Trying to understand Director of Nursing turn over rate


Becoming a Director of Nursing was something I have always wanted to do. I wanted to make things better for ..Fisrt- the residents, staff, facility and every person who cared for the elderly. I don’t judge anyone, I first put myself in that persons shoes. I work hard and will even volunteer to work as nursing assistant when they are short. I believe in seeing the good in people and giving positive feedback to everyone even before I have to pull them aside for corrective action. As director you are the role model not a dictator. You get respect by showing respect. I turned a facility around to nurses feeling appreciated and respected. Nursing assistants started pulling together to make it better. But you must and I mean MUST have leaders above you that support you and embrace your efforts. As I moved into another DON job the turn over rate was astonishing to me. Prior to me the first facility had 5 DON’s, the second had 2 DON’s lasting 2 months. Jobs I interviewed at that offered the job but I took the best one that would fi. Those jobs I turned down also had the DON job re-posted after several months. I know this job is very stressful, tons of responsibility but it’s an opportunity to actually make a difference.

One thing I’ve learned if there is one person above or even your assistant that just does not like you, your struggle is real. I have been yelled at completely inappropriate in front of department heads in IDT.. meetings because I tried to speak up- to do the right thing. We are nurses for one reason and that’s our residents/patients. It’s not about us!


17 Posts

20+ "I's"


Specializes in Director of Nursing. Has 26 years experience.

It’s called broken finger trying to type, lol

Hoosier_RN, MSN

3,711 Posts

Specializes in dialysis. Has 30 years experience.

I've been a DON before. Every time, my upper management threw me to the wolves. I had turned things around, but a couple of the aides decided that they didn't like not being able to text or take personal calls in patient rooms. Or watching tv in empty rooms. Oh, the horror of being expected to work for a paycheck. I left, they got an under 30 lady who let's the staff run wild. Upper management can't understand why the facility has a bad reputation again, because the new DON is just so nice, staff loves her, etc...

119 Posts

Specializes in corrections and LTC. Has 25 years experience.

I have been a DON and an administrator. There is not enough money in the world to be a DON again. That is a position that nobody appreciates, who gets all the dirty work that nobody else wants to do and way too much of it. All you hear all day long is complaints whether it is about care, the schedule, the other employees, smoking, phones, the way someone talked to or fed a resident, etc. It is truly a thankless job and though I have seen a couple of DONs thrive in that job, most fail quickly through their own frustration or the corporation using them as the sacrificial lamb. A Unit Manager is still a thankless job but at least you aren't the DON. I absolutely love LTC but would only be a staff nurse or work MDS. If any LTC DON's read this and love their job then I give kudos to them as they are few and far between. I think DON is one of the hardest jobs there are - I wouldn't be a DON in any type of facility.

I too have been both an Administrator and DON ~ for me the position of Administrator was to support my DON and all employees in whatever was reasonable. They (DONs) make the world go around and if you have a good one you are truly blessed! Seems like both of those positions were sacrificial lambs if anything went south ~ If you let your employees know that they are valued and that you also have certain expectations of them the day to day operation is soooo much smoother. God bless all of you for taking care of our residents ~ it's not as easy as some people think it is ?


42 Posts

Has 6 years experience.

Being a DON is like being on fire and when you finally find your extinguisher you spray it on yourself but it shoots out oil. This is why there is high turnover rates for DON's. For real though it is all about the environment that you are in. It's unfair to say but I'm going to say it anyway- you will notice a big difference between for profit and not for profit facilities.

Hoosier_RN, MSN

3,711 Posts

Specializes in dialysis. Has 30 years experience.
On 4/9/2020 at 12:03 AM, buckchaser10 said:

Being a DON is like being on fire and when you finally find your extinguisher you spray it on yourself but it shoots out oil. This is why there is high turnover rates for DON's. For real though it is all about the environment that you are in. It's unfair to say but I'm going to say it anyway- you will notice a big difference between for profit and not for profit facilities.

That is the straight up truth!

Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr. Has 15 years experience.

Hoosier hit the nail on the head. A lack of support from a higher up or higher ups is major contributing factor to high turnover rates among management. It does not matter if you are a DON or ADON in LTC or a middle nurse manager in an acute care facility. If a management team is not a team and a manager has no support from their upper leadership, then there will be a high turnover rate. Thus, I am weary of any position or facility that has a high turnover rate of managers.

On the other hand, it is possible to join a good team who had a high turnover rate. For example, I am currently in a position that had a high turnover rate due to poor behaviors and poor performances from senior and executive leadership toward frontline nurse mangers and middle nurse managers.

However, I did my homework prior to accepting this position. I talked to people I know who work in the facility (both nurses and managers) prior to interviewing. Plus, when I interviewed I discussed what I knew of the reputation of the facility and the turnover rate of nurse managers. I also explained my expectations on the type of supports I wanted if I were to accept the position.

I am pleased to report that my efforts are being rewarded. I am now apart of a good leadership team and our rate of turnover has dropped in the past 6 months. My peers have informed me that the replacement of the last senior and executive leadership team has made the real difference.


7,735 Posts

Specializes in retired LTC.

A odd peculiarity I noticed was that facilities with freq DON turnovers also often had turnover issues with other top dept heads, like the Soc Wrkr, Admission Dir, Therapy Dir, etc. If there were simultaneous vacancies in those depts, I suspected the facility was like 'septic' on the inside. And esp critical if there were multiple openings. Made me wonder if they just had a bad survey and Corp was 'cleaning house'.

This also happened whenever there was a corporate buyout/merger - like the 'out with the old, and in with the new'. Newly opened facilities were also at risk of instabilities - it takes times to find the 'right' combination of dept heads to work together.

Also, if there were odd duos - like the Admin & Hskpg Dir, or Maint Dir & UMgr of the 'care/skilled unit. They were like 'best buds' or 'power combos' - hard to argue with. Those duos often eroded the DON's role.

Like PPs here have commented, DONs must be supported with supportive team members from above, on par, within, and below their positions. Without that support, success will not be achievable, even when the DON could do so under other circumstances.

Not a job I ever wanted!


1 Post

Specializes in LTC. Has 28 years experience.

Long Term Care has evolved into this unrelenting MONSTER (imho)!  Long gone are the sweet little old ladies living out their last years at a well staffed quiet "rest home."  The residents are younger and more difficult, sicker and needing more by way of ADL assist, dressing changes, IVs, respiratory needs or attention; and this is being asked of us - the few of us that have remained.  Facilities are short staffed which is a haven for unhappy nurses and staff, so to be in charge is simply too much- or at least it was for me.  If a nurse doesn't show up for a shift, or a resident to resident situation comes up, or a traumatic event occurs - you are called upon at all odd hours of the day or night to find a solution or BE the solution.  And that's on top of the constant heavy weight of corporate leaning on you to do whatever new idea is trending for the facilities that are "Best in Class" -all while increasing your census. CENSUS!! When you don't have the staff to take care of what you already have.  You are it when it comes to dealing with angry docs, angry family members, angry staff and angry residents.  Sure you have your 'support' staff but the one's on my team were sort of involved with "their own work" because the work has become so overwhelming its a coin toss as to whether or not it will even get done.  It's sort of every man for themself ya know? So you show up day in / day out and take care of everyone / everything. And you BUST your BUTT to tidy up all the loose ends and get all the work done for your annual survey - Every year. And sure there will be some years where you are rocking it out but what I've learned is that it is all a game.  If you have a stellar year one year they will be coming after you soon enough.  I speak from experience and it is still a bit of a sore spot for me.  We worked so hard to keep our residents well during the pandemic and I was so proud of the team for really hanging in there and keeping the virus at bay and managing all the difficulties that came with it so well.  So when those surveyors came in and slapped us with an IJ for confusion over a Quarantine sign I was beside myself - and I haven't been the same since.  That's when I gave my DON position up - and had to take a mental health leave. I mean who wants all of that crap for most often, much less money than what your floor staff is making because you are a salaried employee? All of it out weighs any perks that are few and far between.  Too many good DONs and nurses in general are walking away from Long Term Care because of similar situations to what I've written above no doubt and it's sad to see but who has time to look up and truly see it happening?  Im so much happier on  the floor - when I bust my tail I get compensated for it and when I leave I get to leave the worst of my day at the door.  To be a DON just isn't worth it.