In hospital settings, clinical leadership and workforce management are usually two different jobs. A chief nursing officer sets clinical standards and direction, while a separate scheduling or workforce function handles coverage, recruiting and onboarding. In skilled nursing facilities, those two jobs are merged into one role: the director of nursing.
The DON owns clinical oversight: care plans, clinical standards, regulatory documentation and escalation if a resident's condition changes. The DON also carries the constant pressure of survey readiness. Documentation, care plans, incident follow-up, infection prevention and quality checks all require attention, even when the schedule is changing by the hour.
The same DON is also responsible for the workforce. Although they may not personally handle every schedule change or orientation step, when coverage breaks down, the issue often lands on the DON’s desk because resident care, compliance and team readiness are all connected to the role.
Why the SNF director of nursing role is different
The director of nursing in long-term care is central to both overseeing the nursing workforce and supporting the delivery of resident care, a scope that spans both clinical and operational work.
An integrative review in the Journal of Nursing Management found that the continual demands on the DON for responsibilities outside of nursing is associated with job dissatisfaction and a more transactional, task-driven style of leadership. In other words, the more the role stretches into workforce logistics, the less room there is for the clinical leadership that the title is supposed to represent.
That stretch is not a sign of weakness. It's how the role has become defined in the setting. Hospitals can afford to separate clinical and workforce functions, but most SNFs run leaner, even in their leadership, so the two responsibilities land on the same desk.
How the dual responsibilities can feed burnout
Workforce management is the half of the job that never holds still. Beyond covering open shifts, the DON carries supply and pharmacy budgets, facility structure and the coordination of admissions and discharges. An assistant director of nursing may share the work, but the buck stops with the DON.
All of this competes directly with clinical priorities. Open shifts happen daily. Coverage falls through at the worst moments. Gaps compete with clinical priorities, and when a clinical leader spends hours chasing coverage, the clinical work doesn't pause to wait, it starts to stack up.
Over time, the dual demands can wear a person in the role down. The DON is asked to be fully present clinically and fully responsive operationally, and these competing responsibilities sometimes can pull in opposite directions on the same day.
The review's finding tracks what operators see in practice: a role defined by differing tracks of responsibilities competing for time tends to produce dissatisfaction, and dissatisfaction is the front edge of turnover.
The leadership pipeline problem
To make matters worse, the industry is undergoing shortages and high turnover among directors of nursing. Often there is no succession plan in place when a DON steps away. Because registered nurses are scarce in many SNFs, willing RNs are frequently moved into the DON seat without leadership training, which can set up another round of overload.
Leadership churn across the sector is real, although it's improving. The 2025–2026 Nursing Home Salary & Benefits Report found that broader leadership turnover has improved, but that does not erase all pressure on the DON role. The DON seat remains uniquely exposed because it sits at the intersection of clinical accountability and daily coverage needs.
Taking load off the role, not adding to it
The structural fix isn't asking the DON to do more, faster. It's removing friction – particularly within the workforce-management half – so clinical leaders can lead clinically. The work is not just finding a name for an open shift. It is the calls, texts, confirmations, cancellations, last-minute changes and follow-up that can consume hours needed for clinical leadership.
Operators are approaching this several ways: building internal PRN pools, cross-training charge nurses to share scheduling and using technology platforms to fill open shifts directly rather than working the phones through an outside agency. Each chips away at the administrative burdens that can default to the DON.
When a DON has confidence in coverage, the core of the role shifts back toward clinical delivery and quality: retention of front-line professionals, skills development, mentoring and consistent team communications. That's the half of the job a director of nursing is most trained for, and the half that suffers when coverage concerns take over a day.
Workforce marketplaces can help facilities post open shifts directly to independent licensed professionals, giving teams more visibility into coverage options and reducing the shift-by-shift back-and-forth that often lands on the DON. The goal is not to add another task to the DON’s day. It is to remove manual steps so clinical leaders have more time for clinical leadership.
Sources
"Examining the Director of Nursing Role in Long-Term Care: An Integrative Review," (Journal of Nursing Management, 2023).
"Study identifies best approaches for filling SNF nurse management positions," (McKnight's Long-Term Care News, 2025).
"Nursing Home Turnover Rate Declines as Salaries Rise Slightly in 2025," (Skilled Nursing News, 2025).
