Being a Director of Nursing is like juggling flaming torches while roller skating at full speed. I used to always say, “Damn, I need to wear skates to work” because that’s how fast I was moving, trying to put out fires left and right.
From staffing crises to ever-changing regulations, tight budgets, and trying to keep your team motivated when they’ve clearly had enough, it’s a LOT.
Some days, it feels like you’re carrying the whole operation on your back, and honestly, your back is screaming for a break.
I get it. I’ve lived it. I’ve had those long nights thinking, If I don’t do it, who will? Spoiler alert:
That mindset will leave you burned out and frustrated.
But here’s the good news—you don’t have to carry it all alone.
Over time, I learned that thriving in this role isn’t about doing everything; it’s about doing the right things and building a team that can stand strong with you.
Let’s break down the five biggest headaches DONs face and, more importantly, how to tackle them head-on without losing your sanity—or your love for what you do.
1. Staffing Shortages & High Turnover
We’ve all been there. Just when you think you’ve got enough staff to cover the floor, someone calls out, someone else resigns, and you’re left scrambling—again. Keeping a facility fully staffed feels like trying to fill a bucket with a giant hole at the bottom. It’s draining, frustrating, and let’s be real—downright exhausting.
How to Fix It
Strategic Workforce Planning: Daily staffing meetings aren’t optional—they’re essential. You need to know exactly where you stand every day. No surprises. Track turnover trends so you can predict those rough patches and prepare ahead of time.
Retention Programs: Want to keep your best people? Get to know what matters to them. Sit down with your team members and ask about their goals. Build retention programs around what they actually care about. People stay where they feel valued—simple as that.
Strong Onboarding Process: First impressions matter, and onboarding is your chance to set the tone. Show new hires from day one that you’re invested in their success. Pair them with a mentor or buddy, and make sure someone from your leadership team checks in regularly. When people feel supported, they’re more likely to stick around.
2. Compliance & Regulatory Requirements
Ah, regulations. Just when you think you’ve got everything under control, BAM—a new rule drops, and you’re back to square one. Keeping up with compliance feels like a never-ending game of catch-up, but staying ahead of it is crucial if you want to stay out of trouble.
How to Fix It
Continuous Education & Training: Keep your team in the loop with regular training. The more they know, the better they’ll perform—and the fewer compliance headaches you’ll have.
Compliance Audits & Checklists: Be proactive, not reactive. I swear by checklists—I have one for everything. They help keep you on track. Regular internal audits give you a chance to catch issues before they become full-blown problems. Delegate compliance tasks so you’re not carrying the load alone.
3. Budget Constraints & Resource Allocation
Heavy on the tight budgets. Balancing a budget in long-term care is like trying to make lemonade out of lemons… but guess what? Those damn lemons are dry as hell, so forget the lemonade. You’re left with the harsh reality of trying to make something out of nothing. It’s a constant game of robbing Peter to pay Paul, Patty, and yep—I even had to throw in the twins.
And if that wasn’t enough, we’re not just expected to hire more staff with wages that aren’t adding up—we also have to retain the ones we have. Spoiler alert: They’re over the pizza parties. So… now what?
How to Fix It
Know Your Census: Census drives revenue, period. If you don’t know your census inside and out, you’re already behind. When census is low, expect budget restrictions. Think of it like your personal finances—you can’t spend what you don’t have. Think outside the box on how to increase your admission rate, keeping in mind if you have the staff to care for them.
Needs vs. Wants: Never cut corners on what residents need, but when it comes to extras, be smart. Present a well-thought-out plan to your administrator that shows exactly how a purchase will benefit the facility. Most admins will listen when you back your request with logic.
Evaluate Equipment Rentals: Equipment can quietly drain your budget. Know what’s in your building and whether renting or buying makes more sense. And when a resident using rented equipment leaves, return it ASAP—don’t let unnecessary charges pile up.
Weekly Supply Review: Sit down with your supply person weekly to review orders and spending. Establish PAR levels to keep things consistent and prevent over-ordering.
Cross-Training Staff: 89Cross-training is a lifesaver. When your team knows how to cover multiple roles, call-outs and resignations don’t hit as hard. Plus, cross-training helps employees feel empowered, which boosts retention.
4. Managing & Motivating a Diverse Team
Managing a team full of different personalities, backgrounds, and experiences? That’s where the real challenge lies. One minute, you’re a coach; the next, you’re a counselor. And on some days, you’re just trying to keep everyone from losing it.
How to Fix It
Leadership Training: Strong leaders build strong teams. Invest in leadership training so your managers know how to motivate, communicate, and resolve conflicts effectively.
Promote Inclusion: Create a culture where everyone feels seen and heard. People want to know they matter. When they do, they bring their best to the table.
Set Clear Goals & Recognize Wins: Clarity is key. Let your team know exactly what’s expected of them. And don’t forget to celebrate wins—whether big or small, recognition goes a long way in keeping morale high.
5. Balancing Administrative Duties
Between compliance, staffing, and budget concerns, it’s easy to get buried under paperwork. But you didn’t become a DON to hide behind your desk all day. Your team needs to see you, and your residents need to feel your presence.
How to Fix It
Time Management & Delegation: Multitasking is a myth. Focus on what only you can do, and delegate the rest. But here’s the kicker—you have to equip your team before you delegate. Make sure they have the tools and knowledge they need to succeed.
Rounding: Rounding isn’t optional—it’s essential. You can’t lead from behind a closed door. Get out there. Be visible. Know what’s happening on the floor and let your team know you’re in it with them.
Streamline Processes: Make meetings count. Morning clinicals should be quick and focused on solving problems, not just status updates. Risk meetings? Keep them action-oriented and outcome-driven.
Final Thoughts: Thrive, Don’t Just Survive
Being a Director of Nursing is no joke. It’s tough, but it doesn’t have to leave you feeling drained.
With the right mindset, strategies, and a solid team, you can thrive in this role—and maybe even enjoy it.
Want to go deeper? Join my Thriving Director of Nursing group, where we tackle these challenges head-on. Whether you’re a new DON or a seasoned pro, we’ve got courses and coaching designed to help you grow and lead with confidence.
And remember, as I always say, “But did you follow through?”
Comments