Fulfilling the Director of Nursing (DON) role in a skilled nursing facility is not an easy challenge. In addition to an extensive list of formal responsibilities and job duties, those who are truly successful in the role have tremendous grit, a sense of purpose, and a list of intangible qualities that could be used to describe the best military generals—confidence, discipline, courage, integrity, strong communicator and a heart for service. The skills required for success as a DON are developed through experience and training, and the job demands a willingness to continually grow, learn and change with shifting requirements.

Common duties included in a DON job description include:

      • Supervising all nursing staff
      • Overseeing department budgets
      • Managing patients’ data and medical records as confidential records
      • Communicating with doctors, patients, and family members about patient health
      • Providing ongoing education classes
      • Implementing new procedures and training Nurses on policies
      • Managing and leading all nursing personnel operations.
      • Planning and overseeing admission, nursing, and patient care processes.
      • Maintaining department budgets and recording all expenses.
      • Responding to any nursing-related issues in a timely manner.
      • Hiring and training new nursing staff members.
      • Participating in creating resident care plans and ensuring they are followed.
      • Ensuring the nursing department is compliant with all local, state, and federal regulations.

Source: Sample Job Description ACHCA;

When considering applying for a DON position, you should also take into account the following job qualifications and duties that may not be included in the job description:

      • Flexibility: Things can change quickly in healthcare and within your facility. Regulatory changes, fluctuation in staffing and census, communicable disease outbreaks, weather alerts/disasters, etc.
      • Prioritization: You will have many tasks to fulfill; this will require you to assess and determine the importance of each task and the order they are to be completed.
      • Time Management: Your day will be filled with unplanned tasks, decision-making, crisis management, etc. You will need to be able to delegate duties, focus on priorities and adjust your schedule as needed.
      • Meetings/Reports: You will not be as involved with the clinical side of nursing. You will spend much of your time in meetings and writing/reviewing reports.
      • Emotional Intelligence: You will have to put your emotions aside when making decisions that might be unpopular with some staff members.

Federal Regulatory Requirements

Federal regulation §483.35(b)(2) requires skilled nursing facilities to have a designated RN to serve as the Director of Nursing (DON) on a full-time basis.

CMS Appendix PP State Operations Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

F727 – §483.35(b) Registered nurse

      • 483.35(b)(1) Except when waived under paragraph (e) or (f) of this section, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week.
      • 483.35(b)(2) Except when waived under paragraph (e) or (f) of this section, the facility must designate a registered nurse to serve as the director of nursing on a full-time basis.
      • 483.35(b)(3) The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents.

DEFINITIONS §483.35(b)

“Full-time” is defined as working 35 or more hours a week.

GUIDANCE §483.35(b)

The facility must designate a registered nurse (RN) to serve as the DON on a full-time basis.

The facility can only be waived from this requirement if it has a waiver under subsection §483.35(e) or (f). This requirement can be met when two or more RNs share the DON position. The roles and responsibilities for each individual serving as the DON must be clearly defined and all facility staff must understand how these responsibilities are shared among the individuals functioning as the DON.

If you are currently fulfilling the role of DON or are considering becoming a DON then we invite you to participate in our 6-part weekly webinar series starting in March: The Dynamic DON. The series will include an emphasis on key principles of successful LTC management, promoting the highest quality of care, and practical strategies for task delegation, overseeing key functions, and achieving 5 Star goals.

Discussion will include:

      • Survey readiness & avoiding frequently cited deficiencies
      • HR management
      • Staff training/competency
      • Risk Management
      • QAPI activities targeting QM areas
      • Fundamentals of reimbursement
      • MDS oversight
      • Promoting 5-Star quality

Here is what previous attendees had to say about this series:

“This was probably the most well organized and informational webinar that I have ever seen!” – Kari C.


“Excellent Information – received great tools that we can utilize.” – Jennifer S.


“I am new to the DON position, but have been a nurse for over 20 some years. I never thought about have the things she described today!” – Dixie B.

Cowritten by: Eleisha Wilkes, RN, GERO-BC, RAC-CT, DNS-CT and Angie Hamer, RN, RAC-CT

Learn more about the rest of the Proactive team.