Unlike many other healthcare roles — or even other nurse leadership roles — compensation for DON, or Director of Nursing, roles in California is not always linear.
There are a handful of factors that play into a DON’s salary, including:
- Whether the company is corporate-driven versus facility-driven
- The intersection of building performance and professional track record
- Geography
- Urgency
- Career stability and reputation in the market
With these factors in mind, we have created Full Spectrum’s 2022 California DON Salary Guide:
| Location | Salary | DON Experience (years) | RN Experience (years) | Bed Count |
| Sonoma County | 130,000 | 3 | 9 | 99 beds |
| San Joaquin County | 150,000 | 5 | 20 | 120 beds |
| Santa Clara County | 135,000 | 3 | 28 | 138 beds |
| San Joaquin County | 147,000 | 9 | 22 | 74 beds |
| Los Angeles County | 120,000 | 0 | 15 | 72 beds |
| Los Angeles County | 140,000 | 3 | 20 | 98 beds |
| Los Angeles County | 125,000 | 1 | 18 | 116 beds |
| Orange County | 140,000 | 17 | 20 | 99 beds |
| San Francisco County | 160,000 | 22 | 26 | 140 beds |
| Fresno County | 150,000 | 13 | 18 | 180 beds |
| Los Angeles County | 178,000 | 5 | 12 | 207 beds |
| San Joaquin County | 130,000 | 5 | 10 | 120 beds |
| San Joaquin County | 136,000 | 10 | 19 | 120 beds |
| Los Angeles County | 100,000 | 5 | 19 | 90 beds |
| Orange County | 130,000 | 3 | 16 | 99 beds |
| Los Angeles County | 140,000 | 6 | 14 | 99 beds |
| Alameda County | 150,000 | 22 | 25 | 48 beds |
| Los Angeles County | 160,000 | 8 | 38 | 159 beds |
| Marin County | 165,000 | 9 | 19 | 72 beds |
| Alameda County | 145,000 | 9 | 16 | 83 beds |
Corporate-driven v. facility-driven companies
First, it’s important that we take a step back and recognize the two primary categories of SNF operators in California: corporate-driven and facility-driven.
Corporate-driven companies are defined by multiple aspects:
- Higher corporate headcount relative to portfolio size
- Higher corporate involvement in facility-level decisions
- Corporate approval on salary offerings
- More standardized and moderate company-wide salary trends
- Less autonomy at the facility level
Meanwhile, facility-driven companies feature:
- Lean corporate or regional staff relative to portfolio size
- Site-level decision-making
- Little to no corporate approval needed in the hiring process
- Scattered salary trends across the company
As in many parts of the country, the California Skilled Nursing market possesses both corporate-driven and facility-driven operators. This topic affords its own whitepaper, but, before we can dive into DON salaries, we must unpack the basics of both categories.
Corporate-driven companies
Corporate-driven companies have a robust corporate office with an FTE individual for each department. The corporate team heavily influences the daily operations of each facility in the organization.
This structure can — and usually does — influence the salary allowance for each position at the facility level. From the operator’s perspective, this helps control and predict spending across the portfolio and creates a standardized process for how people are compensated.
Employees typically enjoy market-competitive wages, company-standard bonus plans, and lucrative benefits as a result of the corporate-driven structure.
Facility-driven companies
In a facility-driven environment, things are quite different. Most facilities are operated similarly to your local neighborhood delicatessen: each administrator takes full responsibility for his or her outcomes, controls labor costs, invests dollars strategically, and reaps the benefits of the profit margins.
A DON interacting with one of these facilities has the opportunity to earn a higher salary and more lucrative compensation plan, simply because the administrator sees that individual as an essential change-maker — especially if they are looking to grow their delicatessen into the next Jersey Mike’s.
In short, facility-driven structures allow for companies to make strategic choices based on their local market. For the DON of a facility-driven company, the trade-off for higher, more personalized pay may lie in longer hours and more hands-on training with their nursing team.
Building performance and professional track record
It’s no secret in the SNF business that a fast-paced facility with a high volume of admissions means less patient hospitalization and a profitable environment for the operator. These facilities look for DONs that can maintain and improve on that cadence of ins and outs.
When an administrator is seeking a DON for this type of building, they are looking for a director with experience running a “high-octane” facility — as I call it. They dig for characteristics that lead them to believe the DON candidate will be willing to put in the work required to last at a high-performance facility.
A DON that lands a job at such a facility is often compensated with above market-competitive wages for the sake of maintaining status as a preferred post-acute provider. On the flip side, facilities that historically run a lower skill mix do not have the financial range to pay a lofty wage. They also don’t have the same expectations for admitting high acuity patients.
There’s no right or wrong way, necessarily, for setting acuity and skill mix expectations. Nonetheless, we’ve identified a correlation between building performance and DON compensation.
Geography
Surprisingly, out of all of the factors mentioned that affect DON compensation, geography holds the least weight.
Our team has witnessed DONs in remote California towns receiving higher pay than Santa Clara County. While operators do take location and cost of living into consideration when deciding on compensation, geography has less of an impact than you might expect.
Consequently, a DON role in a metropolitan market can be just as challenging to fill as a role in Jackson, CA, which has a population of 4,571.
Urgency
As a recruiting firm primarily focused on executives in California long-term care, we see urgency as the number one reason companies are willing to pay a fee to find a candidate.
Furthermore, the urgency to fill a role can be a key indicator of what a company is willing to pay. Urgency is rooted in several factors:
- Length of search. When the role has been open for an extended period of time, clinical staff often get weary of not having a leader.
- External pressure. The state might apply pressure or — in the worst case — cite the facility for not having the position filled.
- Detrimental impact. Lack of leadership can cause the facility to miss out on desirable admissions.
- Interim expiration date. The consultant “sitting the building” might need to move on to other corporate projects or is costing the organization too much money.
In short, operators are often willing to pay more to onboard the right candidate in a timely manner to avoid further expenditures.
Reputation & career stability
When it comes to resumes, the more jumping around — 6 months here, 12 months here, 8 months there — the less attractive the profile is to an employer. DONs are no exception.
A Nursing Director that has a stable job history — with a minimum of three years at each employer — coupled with tangible accomplishments like improving survey results, increasing skill mix, and recruiting nurses to minimize registry usage is an exemplary candidate.
At our firm, we see operators eager to pay a higher dollar amount for a candidate that comes with stable work history and accomplishments to support it. They can clearly see the tangible return on their investment.
Most California markets are tight-knit. DON reputations are often well known between companies. Not to mention, most building performance information is public and can be found through CMS data.
DON salary: next steps
With all of these factors in play, DON salaries can range anywhere from $115k to $200k — with bonus and incentive programs creating even more variation.
Our team talks to DONs throughout California every day. We are continually amazed at the large range of salary asks and comp plans that are attached. If you are a SNF administrator or operator and want to learn more about how your facility can stay competitive in attracting nurse leadership, we welcome a call to compare notes.
Connect with Full Spectrum’s CEO, Max McNamara today or call our office to discuss.
