Nurses play a crucial role in administering high-quality patient care; they are active at every level of the health care system, and often serve as the first point of contact between patients and the doctors and institutions that provide care. As America’s population ages, and chronic health concerns become more and more ubiquitous, the need for qualified nursing professionals just keeps growing. Quality nursing depends on effective nurse leadership, provided at larger clinics and facilities by high-level nursing positions such as the director of nursing.

For nurses who desire to have a positive impact on patient outcomes, affect the policies and procedures of their institution, and play an active role in developing the next generation of nurses — the director of nursing role may be a highly rewarding choice.

Nurses who are interested in such consequential leadership positions typically pursue advanced training and education, which helps them develop clinical acumen as well as administrative and managerial abilities. While the steps in how to become a director of nursing usually include earning both bachelor’s and master’s degrees, many prospective nurse leaders go on to pursue a doctoral degree for additional research, policy, and advanced practice expertise.

Before pursuing this position, it’s helpful to have a clear understanding of what it entails. Exactly what is a director of nursing, and how does this position bring value to a health care organization?

Larger health care facilities, including hospitals, will often have a director of nursing to provide guidance and leadership to an entire nursing staff. As such, the director of nursing fulfills both clinical responsibilities and administrative tasks; they work as the lead nurse for the nursing team, which can entail direct patient care, but they also handle managerial responsibilities and tasks related to the nursing staff.

When it comes to clinical responsibilities, the director of nursing is usually a seasoned and experienced caregiver with ample experience attending to patient needs. The director of nursing may be called on to advise in the most sensitive, complicated, or fraught patient care scenarios, supplying guidance to other nurses working on the same case.

As for administrative duties, the director of nursing handles not only day-to-day managerial tasks, including scheduling and budgeting, but also communication and coordination with doctors and other health care leadership. In many health systems, the director of nursing at a particular hospital or facility reports to the chief nursing officer (CNO), who supervises multiple directors of nursing.

To be an effective director of nursing, it’s vital to have experience providing hands-on care to patients. For this reason, directors of nursing begin their careers as registered nurses, or RNs. The director of nursing position is open to nurses from any subspecialty, whether it’s mental health care, women’s health, or emergency room care. With that said, gaining a breadth of experience working on different shifts or in different departments can be especially beneficial.

As for how to become a director of nursing, however, becoming an RN and gaining clinical experience is only the first step. More advanced training, including exposure to leadership principles, research methods, and broader concerns surrounding health policy, is vital. For this reason, RNs who wish to assume director-level positions need to obtain a Master of Science in Nursing (MSN) or higher.

While every director of nursing balances their time between clinical work and administrative functions, the specific day-to-day duties and responsibilities can vary from one hospital or health system to the next. With that said, most directors of nursing add value to their organizations and make a positive impact in the lives of patients through some of the following activities.

What does a director of nursing do from day to day? Common duties include:

• Supervising a team or department of nurses and other medical personnel, ensuring the highest standards of quality, safety, and efficiency in patient care
• Building a qualified nursing team by recruiting, interviewing, and hiring new nurses, and by providing ongoing opportunities for professional development and training
• Terminating nurses or other medical personnel as needed
• Creating and managing nursing schedules, ensuring patient needs are covered while also monitoring nurse workloads and burnout levels
• Ensuring all nursing programs and policies are in full compliance with local, state, and federal regulations
• Advising the nursing staff on difficult, complicated, or sensitive patient care issues, drawing from their own experience in direct clinical care
• Completing any auditing or reporting requirements in a timely manner
• Developing both short- and long-term goals for the nursing department, and communicating them to all nursing personnel
• Carefully maintaining the nursing department’s budget and documenting expenses
• Responding to any issues or problems related to nursing in a timely manner
• Coordinating with physicians and administrators to ensure the most efficient standards of patient care

By gaining clinical experience and pursuing advanced education, aspiring directors of nursing can cultivate the skills required for success in this nurse leadership position. Some of the most vital competencies for a director of nursing include the following.

• Clinical acumen. Because director-level nurses are brought in to consult on challenging cases, it’s necessary they be able to draw from a deep well of hands-on clinical experience, preferably encompassing a breadth of nursing departments and shifts.
• Not only must nurses be able to clearly communicate policies, procedures, and goals with their team members, but they must also be effective in collaborating with physicians and other leaders.
• Organizational skills are vital, as directors of nursing are often tasked with maintaining records, with documenting nurse performance issues, and with maintaining legal compliance for the entire nursing staff.
• The director of nursing has to be gifted in building and motivating their team and in balancing the workloads of a very large staff.
• Empathy is a core virtue for any nurse leader, as a crucial part of the job is emphasizing a focus on patient advocacy and quality of care.

Honing these core skills can be an essential step in how to become a director of nursing. Ultimately, the director-level position is a great choice for any nurse who has robust clinical skills but also wishes to transition into a more leadership-oriented role.

Aspiring directors of nursing must complete a number of steps. While the specific career trajectory may look a little different from one nurse leader to the next, here’s a basic overview of the pathway to become a director of nursing.

Before landing a position as a director of nursing, it’s first necessary to work as an RN. This means obtaining an undergraduate nursing degree; this can be a two-year associate degree, but most of the time it will be a four-year Bachelor of Science in Nursing (BSN) degree. Earning a nursing degree from an accredited university is necessary to begin a career as an RN. Moreover, it furnishes the basic clinical skills to make a positive impact on the lives of patients throughout any nursing career.

While earning a degree is an important step toward becoming an RN, graduates do not automatically become RNs. Aspiring RNs must also obtain a license, and that means completing the National Council Licensure Examination-Registered Nurse (NCLEX-RN). To take this exam, nursing students must pay a small registration fee, schedule their examination at a local testing site, and then complete the exam questions, which may cover basic concepts related to patient care, regulations, procedures, and ethics. Upon successful completion of the exam, nursing students may attain a license to practice nursing within their state.

To be effective as a director of nursing, it’s essential to have familiarity with day-to-day clinical care. This helps build rapport and earn respect among nursing personnel, and also provides the expertise to consult on difficult patient situations. Most director of nursing positions require at least two years of basic RN experience, though this can vary from one position to the next. Working in a variety of nursing roles, taking on various shifts, and working in several departments can be an essential way to hone clinical care skills and build a greater appreciation of the full breadth of the nursing profession.

Director of nursing positions almost always require an advanced degree. This may be a Master of Science in Nursing (MSN) or a more advanced nursing degree, such as a Doctorate of Nursing Practice (DNP). Alternatively, it may be a Master of Business Administration (MBA) focused on health care, or a comparable degree that combines business, leadership, and health. An MSN or other advanced degree can supply the essential administrative and leadership skills for high-level nurse management, but an even more advanced degree (like the DNP) may provide additional expertise in research and health care policy, and lead to more competitive salaries.

Most director of nursing positions does not require certification. With that said, pursuing certification can be important. It can help distinguish oneself from the competition and potentially make it easier to obtain more prestigious nurse leadership roles or a higher director of nursing salary.

Some of the most common certifications for nurse leaders include the American Nurses Credentialing Center's Nurse Executive Certification (NE-BC) or Nurse Executive Advanced Certification (NEA-BC); the National Association of Directors of Nursing Administration in Long Term Care's Certified Director of Nursing (CDON); and the American Association of Directors of Nursing Services' Director of Nursing Services-Certified (DNS-CT).

The director of nursing position is one of the most high-level nurse leadership roles, and often involves managing and directing a fairly large nursing staff. Potential employers may look more favorably on candidates who bring some managerial experience, such as nurses who have worked in nurse management or as shift leaders and then moved up to greater levels of responsibility.

While the typical director of nursing salary will certainly be enticing to RNs interested in career development, nursing professionals seek out leadership positions like this for many broader reasons.

Many RNs devote their days to performing direct patient care, while most health administrators do little or no time on the clinical floor. The director of nursing position is unique for the way it combines patient care and administration, making it an excellent option for any nurse who wishes to transition into management while still maintaining some patient care responsibilities.

Most nurses choose their vocation because they want to make a direct, positive impact on the lives of patients. Both through consulting on tough cases and through inspiring their staff of nursing personnel, directors of nursing can generate real quality-of-life improvements for patients, ranging from quality of care, to disease prevention, to improving access and efficiency in the health care system.

Another reason to consider the director of nursing position is that it allows opportunities to shape policies and procedures at the departmental or institutional level, which can result in greater standards of quality, safety, and efficiency. In addition to improving patient outcomes, the role can impact the professional experience and career development of the nursing staff — and impact the progress of the nursing profession itself.

Statistics show the health care sector currently faces a deficit of qualified nurses; in particular, there is high demand for nurses with advanced training. Skilled nursing directors can be especially valuable for how they improve morale among the nursing staff, helping lower rates of fatigue and burnout. For these reasons and many others, both the director of nursing salary range and job outlook are promising.

According to November 2022 data from the compensation website Payscale, the median annual salary for a director of nursing is around $93,900. Data from the U.S. Bureau of Labor Statistics (BLS) shows the median annual salary for medical and health service managers is $101,340. A number of factors can affect the director of nursing salary range, including level of education, years of experience, and geographic location.

The same BLS data shows the job outlook for medical service managers, including directors of nursing, is projected to grow 28% between 2021 and 2031. This is much faster than the average for all professions and can be attributed to factors including the overall shortage of qualified nurses in many parts of the country.

Nurses do invaluable work within our health care system. Nurse leaders, in particular, are called on to develop innovative solutions that improve patient care while minimizing fatigue, burnout, and other professional challenges among nursing personnel. For nurses who are drawn to this kind of high-level leadership position, the director of nursing position may be incredibly rewarding.

Pursuing an advanced degree is an essential step in how to become a director of nursing. Future nursing leaders would do well to explore Hawai’i Pacific University’s online Bachelor of Science in Nursing to Doctor of Nursing Practice program, which provides a robust curriculum that carefully balances clinical savvy, leadership, and administration.

Learn more about your next step toward long-term success as a nurse leader.