Become a Director of Nursing in 3 Steps

Nurse Types / Director of Nursing

Are you a nurse who stands out as a leader? Do other nurses often come to you with questions or for your opinion? Becoming a director of nursing might be for you! This management position is perfect for nurses with supervisory experience who are ready for a larger challenge away from the bedside. If you’re intrigued, keep reading to find out:

• What is a director of nursing?
• What do directors of nursing do?
• Where do directors of nursing work?
• What are closely related fields?
• How do you become a director of nursing in 3 steps?
• What are the additional requirements of directors of nursing? 
• What are the salary and career outlooks for directors of nursing?

What is a director of nursing?

The director of nursing is an upper management role responsible for leading and overseeing nursing staff in a healthcare setting. Most commonly, you will receive the title Director of Nursing (DON) but may also be called Nursing Director, Wellness Director, Clinical Director, or Director of Nursing Services (DNS). No matter the title, you are responsible for supervising clinical staff and ensuring your unit runs smoothly. 

Qualities of a successful director of nursing 

Directors of nursing are leaders. Effective leadership results in personal, staff, and workplace success. Your role can be conflicting at times when delegation or discipline is required. You cannot become too friendly or overly strict with your subordinates. You must be able to lead fairly and objectively. Successful directors of nursing are:

• Communicators. Your constant contact with staff, other administrators, vendors, patients, and families requires clear instruction. 

• Confident. This leadership role requires you to be confident in your decisions. You cannot please everyone all the time and sometimes tough calls have to be made.

• Organized. Running a unit, department, or an entire facility requires keeping detailed documentation and staying on schedule for meetings and tasks.

What do directors of nursing do?

The list of responsibilities of a director of nursing are endless. While you are not usually working at the bedside, you should always be prepared to do so when the need arises. Usually, you’ll be in a dedicated office handling the following:

• Policies and procedures. These are often changing and you’ll play an active part in creating policies for your department and staff often related to patient care.

• Budgets and inventory. Directors of nursing are involved in the financial aspects of their workplace and monitor costs of resources, staff, and services. You may also be tasked with placing orders for supplies and tracking equipment usage.

• Ensuring compliance. An integral part of healthcare is remaining compliant with regulations. This is often how hospitals and facilities receive funding.

• Staffing. Directors hire and fire employees. You’ll also complete performance reviews and be heavily involved in day-to-day staffing shifts. You must also ensure staff completes necessary training and professional development activities. 

• Reports. You will often run daily reports and quality improvement checks on incident reports, chart audits, narcotic logs, restraint use, admissions and discharges, and more.

A day in the life of a director of nursing

Most directors of nursing begin their day with a staff huddle. These short 10-minute meetings review any high-priority needs that need to be addressed. This can include a patient concern, staffing needs, and equipment requests.

If you haven’t already done so, you’ll respond to emails and return phone calls. Get prepared for several more meetings and huddles. You’ll have either conference calls, virtual, or in-person meetings with other members of leadership to discuss internal operations, safety, staffing issues, and more.

As a director of nursing, you should check in with your staff and physicians several times a day for any concerns that require your assistance or delegation. You will often be involved in conflict resolution and must be a neutral party that listens and knows when to intervene.

Depending on the facility, you may also interact with patients and families. Directors of nursing in nursing homes, for example, frequently check on and form relationships with residents.

Before ending your day, you’ll follow up on last-minute emails and prepare for tomorrow.

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Where do directors of nursing work?

Directors of nursing are found in virtually every healthcare setting. Along with hospitals, they work in:

• Outpatient settings. Ambulatory care centers, surgical clinics, urgent care settings, dialysis clinics, and free-standing emergency rooms.

• Home health/Home care. These may be private practices or a department within a healthcare system. As a director of nursing, you ensure these settings are staffed accordingly and meet strict regulations.

• Skilled nursing facilities and nursing homes. This also includes rehabilitation and Veterans Administration settings.

• Hospice. Inpatient hospice as well as home care hospice requires the supervision of a director of nursing.
  
• Physician offices. Large primary care or specialty offices need directors of nursing to manage nursing and other clinical staff.

Closely related fields

Directors of nursing are part of a nursing hierarchy. You are considered one step below a Chief Nursing Officer (CNO) which is an executive-level position. Other similar roles that include leadership or organizational improvement include:

• Clinical nurse manager
• Quality assurance nurse
• Charge nurse
• Clinical nurse educator

How do you become a director of nursing in 3 steps?

Step 1 – Become a registered nurse

Graduating from nursing school is the first step to becoming a director of nursing. There are several degree pathways you can choose to take to become an RN.

Earn a nursing degree

You can enter the nursing profession with the minimum of an Associate Degree in Nursing (ADN) and gain experience as you advance your education. Most management positions will require a minimum of a Bachelor of Science in Nursing (BSN) degree. Bridge programs such as the RN to BSN program are a cost-effective way to accomplish this. 

Pass the NCLEX exam

After completing either your ADN or BSN program, you are eligible to take the NCLEX. The NCLEX is the board exam that allows you to practice as a registered nurse. This pass/fail test will assess your nursing knowledge and understanding of clinical concepts.

Earn an advanced degree

Larger health systems may require a Master of Science in Nursing (MSN). RN to MSN programs are also available to get you to your end goal faster. Many schools offer these programs online.

You work hard for your degrees and license. Don’t let them lapse! Each state has their own licensing and renewal requirements that must be met. Incredible Health offers free continuing education courses to make renewals easy.

Step 2 – Accumulate experience

Directors of nursing often have years of professional experience as a nurse. You have to master the clinical aspect of nursing and gain the expertise to lead which takes time and can’t simply be taught.

Helpful skills and experience

Being familiar with the roles of your colleagues is essential to understanding their concerns and meeting their needs. Staff nurses are much more likely to respect the rules and perspectives of a director of nursing if they know their boss has been in their shoes before.

It’s also usually a requirement for you to have supervisory experience. Not everyone is meant to be a leader. Effective leaders are not afraid to delegate tasks, discipline, or make decisions for the greater good.

Changing your specialty to a director of nursing 

As you gain experience in nursing you may feel called to change your specialty or seek a new challenge. You may stand out as a resource to colleagues and a dependable nurse with useful ideas. These skills alone may earn you a promotion as a director of nursing. Often, nurses desire a position away from the bedside yet still want to be involved in clinical outcomes.

It’s helpful if you have experience in the setting you will be supervising. For example, if you apply for a position as a director of nursing of an outpatient surgical center, it’s helpful if you have experience in surgery as an operating room nurse or PACU nurse. This gives you an advantage in understanding the expectations of staff and patients. 

Incredible Health offers resume and interview resources to help you land your new role.

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Step 3 – Obtain certifications

Certifications are proof of mastering a skillset and can help you advance as a leader. 

The DNS-CT (Director of Nursing Services-Certified) is one certification that indicates your leadership strengths and ability to improve facilities. To be eligible for this certification you must:

• Hold an active RN license
• Obtain 2 years of full-time post-acute experience, with at least one year as a DNS or other similar leadership experience
• Take the DNS-CT courses and exams and pass with an 80% score or better

The Certified Director of Nursing Exam (CDONA) is a certification for nursing directors in long-term care. The only prerequisite for this certification is that you have been employed or volunteered as a director of nursing for at least 1 year.

What are the additional requirements of directors of nursing? 

Directors of nursing must be flexible. While this is often a salaried position with 40-hour work weeks, administrative roles often require you to frequently work longer days and fill in staffing holes. Be prepared for phone calls and emails that require your response even when away from the office.

As a problem-solver, you must be:

• Patient
• Able to manage and prioritize your time 
• Remain calm under pressure

What are the salary and career outlooks for directors of nursing? 

Management positions are expected to come with larger salaries to match the increase in responsibilities. This list shows the average director of nursing salary by state. California is usually the highest paying state for nurses, but Nevada has the highest annual salary at $102,573 while the national average is $90,335.

The expected career growth for medical and health services managers is astounding. Employment is expected to grow 32% within the decade, faster than the average for most occupations.

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Job satisfaction

Burnout is a common finding in healthcare workers, with approximately two-thirds of nurses impacted. Factors contributing to the burnout of directors of nursing are their professional responsibility and lack of work-life balance. Not only are you responsible for patients and staff, but you must ensure documentation is compliant with regulations.

Luckily, as a director of nursing, you are in a position to make lasting changes to the healthcare system. You have the authority to propose and implement schedule alterations, documentation procedures, and mental health programs. This can be very rewarding.

Next steps 

As a director of nursing, you likely enjoy managing, making decisions, and the dual responsibilities of nursing and business. The next administrative step is to become a Chief Nursing Officer (CNO). This is a top nursing executive position that often works directly with the CEO of a hospital and oversees all nursing services.

This position at the very least will require a Master’s degree or higher. It’s beneficial to also have additional degrees in business administration, such as a Masters in Business Administration (MBA). 

Incredible Health is here to help you succeed in your nursing journey. Along with our many career resources, we offer access to real-life answers on our nurse advice forum.

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