The NHA & DON Relationship

Making the best of an “Arranged Marriage”

The Administrator and Director of Nurses coupling can be a decision made by management or circumstances beyond your control.  Like an arranged marriage, you need to work to make the relationship successful.  The power of a cohesive Administrator and Director of Nursing is a force to be reckoned with and a great example to the entire staff.  When the opposite is true the results are disastrous.  Nothing can cause a survey to take a nosedive into IJ’s than a NHA and DON that are not on the same page, or worse playing the “blame game”.

Tips to strengthen this key relationship resemble marriage counseling.  All relationships thrive on open and honest communication.  Talking several times a day face to face (texting doesn’t count) will quickly improve any relationship.  Making rounds together not only improves communication and operations, it will show strong leadership to coworkers.


It is expected that there will be times of stress while working together.   The Administrator and Director of Nursing do not always have the same priorities and don’t agree on everything.  The worst reaction to disagreements is to stop communication.  If you have every walked into work, wanting to be anywhere else because of a personality conflict, that is your signal to reopen the lines of communication.


As the leaders of their nursing centers, the Administrator and Director of Nursing both have a responsibility to build a relationship that promotes quality of care, in good times and in bad.




  1. Create a schedule that includes frequent in-person discussions
  2. Make rounds together
  3. Seek to understand…not agree
  4. Focus on shared, rather than personal goals
  5. Keep disagreements private, show a united front
  6. Join efforts on staff morale projects