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An Interview With A Director Of Nursing

“NurseExec” is the director of nursing (DON) at a 120-bed skilled nursing facility (SNF) that has a 50/50 mix of patients needing short-term rehab and long-term care.

After working in the OR as a circulator nurse, she started out as a charge nurse in her current building, which entailed pushing a med cart and taking care of 20 patients. After nine months, she was promoted to Risk Manager and three years later became the DON.

She starts her day at 7am by rounding on nursing units, consulting with unit managers on clinical issues, and dealing with grievances and employee issues. She checks in with the charge nurses and certified nursing assistants (CNAs), checks shower rooms and utility rooms. Then it’s off to Morning Standup with department heads, followed by clinical rounds with the interdisciplinary team to discuss new admissions, new orders, and a report for the last 24 hours. Most days this is all followed with other meetings, lasting until 11am or so.

The afternoon is filled with reports, employee issues, clinical and education issues, pharmacy issues, and another rounding of patients. She typically ends her day at 4pm.

What do you like about your job?

Every day is a different set of challenges. I have great benefits and a wonderful team to work with.

What frustrates you about your job?

People who know the right thing to do, yet don’t do it. Makes me crazy!

What about your job makes you proud to be a nurse?

Meeting with residents, and hearing them say, “So-and-so is a great nurse, I love being here.” That makes me not only proud to be a nurse, but proud of the staff member.

Do you feel you receive adequate support for your responsibilities?

I have a wonderful administrator who has been here as long as I have. She and I are a great team and we think alike.

What is something a nurse who does not work in your particular field might find surprising about your job?

Skilled nursing facilities (SNFs) are more regulated than any other industry (including hospitals) except nuclear power. We have approximately 530 rules that we must adhere to on any given day, and that doesn’t include the state ones. My first state survey was an eye opener, that’s for sure.

Are you salaried or paid by the hour?

Salaried, with a clinical performance bonus. Some days I come in early to catch the night shift, and some days I come in later to spend time with the 3pm-11pm shift.

As the DON, does the buck stop with you? Do you get called often on your off-hours to deal with situations?

Yes, the buck does stop with me. It’s my license hanging on the wall, literally. I have very competent unit managers and shift supervisors, but there are some things they need to call about. I usually get a call every other day or so, including weekends.

Do you find that you can accomplish everything you need to do within the hours set for your position?

Some days are better than others.

Does what you do involve a lot of teamwork, or is it more of an individual job?

It’s more individual, with a lot of delegating and having the team follow up and get back to me on certain issues.

Was there any extra training besides on-the-job learning that you were required to complete for this job?

It was strictly on the job for me.

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom. Do you find that to be the case with your job as well?

Meetings on top of meetings get me. I finally just excuse myself.

(I’m sensing a trend here.)

Thank you to NurseExec for her great answers. If you are or know of a nurse who doesn’t have a traditional bedside job, email me at

*This blog post was originally published at code blog - tales of a nurse*

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