Director of Nursing
Job Description
Turn Challenge Into Career-Defining Achievement
Director of Nursing Skilled Nursing Facility Turnaround Opportunity
Spokane, Washington
For Leaders Who Thrive When the Stakes Are Highest
Some nursing leaders prefer smooth operations and stable environments. Others come alive when faced with significant challenges—where their regulatory expertise, clinical knowledge, and leadership capability can create transformational change.
If you're the latter—a seasoned DON with deep regulatory knowledge and proven turnaround experience—this opportunity in Spokane deserves your attention.
A skilled nursing facility with hospital referral relationships is seeking an exceptional Director of Nursing who can lead comprehensive regulatory improvement, strengthen clinical systems, and rebuild nursing operations from the ground up. This isn't a maintenance role. This is a complete turnaround requiring someone with the expertise, stamina, and determination to drive meaningful change.
The Reality: What You're Walking Into
Let's be direct about the situation:
Regulatory Challenges Are Significant
Current CMS rating is 1 star overall. Recent surveys have resulted in substantial deficiency counts well above state averages across multiple areas of clinical care and nursing operations. This community needs someone who knows regulations inside and out and can systematically address compliance gaps.
Clinical Systems Need Rebuilding
Multiple survey cycles with recurring deficiency patterns indicate systemic issues, not isolated incidents. You'll need to rebuild clinical processes, strengthen nursing documentation, implement evidence-based protocols, and create sustainable systems that prevent recurrence.
This Is Not for Everyone
If you're seeking a stable, low-stress environment, this isn't it. If you need perfect conditions before you can succeed, this isn't it. This role demands a leader who can assess broken systems, develop corrective strategies, and execute relentless follow-through under pressure.
Why This Opportunity Matters
Supportive Ownership Committed to Long-Term Success
The ownership group understands the complexity of regulatory turnaround and is committed to providing the support, resources, and time needed for sustainable improvement. They will not terminate leadership for lack of immediate turnaround—they recognize that meaningful change takes time and are looking for a partner who can execute a strategic, systematic improvement plan. This is about building something that lasts, not quick fixes that fail.
Above-Market Compensation Reflecting Required Expertise
Ownership recognizes they need the right person with the right skillset to make a long-term commitment to this turnaround. Compensation is deliberately set above market averages to attract and retain an experienced turnaround DON with proven regulatory expertise. They understand that exceptional challenges require exceptional talent—and they're willing to invest accordingly.
Career-Defining Impact Potential
Successfully turning around a 1-star community to regulatory compliance and quality care delivery is the kind of achievement that defines a nursing leader's career. This is where reputations are built and leadership credentials are earned.
Regulatory Expertise Is Your Competitive Advantage
If you have deep knowledge of CMS regulations, survey processes, and compliance systems, you'll have exactly what this community needs most. Your expertise becomes immediately valuable and visible.
Hospital Referral Relationships Provide Foundation
Strong referral relationships with major Spokane hospitals (Providence and Deaconess Sacred Heart) provide steady admission pipeline. Clinical excellence can strengthen these partnerships and support census stability.
Payor Mix Supports Sustainability
Census composition (80% Medicaid, 13% private pay, 8% Medicare) reflects typical skilled nursing operations and provides financial foundation for improvement investments.
Spokane Location Offers Quality of Life
Work in Spokane—a growing city offering Pacific Northwest lifestyle, outdoor recreation, cultural amenities, and lower cost of living than Seattle or Portland markets, while maintaining professional opportunity and urban conveniences.
What You'll Lead
Comprehensive Regulatory Turnaround
- Conduct thorough operational assessment identifying all compliance gaps and systemic issues
- Develop and implement systematic plan of correction for recurring deficiency patterns
- Rebuild nursing systems addressing clinical care gaps across multiple operational areas
- Prepare community for next survey cycle with proactive compliance management
- Create sustainable monitoring systems that maintain compliance long-term
Clinical Systems Rebuilding
- Evaluate and redesign nursing workflows, documentation, and care delivery processes
- Implement evidence-based clinical protocols that meet regulatory standards
- Strengthen care planning processes to accurately reflect resident needs and interventions
- Develop quality assurance systems that identify issues before they become deficiencies
- Build clinical competency across nursing staff through targeted education and training
Quality & Safety Culture Change
- Address recurring deficiency patterns through comprehensive root cause analysis
- Implement clinical systems that ensure safety, quality, and compliance
- Build culture of accountability, quality, and compliance across nursing team
- Establish daily monitoring processes that catch and correct issues immediately
- Drive behavior change that makes quality and safety non-negotiable
Staff Development & Performance Management
- Assess current nursing staff capabilities and competencies
- Recruit additional nursing leadership and staff as needed to support turnaround
- Provide intensive training on regulatory requirements and clinical best practices
- Hold staff accountable to standards through clear expectations and consequences
- Build nursing team that can sustain improvements after initial turnaround phase
Survey Readiness & Compliance
- Maintain constant survey-ready posture knowing state could return at any time
- Conduct regular mock surveys identifying and addressing deficiencies proactively
- Ensure nursing documentation meets regulatory standards consistently
- Lead nursing preparation for follow-up surveys and complaint investigations
- Partner with administrator and corporate leadership on compliance strategy
Administrator & Corporate Partnership
- Work closely with administrator on operational priorities and improvement plans
- Provide transparent communication about progress, challenges, and needs
- Participate in strategic decisions affecting community operations
- Execute on corporate compliance initiatives and quality improvement programs
- Be available beyond traditional hours when turnaround demands require
Who Succeeds in This Role
You Must Bring:
✓ RN License – Active, unrestricted Washington RN license (or eligible to obtain)
✓ Regulatory Expertise – Deep knowledge of CMS regulations, survey processes, and compliance systems
✓ DON Experience – Proven leadership experience as DON in skilled nursing facilities
✓ Turnaround Track Record – Demonstrated success improving survey performance and regulatory compliance
✓ Crisis Leadership – Ability to lead effectively under pressure with incomplete information
✓ Implementation Strength – Capability to design systems, implement changes, and drive follow-through
✓ Resilience – Stamina to sustain improvement efforts over extended period
What Sets You Apart:
- Multiple Turnaround Experience – You've successfully improved 1-2 star communities before
- Survey Expertise – You understand survey process, deficiency citations, and plans of correction intimately
- Clinical Systems Knowledge – Experience building comprehensive clinical protocols and care delivery systems
- Change Management Skills – Ability to drive culture change and behavior modification
- High-Pressure Performance – You remain calm, focused, and effective during crisis situations
- Quality Improvement Methodology – Knowledge of root cause analysis, PDSA cycles, and systematic improvement
- Staff Development Focus – Experience rebuilding nursing teams and developing competencies
What This Role Demands
Unwavering Regulatory Focus
Every decision, every system, every process must be evaluated through the lens of regulatory compliance. You cannot afford to miss anything or assume issues will resolve themselves.
Relentless Execution
Plans mean nothing without implementation. You must have the discipline to follow through on every initiative, monitor every metric, and address every gap—day after day, week after week.
Strategic Patience with Operational Urgency
While ownership understands that sustainable turnaround takes time, you must still drive daily operational improvements with urgency. Balance long-term strategic planning with immediate tactical execution.
Stamina and Resilience
Turnarounds are exhausting. You'll face resistance, setbacks, and survey pressure. You need the personal resilience to sustain effort over the long term without burning out.
Systematic Problem-Solving
You must be able to analyze complex problems, identify root causes, design effective interventions, and measure results. Reactive firefighting won't fix systemic issues.
Transparency and Humility
You'll need to acknowledge what's broken, ask for help when needed, and report honest progress—even when news isn't good. Ownership values transparency and will support you through the journey.
What We Offer in Return
Premium Compensation for Turnaround Expertise
Above-market compensation that recognizes the specialized skillset and long-term commitment required Ownership understands that exceptional challenges demand exceptional talent and compensates accordingly Comprehensive benefits package Details shared with qualified candidates
Supportive, Patient Ownership
Leadership understands turnaround complexity and will not terminate for lack of immediate results Commitment to providing time, resources, and support needed for sustainable improvement Partnership approach to long-term success
Career-Defining Opportunity
Successfully turning around this community creates resume credentials and professional reputation that opens doors throughout your career
Corporate Support & Resources
Corporate leadership understands challenges and will provide resources, guidance, and support needed for success Access to tools, training, and expertise to support improvement efforts
Hospital Partnerships
Established referral relationships with major Spokane hospitals provide foundation for census stability and growth
Pacific Northwest Location
Spokane offers outdoor recreation, cultural amenities, four-season climate, and quality of life benefits at lower cost than major West Coast metros
The Reality Check
This role is NOT appropriate for:
- Nursing leaders without turnaround or crisis management experience
- Those seeking stable, low-stress environments
- DONs who need perfect conditions to perform effectively
- Leaders without deep regulatory and compliance knowledge
- Those uncomfortable with high-pressure, high-accountability situations
- Individuals who prefer gradual improvement over urgent transformation
This role IS ideal for:
- Experienced turnaround DONs with proven regulatory improvement track records
- Leaders energized by significant challenges and career-defining opportunities
- Those with deep CMS compliance knowledge and survey expertise
- Nursing leaders who thrive under pressure and deliver results in crisis
- Professionals seeking to build resume with substantial turnaround achievement
- Those who find meaning in transforming struggling operations into quality care environments
- Leaders who value supportive ownership that understands turnaround timelines and complexity
- Seasoned professionals ready to make long-term commitment in exchange for premium compensation
Ready for Your Next Turnaround Challenge?
This is not an easy opportunity. But for the right leader—someone with regulatory expertise, turnaround experience, and the resilience to lead through difficulty—this role offers the chance to create transformational change and build career credentials that last a lifetime.
The ownership group is committed to supporting you through this journey. They understand that meaningful turnaround takes time and are seeking a strategic partner who can execute systematic improvement, not someone looking for a quick exit if results aren't immediate. They're compensating above market rates because they recognize that sustainable turnaround requires the right person with proven expertise making a genuine long-term commitment.
If you're a seasoned DON who knows regulations, has successfully improved survey performance before, and finds purpose in turning challenged communities around, this opportunity offers exactly the kind of meaningful work—and supportive partnership—you've been seeking.
The community needs you. The residents deserve better. If you have what it takes, let's talk.
This community is committed to regulatory improvement, quality care delivery, and systematic transformation under experienced turnaround leadership with supportive, patient ownership.