Director of Nursing Job Description: Duties, Template & Pay (2026)
A director of nursing, or DON, is the registered nurse in charge of all nursing care in a nursing home: the nurses and nursing assistants, the staffing plan, clinical policies, resident assessments and survey results. Federal rules require every Medicare- or Medicaid-certified nursing home to have one, and require that person to be an RN working full time. This page has a director of nursing job description template for a skilled nursing facility, the federal requirements quoted at source, interview questions and 2025 pay data.
What a director of nursing does in a nursing home
The director of nursing runs the largest department in the building. Nursing staff are on duty 24 hours a day, and the DON is accountable for all of it: whether there are enough nurses and aides on every shift, whether they are competent, whether each resident's care plan is followed and whether the building is ready when state surveyors arrive. The DON reports to the administrator and works closely with the medical director.
BLS does not publish a separate figure for directors of nursing. O*NET lists “Nursing Director” and “Nurse Manager” among the sample job titles for medical and health services managers (SOC 11-9111), so pay and outlook figures on this page describe that wider group, with the nursing and residential care figure the closest match for a nursing home DON.
Director of nursing duties
- Direct all nursing services in the facility and supervise the assistant director of nursing, unit managers, MDS coordinator, staff development coordinator and charge nurses
- Set the nursing staffing plan and daily staffing, and approve agency or overtime use
- Hire, orient and evaluate licensed nurses and nurse aides, and make sure licenses and nurse aide competency requirements are met
- Write and update nursing policies and procedures, and see that they are followed
- Oversee resident assessments and care plans, including the Minimum Data Set (MDS) process
- Serve on the quality assessment and assurance (QAA) committee and lead nursing quality improvement work
- Work with the infection preventionist on infection prevention and control
- Prepare for and respond to state surveys, and write and carry out plans of correction
- Investigate incidents, falls and allegations, and report them as state and federal rules require
- Meet with residents and families about concerns, and communicate with physicians and the medical director
- Manage the nursing budget, including labor and agency costs
Federal requirements for a nursing home DON
Nursing homes that participate in Medicare or Medicaid must meet the long-term care requirements in 42 CFR Part 483. Under 42 CFR 483.35(b):
- “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.”
- “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.”
- “The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents.”
Paragraphs (e) and (f) allow waivers in limited circumstances, such as a facility that cannot recruit the required nurses; they are granted case by case and are not a staffing plan. Two other sections put the DON in specific roles:
- Quality committee. Under 42 CFR 483.75(g)(1), the quality assessment and assurance committee must include, at a minimum, “The director of nursing services,” the medical director or designee, at least three other staff members including one in a leadership role, and the infection preventionist.
- Resident assessments. Under 42 CFR 483.20(h), “A registered nurse must conduct or coordinate each assessment with the appropriate participation of health professionals.” The DON is not required to do this personally, but is accountable for the process.
States add their own requirements, which can include minimum experience, administrative training or a separate staffing standard. Check your state health department's nursing home licensing rules before you finalize the requirements line; our page on nursing home staffing ratios covers staffing standards. This is general information, not legal advice.
Director of nursing job description template
Copy this into your ATS or job board, replace the bracketed fields and delete what does not apply. It is written for a certified skilled nursing facility; the settings section below covers assisted living, home health and hospitals.
Job title
Director of Nursing (DON), [Facility name], [City, ST]
Summary
[Facility name] is hiring a director of nursing for our [number]-bed skilled nursing and rehabilitation center. You will lead a nursing team of about [number] nurses and nursing assistants, set the standard of care for our residents and guide the building through surveys. You report to the administrator and work closely with our medical director.
[Full-time, Monday to Friday with on-call rotation]. [Pay range]. [One sentence on what makes this building a good place to lead, e.g. stable ownership, recent survey results, a strong ADON.]
What you will do
• Direct all nursing services and supervise the ADON, unit managers, MDS coordinator and charge nurses
• Set and manage the staffing plan and nursing budget, including agency and overtime use
• Hire, orient and evaluate nursing staff, and keep licenses and nurse aide competencies current
• Keep nursing policies current and make sure they are followed on every shift
• Oversee resident assessments, care plans and the MDS process
• Serve on the QAA committee and lead nursing quality improvement
• Work with the infection preventionist on infection control
• Lead survey readiness, survey response and plans of correction
• Investigate and report incidents and allegations as required
• Meet with residents and families about concerns
What you need
• Active registered nurse license in [State] or a multistate compact license
• [Number] years of RN experience in long-term care, including [number] years in a leadership role such as ADON, unit manager or MDS coordinator
• [State-specific DON requirements, if any]
• Working knowledge of federal and state nursing home regulations and the survey process
• Able to work full time in the building and take call
Nice to have
• BSN or higher
• Prior DON experience in a building of similar size
• Long-term care leadership or infection prevention training
• Experience with [EHR system]
What we offer
• [Pay range] and [bonus tied to, e.g., survey results or retention]
• [Benefits and eligibility date]
• [Paid time off]
• [Support: regional clinical consultant, leadership training, tuition help]
How to apply
[One step. Say who will call, and how soon.]
What to require in a DON, and what to leave out
| Requirement | What to know |
|---|---|
| RN license | Required by federal rule for certified nursing homes. Unless a waiver applies, an LPN cannot be the DON of a certified facility. |
| Full-time availability | Required. Say whether the role is Monday to Friday and how on-call works. |
| Long-term care experience | Keep it. The regulations and survey process are specific to nursing homes, and hospital leadership experience does not fully transfer. |
| Prior DON title | Prefer it, but do not require it. ADONs, unit managers and MDS coordinators are the usual pipeline, and many good DONs were promoted from one of those roles. |
| BSN or MSN | Usually a preference. Federal rules require an RN, not a degree level; check your state. |
| State-specific requirements | Some states set extra qualifications for a DON. Name them in the posting if they apply. |
Director of nursing job description by setting
Skilled nursing and long-term care
The template above. Say whether the building is mostly short-stay rehab or long-term residents, the bed count and your most recent survey outcome if it is a strength.
Assisted living director of nursing
Assisted living and memory care communities are licensed by states, not certified under the federal nursing home rules above, so the RN and full-time requirements come from your state, if at all. Requirements for the lead nurse vary by state. The job leans toward resident assessments for move-in, medication oversight, training med techs and caregivers, and family communication. Check your state rules and write the requirements to match.
Home health and hospice
Home health agencies and hospices often use titles such as director of clinical services or clinical manager, with field nurses rather than a building staff. Say how much field work and on-call the role carries.
Hospitals
In a hospital, the top nursing role is usually titled chief nursing officer or vice president of nursing, and directors of nursing run service lines with nurse managers under them. For a unit-level leader, use the nurse manager job description.
Assistant director of nursing (ADON)
Federal rules do not require an ADON, but most larger buildings have one. The ADON usually handles scheduling, staff education or clinical rounds and covers the DON's absences. It is the natural succession role; hire for it with that in mind.
Director of nursing salary
BLS does not publish a director of nursing wage. For medical and health services managers, the group O*NET places nursing directors in, the median was $123,860 a year, or $59.55 an hour, in May 2025, and $100,520 in nursing and residential care facilities. The lowest 10 percent of the whole group earned less than $73,390 and the highest 10 percent more than $224,340.
The floor that matters in practice is what your own nurses earn. Registered nurses in nursing and residential care facilities had a median of $84,300 in May 2025, against $97,550 for all RNs. If the DON package does not clearly beat what an experienced RN supervisor makes with overtime, and account for on-call and survey weeks, you will have trouble promoting from within.
BLS counted 640,400 medical and health services managers in 2025 and projects employment to grow 24 percent by 2035, much faster than average, with about 62,300 openings a year. Nursing homes compete for the same people as hospitals, clinics and home health agencies.
Director of nursing interview questions
These six questions test regulatory knowledge, leadership and judgment, which matter more than years in the title.
1. Walk me through the first 48 hours after surveyors arrive.
A good answer covers the entrance conference, getting requested documents to surveyors quickly, keeping staff calm and on routine, tracking concerns as they come up and addressing them in real time. Candidates who have led a building through a survey will be specific.
2. Your agency spending doubled last quarter. What do you do?
Listen for looking at why shifts are open (vacancies, call-offs, turnover in the first 90 days), fixing scheduling practices, recruiting for the specific shifts, and working with the administrator on pay or incentives. “Just hire more” is not a plan.
3. Tell me about a time you found a care problem that had been going on for a while.
Strong candidates describe finding the root cause, protecting residents immediately, reporting as required, retraining and checking that the fix held. Watch for candidates who describe blaming an individual without looking at the system.
4. How do you work with an MDS coordinator and the care plan team?
A good answer shows they understand that assessments drive care plans, quality measures and payment, and that they check accuracy rather than leaving it entirely to the coordinator.
5. How do you keep good CNAs from leaving in their first three months?
Look for concrete practices: a real orientation with a preceptor, a stable assignment, check-ins at set intervals and fixing schedule problems quickly. A DON who has thought about this will talk about the details.
6. A family says their mother was left in a wet bed for hours. How do you handle it?
Listen for taking the concern seriously, checking on the resident immediately, investigating with staff and records, following reporting rules if it could be neglect, and getting back to the family with what was found and done.
What it costs to reach a director of nursing
The DON must be a registered nurse, so we use the registered nurse role family. In our 2026 Social Job Advertising Benchmark it ran a median cost per applicant of $19.08 on Meta, with the middle half of campaigns between $12.76 and $34.84, a blended figure of $20.00 and an 11 percent apply rate. The healthcare and senior living sector as a whole ran a $15.42 median at a 16 percent apply rate, and the all-role median is $13.88. Cost per applicant is not cost per hire.
Apply rate explains 70 percent of the variation in cost per applicant across the benchmark. For a leadership role, a short form that asks for license state, long-term care experience and current role, followed by a call from the administrator or regional leader, keeps more candidates engaged than a long application.
Staffing the rest of the building? See the registered nurse, LPN, CNA and dietary aide job descriptions, and senior living staffing for the hiring side.
The job description is not the job ad
The template is the document for your files and surveyors. The ad has to reach an ADON, unit manager or experienced long-term care nurse who is ready for the next step.
- Lead with what makes the building good to lead: ownership, stability, support from a regional team, an administrator who backs nursing.
- Be honest about the state of the building. A DON candidate will look up your survey history; saying where things stand builds trust.
- Name the pay range and on-call expectations up front.
- On Facebook and Instagram, employment ads run under Meta's special ad category, which requires at least a 15-mile radius and does not allow targeting by age, gender or ZIP code. That works for a DON search, because the right candidate may be a 30-minute drive away.
More on the ad itself is in healthcare job ad templates and assisted living recruitment.
Frequently asked questions
What does a director of nursing do in a nursing home?
A director of nursing runs all nursing care in the building. The DON sets staffing, hires and supervises nurses and aides, writes nursing policies, oversees resident assessments and care plans, serves on the quality committee, prepares for state surveys, investigates incidents and meets with families. The role reports to the administrator.
Does a director of nursing have to be an RN?
Yes, in a Medicare- or Medicaid-certified nursing home. Under 42 CFR 483.35(b)(2), the facility must designate a registered nurse to serve as director of nursing on a full-time basis, except when a waiver applies. Assisted living is regulated by states, and requirements there vary.
Can the director of nursing work as a charge nurse?
Only in smaller buildings. Federal rules at 42 CFR 483.35(b)(3) say the director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents. In larger facilities the DON cannot also be the charge nurse.
What should a director of nursing job description include?
A director of nursing job description should state the facility type and bed count, the reporting line, and duties for staffing, policy, assessments, quality, surveys and incident reporting. Include the RN license requirement, long-term care leadership experience, any state-specific DON rules, the full-time schedule and on-call, the pay range and a clear way to apply.
How much does a director of nursing make?
BLS does not publish a director of nursing wage. Medical and health services managers, the group that includes nursing directors, had a median of $123,860 a year in May 2025, and $100,520 in nursing and residential care facilities. Check local nursing home postings before you set your range.
What qualifications does a nursing home DON need?
Federally, a DON in a certified nursing home must be a registered nurse working full time. Employers typically add several years of long-term care nursing, prior leadership as an ADON, unit manager or MDS coordinator, and knowledge of the survey process. Some states set extra requirements, so check your state's licensing rules.
What is the difference between a DON and an ADON?
The director of nursing is accountable for all nursing services in the facility and is required by federal rules in certified nursing homes. The assistant director of nursing supports the DON, often handling scheduling, education or clinical rounds, and covers when the DON is out. Federal rules do not require an ADON.
Is the director of nursing on the QAPI committee?
Yes. Under 42 CFR 483.75(g)(1), the quality assessment and assurance committee must include at a minimum the director of nursing services, the medical director or designee, at least three other staff members including one in a leadership role, and the infection preventionist.
What interview questions should I ask a director of nursing?
Ask the candidate to walk you through the first days of a state survey, how they would cut agency spending, how they found and fixed a long-running care problem, how they work with the MDS coordinator, how they keep new CNAs from leaving and how they would handle a family complaint about neglect.
How much does it cost to recruit a director of nursing?
On Meta, the registered nurse role family in Boostpoint's 2026 benchmark ran a median of $19.08 per applicant, with the middle half of campaigns between $12.76 and $34.84 and an 11 percent apply rate. That is cost per applicant, not cost per hire; a DON search usually needs a small number of strong candidates.
Related job descriptions
Hiring a director of nursing?
The description is the document. Getting it in front of ADONs, unit managers and experienced long-term care nurses near your building is the part we do.
Wage, employment and projection data for medical and health services managers (SOC 11-9111), the group O*NET lists nursing directors under: U.S. Bureau of Labor Statistics Occupational Outlook Handbook, Medical and Health Services Managers, last modified 27 August 2026; registered nurse wages from the OOH Registered Nurses page; job titles from O*NET OnLine 11-9111.00. Wages are May 2025 OEWS. Federal requirements from 42 CFR 483.35, 483.75(g) and 483.20(h) on eCFR. Cost-per-applicant and apply-rate figures: Boostpoint 2026 Social Job Advertising Benchmark, 891 managed campaigns and 1,334 campaign-months. General information, not legal advice. Read at source 24 September 2026.