Director of Nursing

POSITION SUMMARY

The Director of Nursing (DON) is the senior clinical leader responsible for the overall quality, safety, compliance, staffing, and performance of nursing services within the skilled nursing facility. The DON establishes clinical standards, directs nursing operations, maintains continuous survey readiness, and ensures residents receive person-centered care consistent with federal and state requirements, professional standards, physician orders, facility policies, and the organization's mission. The DON is expected to maintain a visible leadership presence, promptly address clinical and regulatory risk, and build a culture of accountability, service excellence, and continuous improvement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

•  Direct, organize, and evaluate all nursing services; establish clear clinical expectations and ensure consistent leadership coverage across all shifts, weekends, holidays, and emergencies.
•  Conduct regular clinical and environmental rounds to evaluate resident conditions, staff performance, infection-control practices, documentation, care-plan implementation, and resident safety.
•  Ensure changes in condition, adverse events, and significant clinical findings are promptly assessed, treated, documented, communicated, and escalated to physicians, responsible parties, and organizational leadership as required.
•  Ensure residents receive care consistent with their assessments, diagnoses, preferences, physician orders, and comprehensive plans of care, while protecting dignity, choice, privacy, autonomy, and quality of life.
•  Monitor and improve high-risk clinical areas, including falls, pressure injuries, wounds, weight loss, dehydration, infection, pain, medication management, behavioral health, psychotropic medication use, restraints, elopement, incontinence, restorative nursing, hospital transfers, and readmissions.
•  Ensure incidents, accidents, medication errors, injuries, allegations, and adverse outcomes receive immediate clinical response, complete investigation, root-cause analysis, required reporting, corrective action, and follow-up monitoring.
•  Maintain continuous compliance with CMS, state licensing, professional practice, mandatory reporting, resident-rights, abuse-prevention, and other applicable requirements; remain prepared for surveys, complaint investigations, and audits at all times.
•  Lead or support survey response, plans of correction, directed plans, and regulatory follow-up; ensure corrective actions are implemented, sustained, audited, and incorporated into the Quality Assurance and Performance Improvement program.
•  Provide executive clinical oversight of infection prevention and control, including surveillance, isolation practices, hand hygiene, personal protective equipment, outbreak response, immunization, antibiotic stewardship, and required public-health reporting.
•  Oversee the accuracy, completeness, timeliness, and consistency of nursing documentation, including assessments, physician orders, medication and treatment records, nursing notes, care plans, and change-of-condition documentation.
•  Collaborate with the MDS Coordinator and interdisciplinary team to support accurate assessments, care planning, reimbursement documentation, skilled coverage, medical necessity, quality measures, and Patient-Driven Payment Model performance.
•  Support a responsive short-term rehabilitation and post-acute model by coordinating with admissions, rehabilitation, social services, physicians, case managers, and payers on clinical acceptance, timely treatment, length of stay, discharge planning, readmission reduction, and safe transitions of care.
•  Ensure adequate numbers of qualified nursing personnel are scheduled based on census, acuity, competencies, resident needs, and regulatory requirements; review call-offs, overtime, registry use, productivity, skill mix, and staffing patterns.
•  Partner with Human Resources and nursing education leadership on recruitment, orientation, competency validation, retention, succession planning, performance evaluation, attendance, corrective action, and employee development.
•  Ensure nursing personnel maintain current licenses, certifications, health clearances, required training, and competencies and practice within their authorized scope.
•  Lead nursing quality improvement by reviewing trends in quality measures, falls, wounds, infections, weight loss, antipsychotic use, hospitalizations, readmissions, grievances, incidents, staffing, and other relevant indicators.
•  Develop and oversee performance-improvement projects with measurable goals, assigned accountability, completion dates, monitoring methods, and sustainability plans; report meaningful results to the QAPI Committee and executive leadership.
•  Manage nursing operations in a fiscally responsible manner by monitoring labor, overtime, registry utilization, supplies, equipment, and departmental expenses without compromising resident safety or quality of care.
•  Maintain effective communication and collaboration with residents, families, physicians, employees, consultants, vendors, regulators, and organizational leaders; promptly report significant clinical, staffing, regulatory, and operational risks.
•  Perform other duties and leadership responsibilities as assigned based on resident needs, regulatory requirements, and organizational priorities.

LEADERSHIP, MEETINGS, AND ACCOUNTABILITY

•  Lead, attend, or actively participate in daily clinical, care-plan, QAPI, utilization review/PDPM, weight-management, behavior-management, restorative nursing, fall, wound, infection-prevention, staffing, admissions, discharge-planning, and department-head meetings as applicable.
•  Ensure meeting decisions, assigned actions, responsible parties, due dates, and follow-up monitoring are documented and completed.
•  Model ethical conduct, sound judgment, professionalism, respectful communication, confidentiality, and non-retaliation for reporting concerns.
•  Provide timely, accurate reports regarding clinical outcomes, staffing performance, survey readiness, regulatory compliance, investigations, corrective actions, and nursing budget performance.
•  Remain available to respond to urgent clinical and operational matters outside normal business hours and provide leadership during emergencies, outbreaks, surveys, and staffing disruptions.

SUPERVISORY RESPONSIBILITIES

•  Provides direct or indirect supervision to nursing leadership, registered nurses, licensed vocational nurses, certified nursing assistants, the Director of Staff Development, Infection Preventionist, wound/treatment staff, restorative nursing personnel, and other assigned clinical team members.
•  Supervisory responsibilities include participation in hiring, onboarding, scheduling oversight, competency review, coaching, performance evaluation, corrective action, and workforce development.

MINIMUM QUALIFICATIONS

• Current, active, unrestricted Registered Nurse license in the state where the facility operates.
•  Graduate of an accredited school of professional nursing. 
• At least three years of progressive nursing leadership experience in skilled nursing, post-acute, long-term care, rehabilitation, or a comparable setting. 
• Prior DON, ADON, Nurse Manager, or equivalent clinical leadership experience strongly preferred. 
• Working knowledge of federal and state skilled nursing requirements, resident assessment, care planning, QAPI, infection prevention, staffing, and clinical risk management. 
• Current CPR certification, or ability to obtain it within the required timeframe.
•  Ability to satisfy all required background, health, and employment screening requirements. 
• Bachelor of Science in Nursing, advanced degree, DON certification, and experience with Medicare, managed care, PDPM, and survey recovery preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

• Strong clinical judgment; knowledge of geriatric, rehabilitative, post-acute, behavioral, and chronic-disease nursing; and the ability to identify risk and act decisively.
• Ability to interpret regulations, conduct investigations and root-cause analyses, analyze clinical and staffing data, and translate findings into sustained corrective action.
•  Demonstrated leadership, delegation, coaching, communication, organization, prioritization, and performance-management skills.
•  Proficiency with electronic health records, staffing systems, clinical analytics, quality-measure reporting, and standard business software.
• Ability to remain calm and effective during emergencies, regulatory surveys, staffing shortages, and other high-risk situations.

Salary Range $170,000 to 195,000 per year,