How to become a director of nursing: requirements, career path, and salary

The director of nursing manages nursing operations across a department, division, or entire facility. The path requires an RN license, a BSN at minimum (most facilities expect an MSN), three to five years of bedside RN experience, and two to three years in a management role. From there, the progression runs through charge nurse and nurse manager before reaching the DON level – typically 10–15 years of career building in total. Compensation ranges from roughly $95,000 in skilled nursing settings to $210,000 or more at large academic medical centers, against a national median of $123,860 for the broader BLS management category the role sits in.

DON role snapshot

What does a director of nursing do?

The DON oversees nursing operations across multiple units, service lines, or an entire nursing department. The role sits above unit-level management and, at large health systems, below the chief nursing officer. At smaller facilities – community hospitals, skilled nursing facilities, hospice agencies – the DON may be the highest-ranking clinical leader in the building.

Core DON responsibilities:

• Supervising a team of nurse managers and, at some facilities, assistant DONs
• Setting department-wide staffing models, scheduling policies, and float pool strategy
• Owning the nursing department budget – labor costs, capital equipment, supply contracts
• Leading clinical quality and patient safety initiatives across the department
• Maintaining regulatory compliance (The Joint Commission, CMS, state health department survey readiness)
• Recruiting, developing, and succession-planning nurse manager talent
• Participating in hospital or health system strategic planning
• Serving as the escalation point for unresolved clinical, staffing, and HR issues

In long-term care and skilled nursing facilities, the DON frequently holds clinical authority equivalent to a CNO at a hospital – responsible for all nursing operations, annual CMS surveys, and staff competency oversight. In those settings, the DON is the top nursing voice at the table.

DON vs. CNO: understanding the distinction

Many searchers use “director of nursing” and “chief nursing officer” interchangeably. At large health systems they are distinct roles with meaningfully different scope, reporting lines, and compensation. At smaller facilities, the titles may overlap – a critical access hospital may call its top nursing leader the CNO while the role functions like a DON.

A DON at a 300-bed community hospital may carry responsibilities similar to a CNO at a 50-bed critical access hospital. Salary benchmarking depends on understanding where a specific role falls within this spectrum – not just the title itself. For the CNO pathway at larger organizations, see the guide to becoming a chief nursing officer.

DON vs. nurse manager: where the scope changes

Before reaching the DON level, most nurses spend two to five years as nurse managers. Understanding exactly where nurse manager responsibility ends and DON responsibility begins helps clarify what skills you need to develop.

The practical gap between nurse manager and DON is one of scope and abstraction. As a nurse manager, your world is the unit. As a DON, your world is the department – and you’re managing managers, not bedside staff. That transition requires a different skill set: financial acumen at a P&L level, political navigation across multiple departments, and the ability to drive performance through people who are themselves leading teams.

Requirements to become a director of nursing

Education

BSN: The practical floor for most DON positions in acute care, and the hard floor for ANCC’s NE-BC credential, which requires a baccalaureate or higher in nursing. Facilities in competitive nursing labor markets rarely consider BSN-only candidates for DON roles. The graduate degree is also the gate on the senior credentials: NEA-BC requires a graduate degree outright, and CENP halves its experience bar from 8,320 hours to 4,160 for candidates holding a master’s or higher.

MSN: Required or strongly preferred at most acute care hospital and health system DON positions. Relevant specializations include Nursing Administration, Healthcare Leadership, and Nursing Informatics. Some hospitals specify MSN in their minimum qualifications language.

DNP or MBA: Increasingly listed as preferred at large health systems and academic medical centers. An MBA is a viable alternative to the DNP for nurses whose DON path runs through finance, operations, or strategy – common in multi-facility or corporate LTC environments.

RN experience

Most DON postings specify:

• 3–5 years of clinical bedside RN experience at minimum
• 2–3 years in a nursing management role (nurse manager, assistant nurse manager, or equivalent)

Clinical depth matters because the DON must maintain clinical credibility with the managers they supervise. Facilities that have hired DONs without strong bedside experience report challenges with staff trust and clinical authority, particularly in unionized environments.

Licensure

An active RN license in the state of practice is required, and no additional license attaches to the DON role itself in either acute care or long-term care. Federal regulation is explicit but minimal here: 42 CFR § 483.35 requires every Medicare- or Medicaid-participating facility to designate a registered nurse as director of nursing on a full-time basis, and sets no minimum years of experience, degree, or specialty certification beyond the RN license.

The Nursing Home Administrator (NHA) license is a separate credential attached to the administrator position, not the DON – every licensed SNF must have a licensed administrator, but that person is a distinct officer from the director of nursing. Some nurses hold both and run the two roles in tandem at small facilities where state rules permit it, and the NHA is a common lateral move for LTC DONs heading toward facility leadership. Do not read it as a DON prerequisite. One CMS restriction is worth knowing: the DON may serve as a charge nurse only at facilities with an average daily occupancy of 60 or fewer residents.

Certifications for directors of nursing

Certifications signal executive readiness to hiring committees and can be the differentiating factor in competitive DON searches.

For acute care DON roles, NE-BC is the most commonly requested credential. The NEA-BC is more common at the senior director or CNO level, and the reason is in the eligibility rule rather than the exam: NE-BC accepts unit or department-level operational responsibility, while NEA-BC requires that your primary responsibility be organization-wide or system-wide. A nurse who has run three units for a decade still does not qualify for NEA-BC on tenure alone. For long-term care, CDONA is the most directly relevant – it signals mastery of CMS survey processes, LTC staffing models, and the regulatory environment specific to SNFs.

Many nurses pursue NE-BC while serving as nurse managers to position themselves for DON recruitment. ANCC states the requirement in hours, not years – 2,000 hours of leadership, management, or administrative practice within the last three years – so a nurse manager with unit-level operational accountability and budget authority typically qualifies well before reaching a director title. Note that the 30 hours of leadership continuing education must also fall inside that same three-year window, which is the piece candidates most often discover late.

Career pathway to director of nursing

The path to DON is a ladder. Each rung adds a layer of scope, responsibility, and credibility that the next step requires.

The assistant DON step is not universal. Large health systems often use it as a formal succession pathway, grooming high-performing nurse managers for future DON openings. Smaller facilities may promote directly from nurse manager to DON without an interim step. If the ADON role exists at your facility and a DON opening is on the horizon, taking it is rarely a career risk.

Where the MSN fits: Most nurses pursue their MSN while working as nurse managers – typically through online programs designed for working RNs. The degree takes 2–3 years part-time. Starting your MSN when you take your first nurse manager role means you’ll have it completed before you’re ready to move up.

What to do during the nurse manager years:

• Pursue NE-BC eligibility (accumulate the 2,000 required leadership practice hours plus 30 leadership CE hours, both inside the same rolling three-year window)
• Volunteer for facility-wide committees (patient safety, quality improvement, policy review)
• Lead a Joint Commission or state survey readiness cycle at least once
• Develop financial fluency – ask your DON to walk you through the department P&L
• Build relationships with the CNO – visibility matters in internal promotion decisions

Work settings for DONs

Long-term care represents the largest single market for DON positions. The LTC DON shortage has been acute since 2020 – CMS staffing mandates and ongoing survey pressure have increased demand for qualified DONs while the pipeline has not kept pace. This is creating salary compression upward in LTC markets, particularly for DONs willing to take on facilities with compliance challenges.

Director of nursing salary

The Bureau of Labor Statistics classifies DON roles under SOC 11-9111 (Medical and Health Services Managers). The May 2025 national median for this classification is $123,860, with the highest 10 percent earning more than $224,340. That median moved up from $117,960 in the May 2024 release, so any DON benchmark carried over from the prior vintage is running roughly $5,900 low at the reference point. Directors of nursing at large acute care hospitals and health systems typically sit above this median, reflecting their department-wide scope, while DONs in skilled nursing, hospice, and home health settings commonly land below it. The rollover matters for the middle of the range: at $123,860 the national median now falls inside the regional-hospital DON band rather than beneath it, so a mid-market DON offer that looked like a premium against the old $117,960 figure may be closer to the category midpoint than it appears. For detailed salary breakdowns by setting and state, see the director of nursing salary guide.

Salary by state (BLS SOC 11-9111, May 2025 – 32-state table):

These are medians for the whole SOC 11-9111 category, which spans every level of healthcare management. Read them as relative state-level variation rather than DON-specific benchmarks.

Source: BLS Occupational Employment and Wage Statistics, SOC 11-9111, May 2025, accessed via O*NET state wage tables.

Rank order shifted substantially in this vintage, so do not carry a state’s position forward from an older guide. New York now leads the country by a wide margin, and Hawaii, New Jersey, Washington and Oregon all sit above the California median. Georgia and Arizona climbed from the bottom half of the table to comfortably above the national figure, while Illinois, Minnesota and Pennsylvania moved the other way – Pennsylvania in particular now reads well below the national median despite its size as a hospital market. Arkansas, Alabama and Mississippi anchor the bottom, reflecting lower regional wage floors across healthcare management.

Beyond base salary, most DON roles include annual performance bonuses (commonly 10–20% of base), retirement matching, continuing education funding, and in some health systems, long-term incentive plans. The total compensation picture at large health systems frequently exceeds base salary by 20–30%.

Frequently asked questions

How long does it take to become a director of nursing?

The realistic timeline from RN licensure to first DON role is 10–15 years, assuming you pursue each career step with intent. The minimum pathway (3 years bedside + 2 years management + MSN concurrent) puts some nurses at the DON level in 8–10 years. Most DONs reach the role in their 12th to 15th year of nursing practice.

Do you need an MSN to become a director of nursing?

A BSN is the technical minimum at most facilities, but an MSN is required or strongly preferred for acute care DON roles in most markets. Long-term care is less stringent – BSN-prepared DONs with strong LTC experience can access a broader range of positions in that setting. If you are on a hospital DON track, treat the MSN as mandatory.

Is the director of nursing role clinical or administrative?

Both – but the balance shifts toward administrative at the DON level. You are responsible for clinical quality across the department, which requires clinical judgment and credibility. The day-to-day work, however, is primarily managerial: budgets, staffing models, manager performance, regulatory compliance, and strategy. DONs who try to stay primarily at the bedside typically struggle with the administrative load.

Can a nurse manager become a DON without an MSN?

In acute care, rarely. In long-term care, more commonly – especially at smaller SNFs or rural facilities where the pool of MSN-prepared candidates is thin. If you are targeting a hospital DON role, complete your MSN before applying.

What is the difference between a DON and a charge nurse?

The charge nurse is a shift-level coordination role – managing one unit, one shift, with no 24/7 accountability. The DON manages the department permanently, including the charge nurses’ supervisors (nurse managers). The charge role is a stepping stone – most DONs held charge responsibilities early in their careers, but the roles are separated by at least two rungs of the career ladder.

Does the charge nurse salary reflect the DON pathway?

Charge nurses typically earn an hourly differential above their base RN rate – roughly $1–$5 per hour. This is a shift add-on, not management compensation. The meaningful salary step up comes at the nurse manager level, and again at the DON level. For charge nurse pay data, see the charge nurse salary guide.

References

1. U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Medical and Health Services Managers (SOC 11-9111), median annual wage $123,860,” May 2025 (released 15 May 2026). https://www.bls.gov/oes/current/oes119111.htm
2. National O*NET Consortium, “Medical and Health Services Managers (11-9111.00) national and state wage tables,” O*NET OnLine, sponsored by the U.S. Department of Labor, Employment and Training Administration, 2026. https://www.onetonline.org/link/summary/11-9111.00
3. U.S. Bureau of Labor Statistics, “Medical and Health Services Managers,” Occupational Outlook Handbook, Employment Projections 2024–2034. https://www.bls.gov/ooh/management/medical-and-health-services-managers.htm
4. American Nurses Credentialing Center (ANCC), “Nurse Executive Certification (NE-BC),” nursingworld.org, 2026. https://www.nursingworld.org/our-certifications/nurse-executive/
5. American Nurses Credentialing Center (ANCC), “Nurse Executive, Advanced Certification (NEA-BC),” nursingworld.org, 2026. https://www.nursingworld.org/our-certifications/nurse-executive-advanced/
6. American Organization for Nursing Leadership (AONL), “CENP Frequently Asked Questions” (eligibility hours, 175-question exam format, 3.5-hour limit, three-year validity), aonl.org, 2026. https://www.aonl.org/initiatives/cenp-faq
7. National Association of Directors of Nursing Administration in Long Term Care (NADONA/LTC), “Courses & Exams: Certified Director of Nursing Administration (CDONA) Exam,” nadona.org, 2026. https://www.nadona.org/learn
8. Electronic Code of Federal Regulations, 42 CFR § 483.35, “Nursing services” (full-time RN director of nursing requirement; charge-nurse restriction at 60 or fewer residents). https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.35
9. American College of Healthcare Executives (ACHE), “Fellow of the American College of Healthcare Executives (FACHE) Credential,” ache.org, 2026. https://www.ache.org/fache