Director of Nursing Services (DON)

Department: Nursing/Clinical Services

Summary: Under the direction of the President (CEO), the Director of Nursing Services (DON) is responsible for providing overall clinical leadership, direction, supervision, and oversight of nursing services for the agency’s Personal Care Services (PCS) and Skilled Home Health Care programs. The DON ensures that clinical services are delivered safely, effectively, ethically, and in accordance with applicable federal and state regulations, payer requirements, professional standards, accreditation requirements, and agency policies and procedures. The DON oversees clinical operations, staffing, quality assurance, regulatory compliance, care planning, clinical documentation, incident management, infection prevention, and interdisciplinary coordination to promote positive client outcomes and maintain high-quality, client-centered care.

Education and Work Experience:

❖ Current, unrestricted Registered Nurse (RN) license in the state(s) where services are provided.

❖ Bachelor’s degree in nursing (BSN) preferred; equivalent education and experience may be considered based on applicable requirements.

❖ Significant clinical nursing experience.

❖ Previous supervisory or nursing leadership experience.

❖ Experience with home health care services strongly preferred.

❖ Strong knowledge of nursing standards, care planning, documentation, quality improvement, and regulatory compliance.

❖ Strong leadership, communication, organization, and problem-solving skills.

❖ Ability to manage multiple priorities in a fast-paced environment.

❖Ability to work independently while maintaining effective communication with the interdisciplinary team.

Nature & Scope – Principal Areas of Responsibilities: (This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as management may deem necessary from time to time.)

❖  Provides overall leadership and direction to the Nursing Department.

❖ Establishes and maintains clinical standards for Personal Care Services and Skilled Home Health Care services.

❖ Ensures nursing services are delivered in accordance with authorized care plans, physician orders, individualized service plans, and applicable regulatory requirements.

❖ Provides clinical guidance to Registered Nurses (RNs), Licensed Practical Nurses (LPNs/LVNs), Personal Care Workers (PCWs), and other care team members within their respective scopes of practice.

❖ Reviews complex or high-risk cases and determines appropriate clinical interventions and escalation.

❖ Promotes a culture of safety, accountability, professionalism, and client-centered care.

❖ Oversees RN assessments, reassessments, supervisory visits, and other required nursing encounters.

❖ Ensures assessments accurately reflect client needs, diagnoses, functional limitations, risks, and service requirements.

❖ Monitors Personal Care Worker performance, attendance, competency, training, and compliance with assigned duties.

❖ Reviews concerns involving caregiver performance, client complaints, attendance issues, and service delivery concerns.

❖ Ensures timely follow-up regarding client condition changes and service needs.

❖ Monitors high-risk clients and coordinates interventions as necessary.

❖ Collaborates with Outreach, Care Management, Scheduling, and other departments regarding service needs and caregiver availability.

❖ Oversees skilled nursing services provided in the home environment.

❖ Ensures services are delivered according to physician/provider orders and established Plans of Care.

❖ Reviews and oversees comprehensive assessments, reassessments, and individualized Plans of Care.

❖ Monitors skilled nursing interventions, client outcomes, medication-related services, wound care, disease management, infection prevention, catheter care, injections, and other skilled services.

❖ Ensures timely communication with physicians, advanced practice providers, therapists, social workers, and other healthcare professionals.

❖ Oversees recertification, discharge planning, and transition-of-care processes.

❖ Establishes standards for comprehensive nursing assessments and care planning.

❖ Reviews assessments and care plans for accuracy, completeness, clinical appropriateness, and regulatory compliance.

❖ Ensures documentation supports medical necessity, functional need, and services provided.

❖ Identifies discrepancies in assessments, care plans, physician orders, and service delivery and ensures corrective action is taken.

❖ Collaborates with Quality Assurance staff to develop, implement, and monitor quality improvement initiatives.

❖ Reviews incidents, complaints, adverse events, hospitalizations, falls, infections, medication errors, and quality concerns.

❖ Participates in root-cause analyses and corrective action planning.

❖ Develops and monitors nursing quality indicators and performance metrics.

❖ Provides clinical oversight of significant incidents involving clients or staff.

❖ Ensures incidents are appropriately documented, investigated, escalated, and followed up on.

❖ Participates in emergency preparedness and response activities.

❖ Oversees infection prevention and control activities and programs.

❖ Ensures staff receive appropriate infection prevention education and training.

❖ Monitors infection trends and implements interventions when necessary.

❖ Ensures compliance with infection prevention regulations, standards, and agency policies.

❖ Recruits, interviews, orients, trains, supervises, and evaluates nursing
personnel in collaboration with Human Resources and agency leadership.

❖ Establishes appropriate staffing levels based on client needs and service volume.

❖ Ensures nursing staff maintain required licenses, certifications, competencies, and training requirements.

❖Coordinates orientation programs, competency validations, and continuing education initiatives.

❖ Addresses performance concerns and implements corrective action when necessary.

❖ Promotes professional development, staff retention, and succession planning.

❖ Ensures staff receive education regarding documentation requirements, abuse and neglect prevention, infection prevention, emergency procedures, client rights, incident reporting, and changes in client condition.

❖ Maintains knowledge of applicable Medicaid, Medicare, CMS, OSHA, HIPAA, state licensing, accreditation, payer, and agency requirements.

❖ Assists with surveys, audits, accreditation reviews, corrective action plans, and regulatory inquiries.

❖ Ensures nursing documentation is timely, accurate, complete, objective, and clinically appropriate.

❖ Monitors documentation within the agency’s electronic medical record systems.

❖ Reviews documentation for deficiencies, inconsistencies, and compliance concerns and provides corrective guidance.

❖ Protects confidential client information and ensures compliance with privacy requirements.

❖Facilitates communication among clients, families, physicians, care managers, MCO representatives, nursing staff, scheduling personnel, Outreach staff, Human Resources, Quality Assurance personnel, hospitals, facilities, and other service providers.

❖ Promotes continuity of care and timely communication regarding client condition changes and service needs.

❖ Promotes respect for client dignity, autonomy, privacy, and preferences.

❖ Ensures clients receive care free from discrimination.

❖ Addresses clinical complaints and concerns appropriately.

❖ Identifies and escalates suspected abuse, neglect, exploitation, or unsafe living conditions.

❖ Participates in agency leadership meetings.

❖ Assists with the development and implementation of nursing policies and procedures.

❖ Establishes departmental goals, performance expectations, and operational priorities.

❖ Participates in budgeting, resource planning, strategic planning, and service-line development.

❖ Evaluates clinical workflows and recommends process improvements.

❖ Maintains effective communication with agency leadership.

Knowledge/Special Skills/Abilities Needed:

❖ Strong clinical assessment and critical-thinking skills.

❖ Knowledge of home health care, personal care services, and community-based healthcare operations.

❖ Knowledge of Medicaid, Medicare, managed care organizations (MCOs), CMS requirements, and state regulations.

❖ Ability to lead interdisciplinary teams and manage clinical operations.

❖ Strong written, verbal, and interpersonal communication skills.

❖ Ability to maintain confidentiality and professionalism.

❖ Strong organizational, time-management, and problem-solving skills.

❖ Proficiency with electronic medical records and Microsoft Office applications.

❖ Ability to work independently and exercise sound judgment.

Essential Functions:

Physical Demands: Approximately 70% sitting, 20% standing/walking, and 10% travel between office locations, client homes, meetings, and community settings. Occasional bending, stooping, reaching, lifting, and carrying up to 25 pounds may be required. Specific vision abilities include close vision, distance vision, and the ability to adjust focus.

Work Environment: This position is performed in a combination of office, client home, healthcare facility, and community-based environments. The incumbent may be exposed to communicable diseases, environmental hazards, and varying client home conditions. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.