How to Hire Directors of Nursing: An Employer's Guide

Hiring a director of nursing means filling the seat the rules treat as your clinical chain of command. The title changes with the provider type: director of nursing in a nursing home, clinical manager in a Medicare-certified home health agency, the RN coordination seat in a hospice. Every version owns your clinical standards, your clinical staffing and your survey or audit readiness. Write the posting for the seat your provider type actually requires, and say so in the title: director of nursing in a nursing home, clinical manager in home health.

In a nursing home, the federal rule is specific about the seat. A facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week, and designate a full-time registered nurse director of nursing, with waivers possible (42 CFR 483.35(b)). The DON runs the nursing department: delegation and supervision, clinical standards, and the staffing plan.

The staffing plan itself rests on a "sufficient" standard, not a ratio. Federal nursing home rules require sufficient nursing staff on a 24-hour basis based on the facility assessment rather than a fixed numeric ratio (42 CFR 483.35(a)). The 2024 federal rule that would have added numeric minimums — 24/7 RN onsite and 3.48 total nurse staffing hours per resident day — was blocked by statute until September 30, 2034, and CMS repealed those provisions effective February 2, 2026. Your DON designs against the facility assessment, so hire someone who can document sufficiency, not just count heads.

One structural limit matters before you write the posting: the director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents (42 CFR 483.35(b)(3)). In a larger facility the DON seat cannot double as charge coverage, so the hire has to be a genuine management position with its own coverage underneath it.

The seat also owns the survey calendar. The state survey agency must conduct a standard survey of each nursing facility no later than 15 months after the previous one, with a statewide average interval of 12 months or less (42 CFR 488.308). Your DON lives on that clock — which is why survey readiness is an interview topic, not a line on a resume.

In a Medicare-certified home health agency, the seat is the clinical manager, and the federal conditions fix who may hold it: a licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker, or registered nurse (42 CFR 484.115(c)). The administrator must ensure a clinical manager is available during all operating hours (42 CFR 484.105(b)). The agency must also maintain an effective, ongoing, data-driven QAPI program that uses quality indicator data, including OASIS-derived measures (42 CFR 484.65) — the program a clinical manager candidate should be able to speak to in the interview.

In a hospice, the federal rule requires the hospice to designate an RN member of the interdisciplinary group to coordinate care (42 CFR 418.56(a)). If your hospice titles that coordination seat director of nursing, you are hiring into an RN seat by rule.

Assisted living is different: residential care settings are governed almost exclusively by state laws and regulations rather than federal rules, and they vary from state to state. There is no federal director-of-nursing seat here the way there is in nursing homes and home health — what your state's licensing agency requires of the person who oversees resident care is a state question. Confirm it with your state agency before you fix the qualification line.

The worker-side view of this career — what draws nurses to the seat, the routes in, and the pay expectations they arrive with — lives in the director of nursing career guide. This page stays on the employer's side.

Start with the license. The nursing home DON seat is a registered nurse designation under the federal rule, so the base credential is a current RN license — verified directly with the issuing state board of nursing, not from the copy in the candidate's file.

Multistate practice has a shortcut worth knowing. The Nurse Licensure Compact, the multistate RN/LPN license, had 43 participating jurisdictions as of October 2026. If your facility or agency sits near a state line, confirm with your board of nursing how a multistate license applies before you write the posting's licensure line.

For the home health clinical manager seat, the federal rule names seven qualifying occupations: a licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker, or registered nurse (42 CFR 484.115(c)). Nursing is one qualifying occupation on that list, not the only one. If your model wants an RN in the seat, write that as your organization's own requirement in the posting, on top of the federal list — and say so plainly, so candidates from the other qualifying professions do not waste an application.

Keep this hire distinct from the administrator seat. Federal rules require a nursing facility to be administered by an administrator licensed by the state where licensing is required (42 CFR 483.70) — a separate role with its own state license, hired separately from the DON. Conflating the two in one posting leaves candidates unsure which seat they are applying for.

Experience requirements are yours to set, and the useful move is to define them in terms of the seat's work. Name the record you want to see: a staffing plan run against a facility assessment, a standard survey or accreditation review carried, delegation and supervision records managed, QAPI data read. State what you will train versus what you require on day one, so strong clinical leaders from adjacent settings can screen themselves in honestly.

In assisted living, qualifications are a state question. Residential care is governed almost exclusively by state law, so the requirements for whoever oversees resident care come from your state's licensing agency — not from another state's rulebook, and not from a national job-ad convention.

Rules change, and they are state-specific. Confirm RN licensure with your state board of nursing, nursing home and home health requirements with CMS's conditions of participation and your state survey agency, and assisted living requirements with your state's licensing agency, before you finalize the qualification lines in your posting.

Frame the market first. BLS Employment Projections put medical and health services managers — the broad category that covers directors of nursing — at 24.2% growth from 2025 to 2035, with about 62,300 openings per year across the category. Your opening competes with hospitals, other facilities and agencies, and with employers outside senior care hiring from the same category.

Look internal first. The charge nurses, RN supervisors and home health case managers already on your roster know your residents or clients, your documentation platform and your survey history. A development path into the seat is also retention infrastructure for the RNs underneath it.

Externally, post where nursing leadership candidates look, work referrals from your clinical staff, and show up where the profession gathers. For home health and hospice, that includes the National Alliance for Care at Home — the association formed when NAHC and NHPCO combined. For nursing homes and assisted living, your state health care association is the equivalent venue.

Search firms are a legitimate channel for a seat this senior, and the fee structure is yours to negotiate; our research found no published fee benchmark, so treat any figure you are quoted as one firm's price, not a market rate.

Two sourcing rules apply. It is illegal under EEOC-enforced laws to publish a job ad that shows a preference for, or discourages, applicants because of race, color, religion, sex, national origin, age (40 and older), disability or genetic information. An ad seeking "females" or "recent college graduates" is the EEOC's own example of wording that can cross that line. And recruiting itself is covered: relying on word-of-mouth recruiting through a workforce that is mostly one group can violate federal anti-discrimination law if almost all new hires end up sharing that group, so spread sourcing across channels.

Name the realities in the posting itself: the setting and census band, the on-call and weekend coverage expectation, the survey or audit calendar, the documentation platform, and the delegation structure the DON inherits. Candidates for this seat will ask about all of it; an ad that answers up front gets better shortlists.

The channel mechanics — budget across boards, referral structure, and how a leadership funnel differs from an aide funnel — belong to the recruitment strategy guide. To sanity-check your posting against what candidates see, browse the director of nursing jobs board before you publish.

Screen in a fixed order, license first. Verify the RN license with the issuing state board of nursing, then pull references from people who supervised the candidate's clinical work — an administrator or governing-body member they reported to, or a medical director — rather than an employment-dates confirmation.

Say you order a consumer report on an applicant: a criminal background report, a license-verification service report or a motor vehicle record. The Fair Credit Reporting Act requires a clear written disclosure in a stand-alone document and the applicant's written authorization before you obtain it (15 U.S.C. 1681b(b)(2)).

Exclusion screening comes next, and it matters more the higher the seat sits. No Medicare, Medicaid or other federal health care program payment covers items or services furnished by an excluded individual. A provider that employs or contracts with a person it knows or should know is excluded can face civil monetary penalties, an assessment of up to three times the amount claimed, and exclusion. Federal law does not require providers to check the OIG's List of Excluded Individuals — OIG says so itself — but OIG recommends screening before hiring and periodically thereafter, and the list updates monthly. If your organization bills federal health care programs, run the check.

If you operate a nursing facility, the registry rules are separate and specific. A facility must not employ individuals with a finding in the state nurse aide registry concerning abuse, neglect, exploitation, mistreatment or misappropriation of resident property (42 CFR 483.12(a)(3)). And before allowing an individual to serve as a nurse aide, the facility must receive registry verification and seek information from every state registry it believes will include information on that individual (42 CFR 483.35(d)(4)-(5)). Those rules are aimed at nurse aide hires — your DON screening policy is your own to set on top of them.

Sequence the health steps lawfully. Under the ADA, a covered employer may require a medical examination only after a job offer and before duties begin, and only if every entering employee in the job category gets one. A test to determine the illegal use of drugs is not a medical examination under the ADA; whether to test at all is your policy, with state law to confirm. On TB, the CDC recommends screening health care personnel upon hire rather than routine annual testing absent known exposure or ongoing transmission.

Add a work-sample screen alongside the compliance screens. A staffing-plan exercise, a survey-scenario walkthrough or a QAPI data review shows you how the candidate actually prioritizes — the judgment a license and a resume never fully show.

The step-by-step — what to order, in what order, with which disclosures — is the background checks guide's territory. Confirm your screening sequence with your state agencies, the EEOC or HHS-OIG, or health-care counsel.

Anchor the offer to the closest published figure — and label it honestly, because BLS publishes no director-of-nursing occupation. In the Occupational Employment and Wage Statistics for May 2025, medical and health services managers (SOC 11-9111), the broad category that covers directors of nursing and other health-care managers, earned a national median of $123,860 a year ($59.55 an hour), with 597,080 employed. That is a category median, not a DON wage.

The industry rows sharpen it for your setting. The same release puts the broad category — medical and health services managers — at a median of $105,550 a year in skilled nursing facilities and $101,830 a year in home health care services. In continuing care retirement communities and assisted living facilities it was $92,340 a year, and in services for the elderly and persons with disabilities, $84,640 a year. Each row is the broad category in that setting — the closest published anchor your setting has, and not interchangeable with the national figure.

National percentiles and the full pay tables sit on the director of nursing salary data page — link your hiring managers to it rather than rebuilding the table by hand. Then check the live postings in your market, because what you need to offer to compete is set locally.

If you classify the seat as exempt from overtime under the FLSA's professional exemption, the salary or fee basis must be at least $684 a week (29 CFR 541.600(a), as amended May 15, 2026). Meeting that floor is one required test, not exemption on its own — the duties tests still apply. State salary thresholds can be higher, so confirm classification with the DOL's rules or employment counsel before you set the structure.

On bonuses and differentials, our research found no published benchmark for director-of-nursing sign-on bonuses, retention bonuses or on-call stipends. Build any of those from your own budget and the postings you compete with, and put the terms in the offer letter rather than in the ad.

One posting rule to check before you publish: Washington requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each job posting. Other states have their own pay-transparency laws, so confirm your state's requirements with your state labor agency.

Interview against the seat's real decisions, not its job description. Build scenario questions around the four things a clinical leader actually handles. Cover a survey deficiency and the correction plan that follows it, two RN call-offs on a Saturday, a quality metric trending the wrong way in QAPI data, and a family complaint that touches your assignment policy. Listen for the chain of command, documentation habits and delegation judgment in every answer.

Keep the questions lawful. The EEOC's guidance is to limit pre-employment information requests to what is essential for determining whether a person is qualified, and to generally avoid questions that would indicate race, sex, national origin, disability status, age, religion, color or ancestry. If you require a test or exercise, it must be necessary and related to the job, and it may not exclude people based on protected characteristics. Reasonable accommodation applies to applicants, so build the screen so a qualified candidate can request an adjustment.

Because the DON enforces your employment rules day to day, probe that fluency directly. Ask how they handle a resident family's request for a nurse of a particular sex — job assignment decisions based on protected characteristics are illegal under EEOC-enforced laws. Ask how they keep discipline consistent between two shifts, since similar offenses must be treated alike. Ask how they run a harassment complaint between staff members, and what retaliation looks like from the inside.

Sequence after the yes. The ADA allows a required medical examination only after an offer and before duties begin, and only if every entering employee in the job category gets one. That is the same point where license verification, exclusion screening and background reports should be wrapping up ahead of a start date. The offer then turns into paperwork with a fixed deadline: Form I-9 Section 2, the employer's review and verification of documents, must be completed within three business days of the hire.

Write the offer around what candidates for this seat actually weigh. Cover the salary and its exemption basis, coverage and on-call expectations and how they are backed up, the survey or audit calendar they inherit, the delegation structure, the documentation platform, and the length and shape of orientation. Name the licensure requirement in the same words the posting used, so the offer, the posting and the credential file all match.

Onboarding for a clinical leader is a handover, not an orientation video. Complete the credential file before day one; walk the staffing plan and the facility assessment it rests on; hand over the survey calendar, with the standard survey falling no later than 15 months after the last one. In home health, add the QAPI calendar and the operating-hours coverage requirement; in hospice, add the RN care-coordination designation the rule requires.

If you contemplate having the DON cover charge shifts, check the dual-role limit first: the director of nursing may serve as a charge nurse only when the facility's average daily occupancy is 60 or fewer residents. In a larger facility, coverage has to come from the roster underneath the DON, which is the stronger staffing design anyway.

Build the bench as part of retention, not as a contingency. In home health, the administrator must ensure a clinical manager is available during all operating hours — coverage that is hard to sustain without a second qualified person developing underneath the seat. Naming and developing that person is your succession plan.

Set retention expectations from context, not folklore. PHI reports median turnover in home care at nearly 75% in 2024 and nearly 100% for nursing assistants in nursing homes in 2017-2018, and says no comprehensive turnover measure exists for the whole direct care workforce. Judge leadership retention from your own records instead — separations, exit reasons, and weeks from posting to start — then fix what your records name.

The levers that keep a clinical leader are ones you control: authority that matches responsibility, a delegation structure they did not have to invent, coverage expectations that survive a bad week, and a development path toward administrator seats. Set the seat up that way and judge the result in your own records.

The scheduling, wage-hour and workforce topics around this hire sit in the employer hiring guide, alongside the rest of the cross-role guides.

Employer information, not licensing, legal, medical, benefits or tax advice. RN licensure is verified with your state board of nursing. Nursing home and home health requirements come from CMS and your state survey agency, hospice requirements from the Medicare hospice conditions, and assisted living requirements from your state's licensing agency. Screening, pay-disclosure and overtime rules come from HHS-OIG, the EEOC, the DOL and your state labor agency. Confirm the current requirements with the bodies named above, and with a CPA or health-care counsel for classification and pay-structure questions, before you hire.