What does it take to be a successful DON? Is it specific training, is it years of experience, or is effective nurse leadership inherent in the DNA of the person? If you were to review the performance characteristics of the most successful Directors of Nursing, these top 5 attributes would stand out…
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- Ability to lead the nursing team in adapting to changes
- Critical thinking skills
- Ability to successfully delegate
- Ability to prioritize, and
- Ability to manage crisis
If there is one thing that is constant in long term care it is change. This is especially true of the last 10 years, where long term facilities have seen dramatic changes in all aspects of providing care. Regulatory revisions, major reimbursement system overhauls, MDS manual revisions, and a pandemic that totally altered the delivery of care in the facilities are just a few examples of the evolution that’s taken place across the industry. With this in mind, the DON must be able to effectively analyze, develop and implement plans for successfully integrating change within not only the nursing department, but the entire facility.
Adapting to Change
Staying up to date with information provided by the entities that impact long term care is essential. CMS updates, professional associations and periodicals, Medicare and Medicaid information releases, and CDC alerts are all examples of critical information sources that help the DON to stay informed and abreast of educational needs for the staff as well. Health Care Association conferences, and trainings offered by expert organizations provide wonderful opportunities to keep up to date with the latest trends and “best practices” for all care givers. But most of all, the DON must set the example that change offers opportunities to not only improve quality, but to find more efficient ways to operationalize care tasks.
Applying Critical Thinking
The DON is called upon to analyze and evaluate events every day. Whether it is an incident/accident, an allegation of abuse, or a system failure in the EMR, the DON must be able to critically think through the event and determine what needs to be done. They must then be able to communicate the necessary actions to the staff, helping them to understand why they must do what is needed along with the importance of timely implementation. The use of effective root cause analysis applies to more than just investigating a fall. Using this process successfully can guide the DON through critical thinking in almost all problem situations.
Delegation and Prioritization
The ability to successfully delegate and to prioritize are symbiotic processes and must be used together. DONs cannot accomplish quality care and compliance by themselves. It takes the entire team to have continuously compliant and effective systems in place. Tasks should be delegated based on an evaluation of the team members’ strengths, competencies and interests, prioritizing which tasks are the most imperative to address first and/or most frequently. Staff need the training and resources to carry out the job assigned, and the best practice is to trust, but verify, that assigned tasks are being completed successfully.
Crisis Management
Last, but certainly not least, is the ability to manage crisis. The DON must be able to stay calm and collected in all situations. The nursing staff look to the DON to determine if panic is indicated in a crisis. The most effective DONs are able to swim like a duck–above water is smooth and peaceful, underwater they are paddling like crazy! Growing in the four skills above will assist the DON to be able to critically think through, prioritize and delegate, and successfully manage the crisis while guiding the nursing team through the changes the crisis may prompt. Successful crisis management will instill confidence and motivate the nursing team to effectively face the challenges that are bound to come.
Next steps:
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- Make plans to participate in the 12-month Proactive DON Playbook webinar series beginning January 20, 2026. This series equips DONs and other nurse leaders with actionable insights and best practices for advancing nurse leadership skills in 2026.
- Contact Proactive to learn more about an Annual Partner Plan with a year-long “bucket” of QA support hours delivered as a combination of onsite and offsite support over 12 months at a flat monthly installment. Plans start as low as 8 hours per month with facility customized work plans providing just-right support for nurse consulting on key clinical programs, survey readiness, QM improvement, and reimbursement accuracy.
Written By:
Janine Lehman, RN, RAC-CT, CLNC
Director of Legal Nurse Consulting
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