Free Director of Nursing Job Description Templates
Free director of nursing job description templates for nursing homes, assisted living, home health, and hospice, with CMS 42 CFR 483.35 and FLSA notes.
6 templates for nursing homes, assisted living, home health, hospice, and small facilities, with the CMS 42 CFR 483.35 compliance block no competitor includes. Download as DOCX.
The director of nursing is one of the most important and most regulated hires a care facility makes. The same title means different things across settings: a federally required full-time RN in a nursing home, a Wellness Director in assisted living, a Clinical Manager in home health, and the RN who coordinates the interdisciplinary group in hospice. So the first job of any director of nursing job description is to say which setting you mean, because the title, the license, and the rules all change with it.
At FirstHR, we build hiring templates for the smaller long-term care providers that make this hire, the assisted living communities, home health agencies, and small or rural nursing homes, usually with a lean back office. The six templates below cover the role by setting, with the CMS compliance, licensure, and FLSA guidance the generic templates skip. The guide to writing a job description covers the fundamentals.
TL;DR
Six free templates by setting: Nursing Home / SNF, Assisted Living, Home Health, Hospice, Long-Term Care, and Small Facility / First Hire. In a nursing home a full-time DON is federally required under 42 CFR 483.35(b)(2). The role needs an active RN license and is generally exempt from overtime. Federal data maps it to medical and health services managers (SOC 11-9111), median $117,960 (May 2024).
What Does a Director of Nursing Do?
A director of nursing leads the nursing department, directing nursing staff and ensuring safe, high-quality, compliant care. The work runs across leadership and staffing, clinical oversight, regulatory compliance, and quality, with the DON accountable for both the care residents or patients receive and the facility's compliance with federal and state rules.
With no dedicated occupational code, federal data maps the role to medical and health services managers (SOC 11-9111), and O*NET lists Nursing Director among the sample titles. The scope shifts by setting: a federally required full-time RN in a skilled nursing facility, a state-regulated Wellness Director in assisted living, a Clinical Manager in home health, and an interdisciplinary-group coordinator in hospice. The templates below split along those lines.
Director of Nursing Duties and Responsibilities
A director of nursing's duties cluster into leadership and staffing, clinical oversight, regulatory compliance, and quality and coordination. The mix shifts by setting, but these areas hold across roles.
Leadership and staffing
Direct, supervise, and evaluate nursing staff
Manage recruitment, scheduling, and competency
Tie staffing to resident acuity and the facility assessment
Clinical oversight
Oversee care plans, assessments, and documentation
Lead infection prevention and medication management
Ensure safe, resident-centered care
Regulatory compliance
Lead CMS and state survey readiness
Respond to deficiencies and plans of correction
Maintain state board of nursing compliance
Quality and coordination
Drive QAPI and quality improvement
Partner with the administrator and providers
Coordinate with families and outside care
In a nursing home the regulatory and survey-readiness duties dominate; in home health the emphasis shifts to plan-of-care and OASIS oversight; in hospice to coordinating the interdisciplinary group. For a structured way to scope the role, the guide to defining job responsibilities walks through the process.
Which Template Should You Use?
Pick the template by your setting. The nursing home version is the flagship with the full CMS block; the assisted living, home health, hospice, long-term care, and small-facility versions match different settings, titles, and regulations. Use this guide to choose.
Nursing Home / SNF
Federally required DON
The flagship: a full-time DON in a skilled nursing facility, with the 42 CFR 483.35 mandate, CMS survey readiness, and an administrator reporting line built in.
Assisted Living
Often Wellness Director
For a residential, non-skilled community, where this role is often titled Wellness Director or Clinical Director and the license required (RN or LPN) is set by state rules.
Home Health
Clinical Manager role
For a Medicare-certified home health agency, where the DON maps to the Clinical Manager required under 42 CFR 484.105(c), overseeing plans of care and OASIS.
Hospice
Coordinates the IDG
For a hospice, leading nursing services and coordinating the interdisciplinary group, with 24/7 nursing availability and palliative care oversight.
Long-Term Care (DNS)
General umbrella
A general long-term care version, also titled Director of Nursing Services or Nursing Director, that you adapt to your setting and its regulations.
Small Facility / First Hire
Hands-on, owner-led
For a small independent facility making its first DON hire: a hands-on leader who builds the nursing function and often serves as charge nurse, with FLSA and licensure built in.
Match the Template to Your Setting
Skilled nursing facility: Nursing Home / SNF. Residential, non-skilled community: Assisted Living (often Wellness Director). Medicare-certified home health agency: Home Health (Clinical Manager). Hospice: Hospice (Clinical Coordinator). A general post-acute or LTC version: Long-Term Care (DNS). A small independent facility making its first DON hire: Small Facility / First Hire. Whichever you pick, require an active RN license and confirm the current rules for your setting.
6 Free Director of Nursing Job Description Templates
Download all six as a single Word document or copy individual templates. Each follows the same structure: facility and position summary, key responsibilities, qualifications, a regulatory or FLSA note, an EEO statement, and pay. Fill in the brackets and post.
Download All 6 Templates
Nursing home, assisted living, home health, hospice, long-term care, and small facility. All in one DOCX.
Template 1: Nursing Home / SNF Director of Nursing
The flagship: a full-time DON in a skilled nursing facility, with the 42 CFR 483.35 mandate, CMS survey readiness, and an administrator reporting line built in.
Director of Nursing Job Description (Nursing Home / SNF)
DIRECTOR OF NURSING JOB DESCRIPTION (NURSING HOME / SNF)
Facility: __ ([City, State])
Reports to: [Nursing Home Administrator / Owner]
Employment type: Full-time, salaried, W-2
FLSA status: Exempt (executive and learned professional) [confirm by duties and salary]
Compensation: $______ per year [+ benefits]
ABOUT [FACILITY NAME]
[Facility Name] is a [#]-bed skilled nursing facility in [City, State]
serving [#] residents. We are hiring a full-time Director of Nursing to
lead our nursing department, ensure quality resident care, and maintain
compliance with federal and state requirements.
POSITION SUMMARY
The Director of Nursing (DON) directs and supervises all nursing services
and staff, ensures the delivery of safe, high-quality resident care, and
maintains regulatory compliance. This is a federally required, full-time
registered nurse position under 42 CFR 483.35(b)(2).
KEY RESPONSIBILITIES
•Direct, supervise, and evaluate all nursing staff and services
•Ensure resident care meets federal, state, and facility standards
•Oversee care plans, assessments, and clinical documentation
•Lead survey readiness and respond to CMS surveys and plans of correction
•Manage nursing recruitment, scheduling, competency, and training
•Oversee infection prevention, medication management, and QAPI
•Tie staffing to the facility assessment and resident acuity
•Partner with the administrator, medical director, and providers
•Maintain compliance with the state board of nursing and CMS rules
REQUIRED QUALIFICATIONS
•Active, unencumbered RN license in [State]
•[BSN preferred; MSN a plus]
•[3 to 5]+ years of nursing experience, with [supervisory / LTC] experience
•Knowledge of CMS long-term care regulations and the survey process
•Strong leadership, clinical judgment, and communication
•[DNS-CT or RAC-CT certification a plus]
•Current CPR and required health and background clearances
REGULATORY NOTE (read before posting)
Under 42 CFR 483.35(b)(2), a Medicare or Medicaid certified nursing
facility must designate a registered nurse to serve as director of
nursing on a full-time basis, unless waived. Per (b)(3), the DON may
serve as a charge nurse only when average daily occupancy is 60 or fewer
residents. Confirm current CMS and state requirements before posting.
This is general information, not legal advice.
EEO STATEMENT
[Facility Name] is an equal opportunity employer. Reasonable
accommodations are available for the essential functions of this role.
COMPENSATION AND HOW TO APPLY
Compensation: $______ per year [+ benefits]
To apply, email __.
Template 2: Assisted Living Director of Nursing / Wellness Director
For a residential, non-skilled community, where this role is often titled Wellness Director or Clinical Director and the license required is set by state rules.
Director of Nursing / Wellness Director Job Description (Assisted Living)
DIRECTOR OF NURSING / WELLNESS DIRECTOR JOB DESCRIPTION (ASSISTED LIVING)
Community: __ ([City, State])
Reports to: [Executive Director / Administrator]
Employment type: Full-time, salaried, W-2
FLSA status: Exempt [confirm by duties and salary]
Compensation: $______ per year [+ benefits]
ABOUT THIS ROLE
In assisted living, this role is often titled Wellness Director, Clinical
Director, or Director of Clinical Services rather than Director of
Nursing. The role oversees resident health and wellness in a residential,
non-skilled setting, and the exact license required (RN or, in some
states, LPN) and the duties are governed by state assisted living rules.
POSITION SUMMARY
[Community Name] is hiring a [Director of Nursing / Wellness Director] to
oversee the health and wellness of our residents. You will manage care
staff, coordinate resident assessments and service plans, oversee
medication management, and ensure compliance with state assisted living
regulations.
KEY RESPONSIBILITIES
•Oversee resident health, wellness, and service plans
•Supervise and train care staff and med technicians
•Conduct or oversee resident assessments and ADL support
•Manage medication administration and storage per state rules
•Coordinate with physicians, families, and outside providers
•Support dementia and memory care programming [if applicable]
•Maintain compliance with state assisted living regulations
•Manage health-related records and incident reporting
REQUIRED QUALIFICATIONS
•Active [RN or LPN] license in [State] per state assisted living rules
•[2 to 3]+ years of nursing experience, ideally in senior care
•Knowledge of state assisted living and medication regulations
•Strong leadership and resident-centered judgment
•Current CPR and required health and background clearances
STATE REGULATION NOTE
Assisted living is regulated at the state level, and requirements vary
widely. Some states require an RN for this role, others allow an LPN-level
Wellness Director, and titles and duties differ by state. Confirm your
state's assisted living rules before posting. This is not legal advice.
EEO STATEMENT
[Community Name] is an equal opportunity employer. Reasonable
accommodations are available for the essential functions of this role.
COMPENSATION AND HOW TO APPLY
Compensation: $______ per year [+ benefits]
To apply, email __.
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Template 3: Home Health Director of Nursing / Clinical Manager
For a Medicare-certified home health agency, where the DON maps to the Clinical Manager required under 42 CFR 484.105(c), overseeing plans of care and OASIS.
Director of Nursing / Clinical Manager Job Description (Home Health)
DIRECTOR OF NURSING / CLINICAL MANAGER JOB DESCRIPTION (HOME HEALTH)
Agency: __ ([City, State])
Reports to: [Administrator / Owner]
Employment type: Full-time, salaried, W-2
FLSA status: Exempt [confirm by duties and salary]
Compensation: $______ per year [+ benefits]
ABOUT THIS ROLE
In a Medicare-certified home health agency, the director of nursing role
maps to the Clinical Manager required under 42 CFR 484.105(c), a
qualified individual (often a registered nurse) who provides oversight of
all patient care services and personnel.
POSITION SUMMARY
[Agency Name] is hiring a [Director of Nursing / Clinical Manager] to
oversee all patient care services and clinical staff for our home health
agency. You will manage care delivery in patients' homes, oversee plans
of care and OASIS, supervise field clinicians, and maintain compliance
with the Medicare Conditions of Participation.
KEY RESPONSIBILITIES
•Provide oversight of all patient care services and personnel
•Oversee plans of care, OASIS assessments, and care coordination
•Supervise and support field nurses, aides, and therapists
•Ensure compliance with the Medicare Conditions of Participation
•Manage clinical documentation, audits, and quality
•Oversee intake, scheduling, and visit utilization
•Lead survey readiness and respond to deficiencies
•Maintain compliance with state home health and nursing rules
REQUIRED QUALIFICATIONS
•Active, unencumbered RN license in [State]
•[BSN preferred]
•[2 to 4]+ years of home health or clinical nursing, with supervision
•Knowledge of OASIS, plan of care, and Medicare home health rules
•Strong leadership, organization, and communication
•Current CPR and required health and background clearances
REGULATORY NOTE
Under 42 CFR 484.105(c), the home health agency must have a clinical
manager who provides oversight of all patient care services and
personnel; this is the role that functions as the director of nursing.
Confirm current home health Conditions of Participation and state rules.
This is general information, not legal advice.
EEO STATEMENT
[Agency Name] is an equal opportunity employer. Reasonable accommodations
are available for the essential functions of this role.
COMPENSATION AND HOW TO APPLY
Compensation: $______ per year [+ benefits]
To apply, email __.
Template 4: Hospice Director of Nursing / Clinical Coordinator
For a hospice, leading nursing services and coordinating the interdisciplinary group, with 24/7 nursing availability and palliative care oversight.
Director of Nursing / Clinical Coordinator Job Description (Hospice)
DIRECTOR OF NURSING / CLINICAL COORDINATOR JOB DESCRIPTION (HOSPICE)
Hospice: __ ([City, State])
Reports to: [Administrator / Owner]
Employment type: Full-time, salaried, W-2
FLSA status: Exempt [confirm by duties and salary]
Compensation: $______ per year [+ benefits]
ABOUT THIS ROLE
In hospice, the director of nursing role oversees nursing care and the
coordination of the interdisciplinary group. Hospice nursing care must be
provided by or under the supervision of a registered nurse, and a
registered nurse coordinates the plan of care, consistent with 42 CFR
418.64 and related hospice Conditions of Participation.
POSITION SUMMARY
[Hospice Name] is hiring a [Director of Nursing / Clinical Coordinator]
to lead nursing services and coordinate care across the interdisciplinary
group. You will oversee clinical staff, ensure quality palliative and
end-of-life care, and maintain compliance with the hospice Conditions of
Participation.
KEY RESPONSIBILITIES
•Lead and supervise hospice nursing services and staff
•Coordinate care across the interdisciplinary group
•Oversee plans of care, symptom management, and documentation
•Ensure 24/7 nursing availability and on-call coverage
•Support patients and families through end-of-life care
•Maintain compliance with hospice Conditions of Participation
•Lead survey readiness and quality improvement
•Maintain compliance with state nursing and hospice rules
REQUIRED QUALIFICATIONS
•Active, unencumbered RN license in [State]
•[BSN preferred; hospice or palliative experience strongly preferred]
•[2 to 4]+ years of nursing, with supervisory and hospice experience
•Knowledge of hospice Conditions of Participation and the IDG
•Compassion, leadership, and strong clinical judgment
•Current CPR and required health and background clearances
REGULATORY NOTE
Under the hospice Conditions of Participation (42 CFR 418.64 and 418.56),
nursing care must be provided by or under the supervision of a registered
nurse, and a registered nurse member of the interdisciplinary group
coordinates care. Confirm current hospice rules and state requirements.
This is not legal advice.
EEO STATEMENT
[Hospice Name] is an equal opportunity employer. Reasonable
accommodations are available for the essential functions of this role.
COMPENSATION AND HOW TO APPLY
Compensation: $______ per year [+ benefits]
To apply, email __.
Template 5: Long-Term Care Director of Nursing Services
A general long-term care version, also titled Director of Nursing Services or Nursing Director, that you adapt to your setting and its regulations.
Director of Nursing Services Job Description (Long-Term Care)
DIRECTOR OF NURSING SERVICES JOB DESCRIPTION (LONG-TERM CARE)
Facility: __ ([City, State])
Reports to: [Administrator / Owner]
Employment type: Full-time, salaried, W-2
FLSA status: Exempt [confirm by duties and salary]
Compensation: $______ per year [+ benefits]
ABOUT THIS ROLE
This is a general long-term care version, also titled Director of Nursing
Services (DNS) or Nursing Director, suitable across post-acute and
long-term care settings. Adjust the regulatory references to your setting
(SNF, assisted living, home health, or hospice).
POSITION SUMMARY
[Facility Name] is hiring a Director of Nursing Services to lead the
nursing department, ensure quality resident care, manage nursing staff,
and maintain compliance with applicable federal and state regulations.
KEY RESPONSIBILITIES
•Lead, supervise, and evaluate the nursing department
•Ensure quality, resident-centered care across the facility
•Oversee care plans, assessments, and clinical documentation
•Manage nursing recruitment, scheduling, and competency
•Oversee infection prevention, medication, and quality programs
•Lead regulatory survey readiness and corrective action
•Partner with the administrator, providers, and families
•Maintain compliance with the state board of nursing and applicable rules
REQUIRED QUALIFICATIONS
•Active, unencumbered RN license in [State]
•[BSN preferred; MSN a plus]
•[3 to 5]+ years of nursing experience, with supervisory experience
•Knowledge of long-term care regulations and the survey process
•Strong leadership, clinical, and communication skills
•Current CPR and required health and background clearances
FLSA NOTE
A director of nursing is generally exempt under the executive and learned
professional exemptions, given the RN license and management duties, when
paid on a salary basis above the threshold. Confirm by actual duties and
salary, and apply the higher of the federal or state threshold. This is
not legal advice.
EEO STATEMENT
[Facility Name] is an equal opportunity employer. Reasonable
accommodations are available for the essential functions of this role.
COMPENSATION AND HOW TO APPLY
Compensation: $______ per year [+ benefits]
To apply, email __.
Template 6: Small Facility / First DON Hire
For a small independent facility making its first DON hire: a hands-on leader who builds the nursing function and often serves as charge nurse, with FLSA and licensure built in.
Director of Nursing Job Description (Small Facility / First DON Hire)
DIRECTOR OF NURSING JOB DESCRIPTION (SMALL FACILITY / FIRST DON HIRE)
Facility: __ ([City, State])
Reports to: [Owner / Administrator]
Employment type: Full-time, salaried, W-2
FLSA status: Exempt (executive and learned professional) [confirm by duties and salary]
Compensation: $______ per year [+ benefits]
ABOUT [FACILITY NAME]
[Facility Name] is a small [#]-bed [nursing facility / assisted living /
home health agency] in [City, State]. We are hiring our [full-time]
Director of Nursing to lead clinical care and compliance as we grow. This
is a hands-on leadership role where you build the nursing function, not
just manage a large team.
POSITION SUMMARY
We are hiring a Director of Nursing to lead nursing care, supervise our
clinical staff, and own regulatory compliance. In a small facility, the
DON is both a leader and a working clinician, often serving as charge
nurse, and works directly with the owner or administrator.
KEY RESPONSIBILITIES
•Lead and supervise nursing care and clinical staff
•Provide hands-on care and serve as charge nurse as needed
•Own care plans, assessments, and clinical documentation
•Lead survey readiness and regulatory compliance
•Manage nursing hiring, scheduling, training, and competency
•Oversee infection prevention, medication, and quality
•Work directly with the owner or administrator
•Maintain compliance with the state board of nursing and CMS rules
REQUIRED QUALIFICATIONS
•Active, unencumbered RN license in [State]
•[2 to 4]+ years of nursing experience, supervisory a plus
•Comfortable wearing several hats in a small facility
•Knowledge of the regulations for your setting
•Strong clinical judgment, reliability, and communication
•Current CPR and required health and background clearances
NOTES FOR A SMALL FACILITY (read before posting)
For a Medicare or Medicaid certified nursing facility, the full-time DON
is federally required under 42 CFR 483.35(b)(2), and per (b)(3) the DON
may serve as charge nurse only when average daily occupancy is 60 or fewer
residents, which directly addresses small facilities. The DON is exempt
for overtime purposes when paid on a salary basis and performing
management and professional duties. Confirm current CMS and state rules.
This is general information, not legal advice.
EEO STATEMENT
[Facility Name] is an equal opportunity employer. Reasonable
accommodations are available for the essential functions of this role.
COMPENSATION AND HOW TO APPLY
Compensation: $______ per year [+ benefits]
To apply, email __.
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This is the part no generic template includes, and it is the reason a DON job description matters legally. In a Medicare or Medicaid certified nursing facility, the director of nursing is not an optional management role; it is federally required.
Under 42 CFR 483.35(b)(2), the facility must designate a registered nurse to serve as the director of nursing on a full-time basis, unless waived. Per 483.35(b)(3), the DON may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents, a provision that directly addresses small facilities.
The Full-Time DON Requirement Still Stands
The regulation went through churn recently. CMS issued an interim final rule on December 2, 2025, effective February 2, 2026, that rescinded the 2024 numeric staffing minimums and the 24-hour, 7-day RN requirement, but it reinstated the prior standards, including the full-time director of nursing requirement and an RN onsite at least 8 consecutive hours a day, 7 days a week. So the full-time DON mandate remains in effect for nursing homes, and the facility-assessment requirement was retained. Confirm current CMS and state rules before posting, since the landscape is still settling. This is general information, not legal advice.
Other settings have related requirements. Home health agencies must have a clinical manager under 42 CFR 484.105(c), hospices must provide nursing under RN supervision under 42 CFR 418.64, and assisted living is regulated by each state. Because the job description doubles as a survey-readiness document, keep it accurate and tied to your facility assessment.
FLSA: Is a Director of Nursing Exempt?
A director of nursing is generally exempt from overtime. The role typically qualifies under both the executive exemption, because the DON manages the nursing department and directs other employees, and the learned professional exemption, because a registered nurse licensed by the state board meets the professional duties test.
To be exempt, the DON must also be paid on a salary basis at or above the federal threshold, currently $684 per week ($35,568 per year) under the 2019 rule, since the 2024 increase was vacated by a federal court. DON salaries sit well above that floor, so the classification rests on the duties, which a genuine DON role clearly meets.
Classify by Duties, and Check Your State
Titles do not decide exempt status; the actual duties do, so a nominal DON who mostly works the floor as a staff nurse without real management authority could raise questions. Several states set salary thresholds higher than the federal one, and you must apply whichever law gives the employee greater protection. The guides to exempt versus non-exempt and the Fair Labor Standards Act explain how the tests work. This is general information, not legal advice.
Licensure and Credentialing
The DON role cannot legally be filled by someone without a current RN license, which makes credentialing the non-negotiable core of this hire. Verify and track these before the start date and keep the documentation survey-ready.
RN license verification
The DON must hold an active, unencumbered registered nurse license in your state. Verify it against the state board of nursing before the start date, and set a reminder to re-verify before each renewal so the license never lapses while the person is in the role.
Background and health screening
Complete a criminal background check, abuse-registry screening, and any TB test, health screening, and immunizations your state and setting require before the DON has resident contact, and keep the documentation in the credentialing file.
Certifications and CEUs
Confirm current CPR, and track any setting-specific certifications such as DNS-CT or RAC-CT and the continuing-education hours the role needs, with renewal dates recorded so nothing expires unnoticed.
Survey-ready job description
Keep the signed, dated job description in your CMS survey binder, tied to the facility assessment and your nursing policies, so the role and its duties are documented the way surveyors expect to see them.
The single most important item is the active, unencumbered RN license, verified against the state board of nursing and re-verified before each renewal so it never lapses while the person holds the role. Build the full credentialing list into your hiring process and store it where you can produce it for a survey.
Requirements and Qualifications
This is a senior clinical leadership role built on an RN license, experience, and management ability. Name the must-have credentials precisely and tailor the experience to your setting and size.
Requirement
What to know
License
Active, unencumbered RN license in your state, verified and kept current
Education
BSN commonly preferred; MSN a plus; no degree set in the CFR itself
Experience
3 to 5 years nursing with supervisory or LTC experience typical
Regulatory knowledge
The rules for your setting and the survey process
Certifications
DNS-CT or RAC-CT a plus; current CPR; health and background clearances
Leadership
Clinical judgment, staff management, and communication
For a small facility, hands-on clinical ability matters as much as management experience, since the DON often works as a charge nurse too. Separate the must-haves from the nice-to-haves, and keep the RN license non-negotiable. The guide to writing a job description covers how to structure the rest.
Pay and Hiring Outlook
Director of nursing pay sits in the healthcare-management band and demand is growing fast, since the role maps to medical and health services managers in federal data.
Closest BLS Benchmark (Medical and Health Services Managers, May 2024)
With no dedicated wage code for director of nursing, the closest proxy is medical and health services managers (SOC 11-9111), median $117,960 a year as of May 2024 (lowest 10% under $69,680, highest 10% over $219,080). Employment is projected to grow 23% from 2024 to 2034, much faster than average, with about 62,100 openings a year. DON-specific market data commonly runs in the low-to-mid six figures depending on setting and region (U.S. Bureau of Labor Statistics).
The proxy occupation spans all healthcare managers, so anchor your offer to the setting and region: skilled nursing and hospice DON roles tend to sit higher than assisted living wellness director roles, and major markets pay more. Market data shows DON pay commonly in the low-to-mid six figures, above the home health and personal care benchmark but within the manager band.
Hiring a Director of Nursing for a Small Facility
The honest picture for a small or independent facility: the title and rules change by setting, the DON is federally mandated in a nursing home, and the employer is usually owner-led and running lean while making a high-stakes regulated hire. Here are the three realities to get right.
The title and rules change completely by setting, so name your setting first
Director of nursing is one title across very different settings, each with its own rules. In a skilled nursing facility it is a federally required full-time RN role under CMS rules. In assisted living it is often titled Wellness Director or Clinical Director and may be an RN or, in some states, an LPN, governed by state assisted living regulations. In home health the equivalent is the Clinical Manager required under the Medicare Conditions of Participation, and in hospice it is the RN who coordinates the interdisciplinary group. The duties overlap, but the license required, the regulatory citation, and even the job title differ sharply. Decide which setting you are hiring for, use the matching template, and adjust the regulatory references, because posting a generic DON description attracts the wrong applicants and misses the compliance points a surveyor expects to see.
In a nursing home the DON is not optional, it is federally mandated
For a Medicare or Medicaid certified nursing facility, the director of nursing is not a discretionary management choice but a legal requirement. 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 unless a waiver applies, and per (b)(3) the DON may serve as a charge nurse only when average daily occupancy is 60 or fewer residents, which directly contemplates small facilities. This mandate survived the recent regulatory churn: CMS issued an interim final rule on December 2, 2025, effective February 2, 2026, that rescinded the 2024 numeric staffing minimums and the 24/7 RN requirement but reinstated the prior standard, including the full-time DON requirement and an RN onsite at least 8 consecutive hours a day, 7 days a week. So the full-time DON requirement stands, and the job description doubles as a survey-readiness document, which is why it must be accurate and tied to your facility assessment. Confirm current rules before posting, since the landscape is still settling. This is general information, not legal advice.
The employer is often a small independent facility making a high-stakes, regulated hire
The typical DON employer is not a large hospital but a smaller long-term care provider: an assisted living community averaging around a dozen staff, a small home health agency, or a small or rural nursing home, and a large share of these are independently owned rather than part of a chain. For an owner-led facility running lean, this hire is uniquely high-stakes, because the DON is legally required, owns regulatory compliance and survey readiness, and must hold a verified, current RN license. Get the credentialing wrong and you risk both a survey citation and a gap in a mandated role. That is exactly where a repeatable system helps. FirstHR fits it directly: e-signature for the offer letter, document management to store the RN license, certifications, and CEU records with renewal reminders, training modules for required topics like infection control and abuse reporting, task workflows for a consistent credentialing and onboarding sequence, and a simple HRIS with an org chart showing the DON under the administrator. Because pricing is flat rather than per seat, a small facility pays one rate as it grows. FirstHR does not run payroll or administer benefits, so pair it with a payroll provider. Applicant tracking is coming soon.
After You Hire: Onboarding a Director of Nursing
Onboarding a DON is more than paperwork, because the role is licensed, federally significant, and survey-relevant. Send the offer stating the salary and exempt classification, collect the signed offer, and complete Form I-9 and tax forms as part of the new hire paperwork.
Then handle the credentialing steps that are the core of a clean, survey-ready start: verify the RN license against the state board before the start date and record the renewal, complete background and abuse-registry screening and any required health screening, confirm CPR and any certifications, and have the DON sign acknowledgments for your policies, HIPAA, and the procedures they will oversee. Keep the signed onboarding documents and the dated job description in your survey binder. If this is among your first leadership hires, the guide to hiring your first employee covers the broader steps.
FirstHR fits this hire directly: e-signature for the offer and policy and HIPAA acknowledgments, document management to store the RN license, certifications, and CEU records with renewal reminders so nothing lapses, training modules to deliver and document required topics like infection control and abuse reporting, task workflows so every credentialing and onboarding sequence runs the same way, and a simple HRIS with an org chart showing the DON under the administrator. Because pricing is flat rather than per seat, a small facility pays one rate as it grows. FirstHR does not run payroll or administer benefits, so pair it with a payroll provider. Applicant tracking is coming soon to FirstHR.
Key Takeaways
Director of nursing is one title across different settings: name yours, since the license, regulation, and even the job title change with it.
In a Medicare or Medicaid certified nursing home, a full-time DON is federally required under 42 CFR 483.35(b)(2), a mandate reaffirmed by the December 2025 CMS interim final rule.
The role requires an active, verified RN license; in assisted living it is often a Wellness Director and may allow an LPN per state rules.
A DON is generally exempt under the executive and learned professional exemptions, but duties, not the title, decide it.
Employers skew small: assisted living, home health, and small or rural nursing homes, many independently owned, are the core hirers.
With no dedicated code, federal data maps the role to medical and health services managers (SOC 11-9111), median $117,960 (May 2024).
Frequently Asked Questions
What does a director of nursing do?
A director of nursing (DON) leads the nursing department of a healthcare facility, directing nursing staff and ensuring safe, high-quality, compliant care. The core work includes directing, supervising, and evaluating nursing staff and services, overseeing care plans, assessments, and clinical documentation, leading regulatory survey readiness and responding to deficiencies, managing nursing recruitment, scheduling, training, and competency, overseeing infection prevention, medication management, and quality improvement, and partnering with the administrator, providers, and families. The DON is the clinical leader of the facility, accountable for both the quality of resident or patient care and compliance with federal and state rules. The exact scope depends on the setting: in a skilled nursing facility the DON is a federally required full-time RN role, in assisted living it is often a Wellness Director governed by state rules, in home health it maps to the Clinical Manager, and in hospice it is the RN who coordinates the interdisciplinary group. Across all of them it is a senior leadership role that requires an active RN license and strong clinical and management judgment.
Is a director of nursing required by law?
Yes, in nursing homes. For any Medicare or Medicaid certified nursing facility, federal regulation 42 CFR 483.35(b)(2) requires the facility to designate a registered nurse to serve as the director of nursing on a full-time basis, unless a waiver applies. The rule even addresses small facilities directly: under 483.35(b)(3), the DON may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents. This requirement survived recent regulatory change. CMS issued an interim final rule on December 2, 2025, effective February 2, 2026, that rescinded the 2024 numeric staffing minimums and the 24-hour, 7-day RN requirement but reinstated the prior standards, including the full-time director of nursing requirement and an RN onsite at least 8 consecutive hours a day, 7 days a week. So the full-time DON mandate remains in effect for nursing homes. Other settings have related but different requirements: home health agencies must have a clinical manager under 42 CFR 484.105(c), hospices must provide nursing under RN supervision under 42 CFR 418.64, and assisted living is regulated by each state. Confirm current rules before posting, since the regulatory landscape is still settling. This is general information, not legal advice.
What qualifications does a director of nursing need?
A director of nursing needs an active, unencumbered registered nurse license in the state where the facility operates, plus nursing experience and leadership ability. A bachelor of science in nursing (BSN) is commonly preferred and a master's (MSN) is a plus, though CMS does not specify a degree in the regulation itself; in practice, employers and surveyors look for sufficient experience for the role. Most DON postings ask for three to five years of nursing experience with supervisory or long-term care experience, knowledge of the relevant regulations and the survey process, and strong leadership, clinical judgment, and communication. Setting-specific certifications such as DNS-CT (Director of Nursing Services, Certified) or RAC-CT can strengthen a candidate. For a small facility, hands-on clinical ability matters as much as management experience, since the DON often works as a charge nurse too. The non-negotiable requirement is the current RN license, which must be verified against the state board of nursing and kept current, because the role cannot legally be filled by someone without it. Match the experience level and any preferred certifications to your setting and size.
Is a director of nursing exempt or non-exempt from overtime?
A director of nursing is generally exempt from overtime. The role typically qualifies under both the executive exemption, because the DON manages the nursing department and directs the work of other employees, and the learned professional exemption, because registered nurses who are licensed by the state board generally meet the professional duties test. To be exempt, the DON must also be paid on a salary basis at or above the federal threshold, which is currently $684 per week ($35,568 per year) under the 2019 rule, since the 2024 increase was vacated by a federal court. DON salaries are well above that floor, so the salary test is rarely the issue; the classification rests on the management and professional duties, which a genuine DON role clearly meets. The caveat is that titles do not decide exempt status; the actual duties do, so a nominal DON who mostly works the floor as a staff nurse without real management authority could raise questions. Several states set their own salary thresholds higher than the federal one, and you must apply whichever law gives the employee greater protection. Classify based on real duties and salary, and document it. This is general information, not legal advice.
What is the difference between a DON and a nursing home administrator?
They are two separate, both essential, leadership roles, and confusing them is a common mistake. The director of nursing (DON) is the clinical leader: a registered nurse who runs the nursing department, supervises nursing staff, and is accountable for the quality of resident care and clinical compliance. The nursing home administrator (NHA) is the business and operational leader: responsible for the overall operation of the facility, including finances, staffing across all departments, the physical plant, and overall regulatory compliance, and the DON typically reports to the administrator. The two roles require different credentials. The DON must hold an active RN license, while the NHA must hold a separate state administrator license, usually obtained by passing the national NAB exam and meeting state requirements. A registered nurse can pursue NHA licensure, but the licenses are distinct. In a small facility the two roles are sometimes held by people who work closely together, but they cannot be collapsed into one, because each carries its own legal requirements and credentials. When you hire, you are filling the clinical leadership seat, which is the DON.
What is a DON called in assisted living and home health?
The director of nursing role goes by different titles depending on the setting, which matters when you write the posting. In assisted living, the role is frequently titled Wellness Director, Clinical Director, or Director of Clinical Services rather than director of nursing, and because assisted living is regulated at the state level, the role may require an RN in some states and allow an LPN-level leader in others. In home health, the equivalent role is the Clinical Manager required under the Medicare Conditions of Participation at 42 CFR 484.105(c), a qualified individual, often a registered nurse, who provides oversight of all patient care services and personnel. In hospice, the role is often titled Clinical Coordinator or Director of Clinical Services, centered on coordinating the interdisciplinary group and ensuring nursing care under RN supervision. In a skilled nursing facility it is most often called Director of Nursing or Director of Nursing Services (DNS). Use the title that matches your setting so the right candidates recognize the role, and make sure the duties and the regulatory references match that setting too.
Do small facilities need a director of nursing?
Yes, and small facilities are a core part of who hires for this role. A Medicare or Medicaid certified nursing facility needs a full-time DON regardless of size; the regulation even contemplates small facilities by allowing the DON to serve as charge nurse when average daily occupancy is 60 or fewer residents. Beyond skilled nursing, the employer base for this role skews small: assisted living communities average roughly a dozen to seventeen staff, home health agencies are mostly small, and a large share of nursing homes and assisted living communities are independently owned rather than part of a chain. For a small or independent facility, the DON is often the most important clinical hire the owner makes, because the role carries legal weight, owns survey readiness, and requires a verified RN license. The challenge at small scale is that the same owner handles the regulated hire, the credentialing, and the onboarding with a lean back office. A repeatable process for verifying the license, completing background and health screening, documenting required training, and storing it all for survey matters as much for a small facility as a large one, which is what the small-facility template and the onboarding guidance on this page are built around.
What happens after I hire a director of nursing?
Run a structured onboarding that handles standard employment paperwork plus the credentialing steps that are central to a clinical leadership hire. Start with the basics: send the offer stating the salary and the exempt classification, collect the signed offer, complete Form I-9 in the first days, and gather the W-4 and any state tax forms. Then handle the credentialing items, which are the heart of this hire. Verify the RN license against the state board of nursing before the start date and record the renewal date, complete the criminal background check, abuse-registry screening, and any TB test, health screening, and immunizations your setting requires, and confirm current CPR and any certifications such as DNS-CT or RAC-CT. Have the new DON sign acknowledgments for your policies, HIPAA, and the procedures they will oversee, and keep the signed, dated job description in your survey binder tied to the facility assessment. Then orient them to the facility, the residents or patients, the regulations, and the documentation systems. For a small facility, this sequence needs to be repeatable and survey-ready. FirstHR fits it directly: e-signature for the offer and policy acknowledgments, document management to store the RN license, certifications, and CEU records with renewal reminders, training modules for required topics, task workflows for a consistent credentialing and onboarding sequence, and a simple HRIS with an org chart. FirstHR does not run payroll or administer benefits, so pair it with a payroll provider. Applicant tracking is coming soon to FirstHR.
