in the clinical setting. If their attempts to help the staff member realign objectionable behavior have proven unsuccessful, then the situation has escalated and become serious. I would set up a private meeting with the staff member to review departmental procedures, explaining their relevance to the goal we all share—which is the provision of high-quality patient care. I would ask what recommendations clinical nurse managers made in earlier meetings and ask point-blank: Why didn’t these interventions work? I would let the staff member know that he or she will be given one more chance—but after that, I will initiate the disciplinary actions that are part of the hospital’s protocol.”
Question #5: How would you change our hospital’s patient and family reception area in the lobby?
What the Interviewer Really wants to Know: This may seem like a trivial question. It’s not. The interviewer wants to learn whether you’ve taken the employment application process seriously enough to learn something about the physical facility. It’s also a question about optimal ways to allay patient and family anxiety.
Sample Answer: “Do I have a budget to make these changes?” (This is the type of joke that will draw appreciative laughter from your interviewer.) “If I had a sufficient budget, I would investigate installing a water feature of some sort in front of the main entrance where it could easily be seen from the lobby reception area. I know some hospitals have even installed fountains and water features in their actual lobbies, but I would be reluctant to do that because of issues with Legionnaires’ disease. Water is known to have a soothing effect on people who are feeling anxious. I would make sure the vending machines in the lobby area offer nutritious snacks. I would also update the magazines in the lobby area and install two new television screens so that people waiting will have distraction and entertainment.”
MOST COMMON CHALLENGES DIRECTORS OF NURSING FACE AND HOW TO OVERCOME THEM?
Nursing directors take on enormous responsibilities. In addition to overseeing the work of all nurses in their unit or department, they must also ensure compliance with regulations and serve as a point of contact between nurses, physicians, hospital administrators, patients, and patients’ families. Here’s a look at the top seven challenges that directors of nursing face.
Challenge #1: Staff shortages
About the Challenge:
Nursing staff shortages have been exacerbated by the COVID-19 pandemic. In 2021, 62 percent of hospitals in the U.S. reported a nurse vacancy rate of 7.5 percent or higher
. When a hospital unit is understaffed, the nurses who work there can become so overwhelmed that patient welfare is jeopardized. Even if this lack of focus doesn’t result in medical errors, nurses may not be able to fully engage with their patients, which affects overall patient satisfaction
Nurses working in chronically understaffed units are at greater risk for developing burnout and related health issues such as anxiety, depression, hypertension, and musculoskeletal disorders.
How to Overcome it:
Nursing directors must become proactive in recruiting new staff members. This may mean working with their organization’s financial department to offer incentives like signing bonuses for recruits. They may also want to work with their organization’s human resources department to investigate means of simplifying the hiring process: Currently, the average time to hire a healthcare staff employee is 49 days
; this can be shortened with better candidate sourcing and a more streamlined recruitment process. Consider allowing local nursing programs to use your department or unit for clinical rotations; this will give you access to a motivated pool of nurses-in-training who you may then be able to recruit.
Challenge #2: Nurse retention
About the Challenge:
Resolving this issue will help address the challenge nursing directors are facing with nursing shortages. Ninety percent of the nurses interviewed in a recent Hospital IQ survey indicated they were seriously considering leaving the profession within the next few years
How to Overcome it:
Nursing directors would be well advised to lobby for the implementation of technologies that can help nurses coordinate their work responsibilities more effectively. Nursing directors should also do their best to foster a departmental or unit culture in which the nurses working there feel heard, supported, and valued. It may also be worth exploring incentives in conjunction with the organization’s financial department, for example, offering annual cash retention bonuses to nurses who have been working three years or longer.
Challenge #3: Negative perceptions of the organization on the part of nursing team members
About the Challenge: Nurses tend to like their patients and the other nurses they interact with on a daily basis. But the COVID-19 pandemic exacerbated long-existing tensions between nurses and hospital administrators. Frontline nurses, for the most part, are unsympathetic to hospital administrators’ need to focus on the financial bottom line and may view the administration’s concerns with compliance and patient safety as unnecessary red tape.
How to Overcome it: This is basically an issue that arises from miscommunication and a lack of transparency on the part of hospital administrators. It’s a problem that’s beyond your purview as a nursing director, and yet it impacts your job because you are the link between your department’s nurses and your hospital administration. You can do very little personally to resolve this issue beyond lobbying for the inclusion of nurse representatives on administration work committees in hopes that these nurses can help spread information.
Challenge #4: Burnout
About the Challenge: Even before the COVID-19 pandemic, studies indicated that more than 50 percent of nurses were affected by burnout
. Nurse burnout—characterized by physical and mental exhaustion, inability to meet work requirements and increasing cynicism about nursing as a career choice—can have a devastating effect on both patient care and nurse retention.
How to Overcome it:
Nursing directors can help boost staff morale by forging strong relationships with nursing team members, acknowledging their concerns, and rewarding them for a job well done. Create an open-door atmosphere so that when nurses on your team feel overwhelmed, they know they can come to you to talk it out. Sit down with nurses who come to you with complaints about their work environment and identify specific situations where you may be able to intervene positively.
Challenge #5: Cultural diversity
About the Challenge:
Patients include people of every race, creed, gender, and age. The nursing workforce must reflect this diversity as well. At present, 90 percent of all nurses are female. Ten percent of all nurses are Black; 8 percent are Asian; and 5 percent are Hispanic
How to Overcome it:
As a director of nursing, make sure your commitment to diversity is reflected in your hiring protocols. Cast a wide net to attract nursing talent. Make flexible part-time employment and scheduling opportunities available that will help maintain a workplace that is accommodating to personal lifestyle needs.
Challenge #6: Controlling costs
About the Challenge:
Nursing directors collaborate with their organization’s financial department on the budget for their unit or department. They don’t have the final say. Budgets must be approved: first, by the organization’s administration and next, by the organization’s board of directors. In designing a budget, nursing directors look at historical factors like patient/case mix, payer mix, services offered and patient acuity, and attempt to project these onto the coming year. By far, the greatest driver of expenses for hospital departments is nurse salaries
. In some New York City hospitals, for example, annual overtime pay has exceeded annual salaries
How to Overcome it:
The key to controlling costs is the minimization of nurse overtime. Nursing directors may find it useful to set specific percentage overtime reduction goals for their departments as well as investigate alternative staffing strategies. One useful strategy may be the implementation of a per diem pool of departmental nurses who work on an “as needed” basis. Another method might be to track patient acuity carefully and assign medium-priority and low-priority care functions to non-nursing personnel or to float nurses from other hospital departments.
Challenge #7: Training new nurses
About the Challenge:
The transition from student nurse to working nurse can be rocky. New nurses feel higher levels of stress, and higher levels of stress can imperil patient safety by leading to medical errors. Additionally, practice transition stress affects nurse shortages: the turnover rate among newly licensed RNs ranges as high as 17 to 30 percent in the first year and 30 to 57 percent by their second year
How to Overcome it:
This is another issue that needs to be addressed by your organization at the administrative level, but you can play a part as a director of nursing by lobbying enthusiastically for an integrated and thorough transition program for new graduate nurses, structured to ensure required skills in specific areas of practice are amply demonstrated.
USEFUL RESOURCES FOR DIRECTORS OF NURSING
Organizations And Associations
• National Association of Directors of Nursing Administration in Long Term Care
(NADONA): This organization is designed to support directors of nursing who preside over a variety of providers, including skilled nursing facilities and home healthcare agencies, that offer healthcare services to patients on an ongoing basis. NADONA offers individual and institutional memberships; fees vary according to the state you practice in. NADONA offers several certifications, including the CDONA.
• American Organization for Nursing Leadership
(AONL): AONL is a professional association that represents more than 11,000 healthcare executives, directors of nursing, nurse managers, and nurse clinical leaders. Its annual conference during the second week of April draws thousands of healthcare executives from all over the nation. Benefits include discounts on continuing education classes as well as a subscription to The Journal of Nursing Administration
at a reduced rate. Membership is $225 a year.
• American Nurses Association
(ANA): ANA is the largest professional association for nurses in the U.S. Its membership is over 163,000. ANA is committed to the advancement of the nursing profession, and to that end, it publishes two professional journals: American Nurse Today and The American Nurse
. Other membership benefits include discounted continuing education classes, a jobs bulletin board, and networking opportunities. Membership fees are $180 a year.
• National League for Nursing
(NLN): NLN is a professional association for nurse educators and faculty nurses. It has more than 40,000 individual members and more than 1,200 institutional members. It’s one of the primary providers of nursing program accreditation services. Membership is $120 a year for full members and $80 a year for graduate student members.
• American Academy of Nursing
(AAN): AAN is the health policy arm of ANA, committed to generating and promoting nursing research. It publishes the bimonthly journal Nursing Outlook
. Membership is by invitation only. Members are known by the designation “Fellows of the American Academy of Nursing”.
• Becoming a Successful Nurse Director
: In this one-half hour video, Cheryl Toole, Director of Nursing of Boston Children’s Hospital’s Neonatal Intensive Care Unit interviews Dr. Debra Burke, who is affiliated with Massachusetts General Hospital, on the research Dr. Burke has done on the characteristics of nurse directors that can help them achieve high employee satisfaction scores.
• Director of Nursing Turnover: Intervening with a Long-Term Care Leadership Round Table
: Priscilla Stansell, an assistant professor at Texas Tech University Health Sciences Center, shares her research into what can be done to staunch DON turnover in the long-term practice setting.
• Director of Nursing for a Medical Surge Floor
: The Journey2MedicinePodcast showcases career trajectories within the healthcare sector. In this episode, Kymberly Miller is interviewed about her path to a nursing director position. Ms. Miller is a director of nursing at Parcway, a skilled nursing facility in the Oklahoma City Metropolitan Area. Available on Google podcasts.
• ACNL In Action: Lessons in Nursing Leadership
: The Association of California Nurse Leaders (ACNL) produces a podcast that while not specifically designed for directors of nursing, highlights many of the issues that DONs may come across in the course of working. The podcasts include topics like “Learning to Delegate,” “The Cost of Medical Errors” and “Health Policy and Legislation”.
• The Long-Term Care Director of Nursing Field Guide, Second Edition
: This expensive but extremely useful guide by Barbara Acello has been endorsed by the National Association of Directors of Nursing Administration in Long-Term Care. It focuses on the certification and recertification processes as well as skills DONs must-have in the fields of compliance, employee recruitment and retention, and employee relations generally.
BONUS! A TYPICAL DAY IN THE LIFE OF A DIRECTOR OF NURSING
What is it like being a director of nursing? A nursing director has so many varied responsibilities that it’s fair to say no two workdays are alike! As a director of nursing, the only typical thing is to expect the unexpected. Rebecca is the director of nursing for a neurosurgical unit at a major metropolitan hospital. Here’s what one of her workdays looks like.
7:00 a.m.- 8:00 a.m.:
On paper, at least, I work 8 a.m. to 5 p.m., but I always try to get to the hospital an hour earlier. Seven o’clock is when the day shift starts. It’s also the time when the physicians begin their rounds, so there will be updates on patient orders and acuity that may impact staffing needs for the day. I have the opportunity to review my nurses’ 24-hour reports as well, a compilation that lets me catch up on changes in patients’ nursing care plans.
8:00 a.m. – 9:00 a.m.:
I work from an office that is right off the ward clerk’s desk. All my nurses can see me working there, which I think is a good thing. I try to clear my desk at the end of each day, so the 50 or so emails and voice messages that meet me at the beginning of each day all pertain to issues that have arisen in the past 12 hours or so. I don’t have a secretary, so I answer the emails I need to answer personally, and I take notes on the voicemails, making red checks next to the calls that will need to be returned at some point later in the day.
9:00 a.m. – 10:00 a.m.:
A new group of nurse hires is reporting in for their first day of orientation. I’m excited to meet them! I greet each one of them personally and press them to share details about their background with the other members of the group. I then present an overview of our hospital’s history and the work our particular department does. We mostly work with patients who’ve been affected by back and brain injuries. I’m interested in what drew these nurses into this field and spend some time asking them about it after my presentation is through.
10:00 a.m. – 10:30 a.m.:
I have a disciplinary meeting with one of the nurses on my unit. The hospital administration feels she jeopardized patient safety by leaving the hospital at change of shift before the nurse who was covering her on the next shift arrived.
The nurse feels that she was being compelled to do mandatory overtime and has brought her union representative along to speak on her behalf. I’m not unsympathetic to her predicament, but I explain to her that what she did was tantamount to patient abandonment and could put her nursing license at risk. She is being suspended for two days without pay
10:30 a.m. – 11:30 a.m.:
I have a meeting with members of the hospital’s finance department to go over some data I aggregated and presented to them on patient/staff mix that will help them determine my department’s budget for the coming fiscal year. They have a lot of questions.
11:30 a.m. – 12:00 p.m.:
I take some time to update my department’s HIPPA-mandated (Health Insurance Portability and Accountability Act) documentation. We’re not due for another accreditation audit by the Joint Commission
for another 18 months, but I like to keep necessary records organized so there won’t be last-minute scrambles.
12:00 – 1:00 p.m.:
The nursing director of the hospital’s pulmonary unit will be retiring at the end of this month. A group of our hospital’s nursing directors is taking her out to lunch.
1:00 p.m. – 2:00 p.m.:
The monthly meeting of our department’s unit practice council. This is a group where staff members bring up various practice and policy issues for discussion and resolution. The unit practice council was actually one of my innovations, and now practically every department has one! But nurses are not getting paid to attend, so turnout can be spotty.
1:30 p.m. – 3:00 p.m.:
Paperwork. I look over patient census counts and patient acuity reports, and use that information to begin drawing up next month’s schedule. Many nurses on my team have put in vacation requests. Unfortunately, I’m going to have to refuse at least half of those requests, and I already know that will not go over well.
3:00 p.m. – 3:30 p.m.:
Our hospital is on an 8-hour shift schedule, so a new set of nurses come in at 3:00 p.m. I like to sit in on the afternoon change-of-shift meetings when for an update on how our patients are doing. Listening to the afternoon report also lets me know how day shift nurses are doing with their assignments and which ones are struggling and may need some extra help.
3:30 p.m. – 4:00 p.m.:
I look through my notes and prepare some informal remarks for the monthly meeting DONs have with the chief nursing officer later this afternoon.
4:00 p.m. – 5:30 p.m.:
The monthly meeting of the nursing directors with the chief nursing officer. The meeting is scheduled to last for an hour, but there are so many issues that my DON colleagues have questions about that the meeting goes half an hour early. Still, a 10-and-a-half-hour day is a short one for me. Often, I don’t leave for home until 6:00 or 7:00 p.m.
My Final Thoughts
The aim of this article about the position of director of nursing – what is it, steps to become, pros & cons, and salary—is to give you a better idea of whether this career trajectory is the right one for your talents. A director of nursing makes a comparatively high salary and can do a lot to improve the patient experience in the facility where he or she works. But there’s no denying that it’s a high-stress job, and its stressors do not have easy workarounds. Still, if you’re a gifted manager with strong executive skills, this may be a fruitful professional opportunity to explore.
FREQUENTLY ASKED QUESTIONS ANSWERED BY OUR EXPERT
1. Is Director Of Nursing A Good Career Choice?
The director of nursing career path is an excellent choice for a nurse with strong leadership, analytical and interpersonal skills.
2. Is It Hard To Become A Director Of Nursing?
Competition for director of nursing jobs can be fierce but the demand for DON services is high. If you’re confident that you have the right qualifications and skill set for this position, keep networking, sending out your resume and interviewing as jobs become available.
3. Are Directors Of Nursing Happy With Their Jobs?
While no surveys have specifically measured job satisfaction among DONs, nurse managers, in general, are quite satisfied with their jobs. One survey found that 70 percent of nurse managers would describe themselves as “satisfied” or “very satisfied”.
4. What Is The Fastest Way To Become A Director Of Nursing?
The fastest way to become a director of nursing is to pursue an MSN with a leadership concentration while you are working as a clinical nurse. Once you have your academic credential, pursue leadership opportunities like charge nurse within your unit so that you can begin climbing the nursing leadership hierarchy.
5. What Are The 3 Main Duties Of A Director Of Nursing?
The three main duties of a nursing director are the development of departmental policies and procedures, monitoring and ensuring compliance with legal regulations and preparing a budget based on inventory tracking.
6. What Are The 3 Main Skills Required To Succeed As A Director Of Nursing?
The three main skills required to succeed as a director of nursing are time management, budgeting, and a thorough understanding of quality assurance and legal compliance issues.
7. What Are The 3 Main Qualities Every Director Of Nursing Should Possess?
The three main qualities every nursing director should possess are patience, flexibility, and the ability to think critically.
8. What Are The Top 3 Workplaces Where Directors Of Nursing Work? Forty-three percent of nursing directors work in healthcare systems with 1,000 to 10,000 employees
. Other large employers of directors of nursing include outpatient care centers and skilled nursing facilities (including nursing homes).
9. What Other Healthcare Professionals Does A Director Of Nursing Work With?
On their own units, nursing directors routinely work with nurses, nursing assistants, physicians, residents, and ancillary healthcare professionals such as respiratory therapists and physical therapists. They also work with executives from other parts of their organization such as the chief nursing officer, the CEO, the director of human resources and the director of patient care services.
10. How Many Hours A Week Does A Director Of Nursing Work?
Nursing directors are usually scheduled to work a standard workweek, which in most healthcare organizations is between 36 and 40 hours. In practice, however, directors of nursing typically work far longer hours.
11. Do Directors Of Nursing Work On Holidays?
Directors of nursing are not scheduled to work on holidays. Frequently, however, they may come in on holidays—as a morale boost to members of their nursing team who are scheduled to work on holidays.
12. Is The Job Of A Director Of Nursing Stressful?
A DON position can be very stressful since nursing directors are responsible for ensuring high-quality patient care in the departments or units they supervise. The heavy workload that directors of nursing assume puts them at risk for burnout.
13. Do I Need To Be Certified To Work As A Director Of Nursing?
You do not need to be certified to work as a director of nursing. However, certification signals prospective employers that you are dedicated to providing high-quality management.
14. What Is The Best Certification For A Director Of Nursing?
The best certification for a director of nursing is the Director of Nursing Services Certification (DNS-CT offered by the American Association of Post-Acute Care Nursing (AAPACN).
15. On Average, How Much Does A Director Of Nursing Make Per Hour?
The average director of nursing salary per hour is $48.54.
16. Do Directors Of Nursing Make Good Money?
Yes, directors of nursing make good money. The average salary for a director of nursing throughout all parts of the U.S. is $100,969 annually. In contrast, the average salary for all occupations throughout the U.S. is $56,310, which is 44 percent less than the average DON salary.
Nursing Average Annual Salary
Average Annual Salary
| Difference |
| Number || % |
|$100,969 ||$56,310 ||+$44,659 ||+79.31%|
17. What State Pays The Highest Salary For Directors Of Nursing?
California is the state where directors of nursing earn the highest salaries. In the Golden State, nursing directors earn $61,88 an hour, $10,730 a month, and $128,710 annually.
| California |
18. What Metro Pays The Highest Salary For Directors Of Nursing?
The northern California cities of Vallejo and Fairfield are the metropolitan areas where directors of nursing earn their highest salaries. In Vallejo and Fairfield, nursing directors earn $79.73 an hour, $13,820 a month and $165,830 a year.
19. Does A Director Of Nursing Get Paid More Than Other Nurses?
Directors of nursing earn $100,969 a year on average, which is 54 percent higher than the average salary of all nurses throughout the U.S. ($65,666).
Nursing Average Annual Salary
Average Annual Salary
| Difference |
| Number || % |
|$100,969 ||$65,666 ||+$35,303 ||+53.76%|
20. Are Director Of Nursing Jobs Hard To Get?
There’s a lot of competition for director of nursing jobs, so yes, they are hard to get.
21. Are There Any Travel Jobs For Directors Of Nursing?
Travel jobs for nursing directors are available, but they mostly tend to be interim jobs in which the DON is filling in for an executive who is out on extended leave.
22. Are There Any Work From Home Jobs For Directors Of Nursing?
Work-from-home jobs for nursing directors exist primarily in the academic sector.
23. What Are Some Other Jobs Similar To A Director Of Nursing?
Positions that are similar to nursing director jobs include shift manager, clinical nurse leader, healthcare team leader, patient care director, RN case manager, and chief nursing officer.
24. Can An LPN Be Director Of Nursing?
LPNs don’t have the type of education that will allow them to supervise RNs adequately, so it’s highly unlikely that an LPN would be promoted to a director of nursing position—unless he or she agrees to earn a BSN within a stipulated timeframe.
25. Can An LPN Be An Assistant Director Of Nursing?
LPNs frequently serve as assistant directors of nursing and in other managerial capacities in nursing homes and other long-term care facilities, home health agencies, and hospices. If these LPNs supervise other LPNs, LVNs, and nursing assistants, their scope of practice is sufficient for their managerial responsibilities.
26. What Is The Role Of An Assistant Director Of Nursing?
Assistant directors of nursing do the tasks delegated to them by the director of nursing, which generally involve recruiting and training employees, budgeting, scheduling shifts, assigning tasks, and making sure patient care conforms to high-quality standards.
27. Can I Be A Director Of Nursing Without Being A Nurse?
No. An important part of being a nursing director involves overseeing and evaluating the nurses who work under you to ensure a high standard of patient care. If you’re not a nurse and have no clinical experience at the bedside, you may have difficulties understanding what a high standard of patient care is.
28. Who Reports To The Director Of Nursing?
Personnel who report to the director of nursing include clinical care managers, assistant directors of nursing, unit shift managers, compliance nurses, and quality control nurses.
29. Who Is Above The Director Of Nursing?
In the nursing hierarchy within a medical organization, only the chief nursing officer is ranked above the director of nursing. However, a medical organization can have multiple directors of nursing who will all be considered peers.
30. Can A Director Of Nursing Become A CEO Of A Hospital?
Yes, a director of nursing can become the CEO of a hospital, but he or she would likely have to put in some time as a chief nursing officer first before they’d be considered seriously for a CEO job.
31. What Is The Difference Between The Role Of An Assistant Director Of Nursing And The Director Of Nursing?
The assistant director of nursing provides backup for the assistant director. This can entail anything from filling in on projects when the DON’s plate is too full to accommodate them to routine monitoring of nursing activities and ensuring that such nursing activities comply with federal, state, and local standards.
32. What is The Difference Between A Director Of Nursing And A Nursing Manager?
The director of nursing oversees a unit or department offering nursing care within the context of a larger healthcare organization. In contrast, nurse managers oversee a single aspect of nursing services. Those aspects can be categorized by functionality as in “Utilization Review Nurse Manager” or “Compliance Nurse Manager” or by clinical specialty as with “Wound Care Nurse” or “Pain Management Nurse”.
33. Can A Director Of Nursing Work On The Floor?
In hospitals, nursing directors may work on the floor from time to time as a morale booster for their staff nurses or in situations like strikes where their departments are extremely short-staffed. But bedside nursing isn’t what hospital directors of nursing are getting paid to do.
It's not uncommon, however, for directors of nursing working in assisted living facilities or other long-term care facilities to pick up nursing shifts that can’t be filed by other employees, particularly in states that have laws against mandatory overtime.
34. What Are 5 Important Leadership Qualities A Director Of Nursing Must Have?
Five important leadership qualities a director of nursing must possess include critical thinking, accountability, emotional intelligence, effective communication, and the ability to give constructive feedback.
35. How Much Does A Director Of Nursing Make In A Nursing Home?
Nursing directors in nursing homes earn $55.67 an hour, $9,650 a month, or $115,800 a year on average.
36. How Much Does A Director Of Nursing Make In An Assisted Living?
Nursing directors in assisted living facilities earn $48.64 an hour, $8,430 a month, or $101,180 a year on average.
37. How Much Does An Assistant Director Of Nursing Make?
An assistant director of nursing earns $38.55 an hour, $6,680 a month, or $80,193 a year on average.
38. As A Director Of Nursing, Can I Quit Without Notice?
You can quit without notice as a director of nursing. But it would be highly unprofessional, and it’s likely you would never be hired into a nurse manager role again.
39. Can A Director Of Nursing Be Fired?
Yes, a director of nursing can be fired although this would be considered an extreme action that would only be resorted to in cases of extreme misconduct. The more likely scenario for a director of nursing whose efforts are deemed unsatisfactory would be for the chief nursing officer to offer the DON the opportunity to resign.
40. Can An RN File A Complaint Against The Director Of Nursing?
A nurse can file a complaint with the state board of nursing against any other nurse if, in that first nurse’s opinion, the second nurse was violating the state’s nurse practice guidelines. Nurses can also write incident reports that move up their employers’ internal chain of command about issues that may come under a nursing director’s purview like inadequate staffing levels, unsafe work environments, or a lack of personal protective equipment.
Pattie Trumble, MPP, MPH
Pattie Trumble is a nurse who worked in both California and New York for many years as an emergency room nurse. She holds a Bachelor’s Degree in Economics from the University of California, Berkeley, and an Associate Degree in Nursing from the Samuel Merritt Hospital School of Nursing. After 10 years of providing direct care, she went back to school and earned concurrent Master’s degrees in both public policy and public health from the University of California, Berkeley. Thereafter, she worked for various public health agencies in California at both the community and state levels providing economic and legislative analysis.