Registered nursing is America’s fifth largest occupation comprising a dedicated workforce over 2.8 million strong. Coordinating and supervising all of these RNs is a job landing on the director of nursing’s sturdy shoulders. The director of nursing (DON) is an upper-level administrator given managerial capacity for maintaining high standards of patient care. DONs oversee a healthcare organization’s nursing departments to ensure excellent bedside manner. Although they’re the head nurse, DONs report to senior executives, especially in the Chief Nursing Officer (CNO). Directors of nursing are responsible for making strategic decisions that improve patient outcomes and cultivate empowered nurses. It’s important for the DON to bridge communication gaps between physicians, nursing staff, and patients. In large medical centers, an assistant director of nursing (ADON) could be hired to maintain order during the DON’s absence.


According to survey statistics on, the median yearly salary for directors of nursing in the United States is currently $134,016. This could be equated to a mean hourly wage of $64, or $2,577 weekly. DONs typically qualify for added benefits like bonuses, social security, 401k, healthcare, and vacation for a median total compensation of $186,233 each year.

Beginning Salary

After nurses are promoted to director of nursing, they’ll likely begin in the bottom 10th percentile of earnings with a six-figure yearly income around $101,973. However, experienced DONs in large healthcare organizations can eventually bring home base salaries above $173,028. Those who advanced further to Chief Nursing Officer could earn from $206,000 to $279,000 annually.

Key Responsibilities

Directors of nursing are bestowed ultimate responsibility in developing, implementing, and enforcing effective protocols for preventing medical errors. The DON makes certain the facility has a qualified nursing staff by overseeing the hiring and firing of nurses. Directors often organize training workshops to keep their nurses’ clinical skills up-to-date. Most DONs are involved in evaluating staff conduct in accordance with safety regulations and nursing standards. When patient incidents occur, the DON may testify in criminal and civil legal cases to determine nursing negligence. The director of nursing will also review medical records carefully to ascertain whether patient needs are met.

Necessary Skills

Even though DONs have predominantly administrative duties, they must have significant clinical knowledge of proper nursing practices. Directors of nursing must have the interpersonal skills to clearly communicate with physicians, nurses, patients, and executives. Having good problem-solving skills is important for DONs to form difficult decisions that could be life-or-death. Strong leadership abilities help directors of nursing motivate and retain a satisfied workforce. Good judge of character is a must when the DON needs to select the best hiring candidates. DONs should have the technical skills to utilize electronic health records and communication systems. Analytical skills are essential for allocating budget resources in a cost-effective manner. The director of nursing should also be organized, team players, caring, and empathetic.

Degree and Education Requirements

The director of nursing title isn’t available to newbies without at least a four-year bachelor’s degree from an accredited nursing school. Attaining a Bachelor of Science (BSN) is required to satisfy licensing requirements and develop clinical expertise. It’s common for employers to prefer hiring DONs with graduate training though. Earning a Master of Science in Nursing (MSN) degree is advised for greater advancement. Some nurses also sharpen their leadership acumen with a dual Master of Health Administration (MHA) or Master of Business Administration (MBA). Many universities offer a specialized track in nurse management to master the financial, business, legal, HR, and political aspects of clinical performance.

Pros and Cons of the Position

Like other supervisory positions, working as director of nursing offers rewards with some potential drawbacks. On the sunny side, DONs have high job satisfaction from running their health organization’s nursing workforce. Demand for medical treatment is high, which translates into long-term career stability. Directors of nursing can find leadership in many clinical practices, from nursing homes to hospitals. The average DON salary is very lucrative and surpasses the earnings of many advanced practice nurses. For extroverts, the DON job provides the chance to interact more with healthcare professionals rather than simply patients. However, DONs have stressful responsibilities and could be held legally liable if found negligent. The director of nursing must stay abreast of complex healthcare standards. Investing in graduate school and continuing education can leave DONs strapped with debt. In round-the-clock medical facilities, DONs may work irregular shifts beyond 40-hour weeks. The director of nursing is also showered with paperwork and more behind-the-scenes duties than RNs.

Getting Started

Hit the ground running by fostering your nursing resume for administrative leadership. During your college years, jump on every opportunity to participate in clinical practicum and internships. Take the National Council Licensure Exam (NCLEX-RN) exam immediately following your graduation for state approval. RNs can then apply for entry-level staff nursing jobs to develop their patient care competency. Most directors of nursing need at least eight to 10 years of experience under their scrubs. Gaining supervisory positions is important as you climb the healthcare ladder. Aspiring DONs may work up as administrative nurses, nurse supervisors, head nurses, and clinical nurse specialists. Pursue your MSN either online or part-time to continue developing experience while studying. Earning professional certification can aid in your promotion. For instance, the Certified Director of Nursing in Long Term Care (CDONA/LTC) credential is available. The ANCC Credentialing Center also provides many certifications.

Future Outlook

Rising patient numbers are taking a toll on today’s stretched-thin healthcare industry. More patients are seeking insured treatment under the Affordable Care Act, especially the aging baby boomers. This same demographic represents a large chunk of the nursing workforce. As more nurses reach retirement age, the United States may face a critical shortage. Not only will director positions open, but more will be added to help hire and train new nurses. Overall nursing employment is expected to jump by 16 percent from 2014 to 2024. That will drum up around 439,300 new jobs for RNs and their supervisors. Directors of nursing can find good prospects in outpatient centers, long-term rehabilitation facilities, nursing homes, physician groups, assisted living, and hospital systems.

The director of nursing assumes full authority over successfully coordinating the effective delivery of patient services in their facility. DONs join the management team to monitor nursing staff practices and ensure compliance with internal protocols. Making the switch from bedside to corner office by becoming the director of nursing can increase your ability to positively touch the lives of countless patients.