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have worked with long-term care facilities for 30 years, and I have more respect and appreciation for Directors of Nursing (DONs) than any other discipline. There are so many hats the DON wears 24 hours a day, 7 days a week. He or she is the one discipline that must understand every job of every other discipline in the facility. He or she has to be concerned first about the care of the residents and then involved in many other areas of the operation of the facility.
       Whereas the DON is primarily concerned with the clinical aspects of the resident’s care, he or she has to also be concerned about infection control, which involves all departments; he or she has to be concerned about nutritional status, which also involve dietary; he or she has to be concerned with psychosocial needs, which involve social services and activities; he or she has to be concerned about rehabilitation outcomes, which involve therapy services; he or she has to be concerned about medication regimes and potential adverse reactions, which involve physicians and pharmacists; he or she has to be concerned about the care and services the resident receives, which involve all departments; and last but certainly not least, he or she has to be concerned about the financial success of the facility as impacted by the nursing department, which involves budget, staffing, accounting, and selection of the most cost-effective products and vendors.
       So, how does the DON balance all of these and many more challenges? Unfortunately, many do not and experience frustration that results in personal and physical problems and, quite often, burn out. Most DONs have the expertise to do the job, but many do not practice good business/management skills that help them accomplish all of the above.
       First, the DON must acknowledge that he or she “directs” the nursing department, which does not include “doing” all the jobs that accomplish the results desired from the nursing department. In my experience, I have noticed that most successful DONs have learned how to organize, delegate, and build teams effectively, which are key components of successful management. Certainly, good clinical knowledge is imperative, but management skills are just as important. So, it takes a person who has both clinical and management expertise—or is willing to learn them—to be a successful DON.

Organization

       The DON who effectively organizes his or her day/week/month seems to get more accomplished with less effort. There are many different ways for a DON to get organized. First, you may want to make a list of all the things you feel you must do or are responsible for doing or monitoring. Then, you may want to conduct a time study on your own for a couple of weeks and determine how you are spending your time. It is important to identify those things of importance that you are not accomplishing as well as which tasks are taking up most of your time. You may also identify the person who is taking up most of your time. This is the beginning of how you may attempt to organize your time to better accomplish all that you need to accomplish. (In a future “Director’s Chair” article in ECPN, organizational skills and different methods successful DONs use to be better organized will be discussed.)

Delegation

       When getting organized, DONs have to evaluate their delegation practices and skills. I often see DONs conducting many tasks that could and should be delegated. So, why do we not delegate more? I often hear comments, such as, “If I do it myself, I know its done right,” or, “By the time I teach somebody, I can have it done,” or, “I don’t have time to teach somebody how to do it or to check it.” These are generally poor or unfounded reasons for not delegating. Start by listing all the tasks you do and identifying those that could be delegated. Determine the level of expertise needed to perform the task. Select the persons on staff you feel could perform the task. Be careful and do not always select the same person, as you may overload that person and be guilty of “working a good horse to death.” (In a future “Director’s Chair” article in ECPN, successful delegation and methods DONs use to delegate will be discussed.)

Team Building

       There is no power like team power. Are you a team leader or team member? You need to be both. When all staff pulls together to accomplish agreed-upon goals, the outcomes can be very impressive. What teams can you develop that will provide an opportunity for more staff to participate and also give you the results and monitoring you need? How many weekly or monthly meetings do you now have that can become teams? For example, you most likely have an interdisciplinary team for assessment and care-planning purposes. Do you have fall teams, restraint teams, weight teams, etc.? Or, do you have meetings? Sometimes, just referring to a “team leader” or “team member” can indicate that we work as a team for the good of the resident and facility. (In a future “Director’s Chair” article in ECPN, team building and different methods DONs use to build teams will be discussed.)

Conclusion

       DONs wear many hats and must be knowledgeable in many areas other than clinical expertise. Whereas clinical expertise is important, successful DONs also develop management skills (including, but not limited to, organization, delegation, and team building) that enhance clinical and financial outcomes. Nurses are finally being recognized for their management and business skills in addition to their clinical expertise.