Ask most Directors of Nursing what they spent their week on, and the honest answer usually isn't clinical leadership. It's a chart question. It’s chasing down missing referral documentation that’s holding up coding,  It's a coder pinging them about a diagnosis that doesn't quite line up, a clinician asking why a GG0130 score got kicked back, or an ADR letter that needs someone to reconstruct the story behind a score from three months ago. None of that is a bad use of a DON's judgment. It's just an expensive way to spend it.

What a DON's hour is actually worth

A home health DON typically earns somewhere in the ballpark of $95,000 to $115,000 a year, depending on your market and agency size. Break that down across a normal work year, and you're looking at roughly $45 to $55 an hour, sometimes more once benefits and overhead get factored in.

That's not a cheap hour. It's the hour an agency is paying for clinical oversight, staff development, survey readiness, and the kind of judgment that keeps a program running well. It's not the hour meant to get spent untangling why a coder flagged a chart, or re-explaining the same GG0130 scoring nuance to a new hire for the third time this month.

Where the hours are actually going

Sit down and actually track a DON's week, and a few categories tend to eat more time than anyone expects going in.

Coding clarification questions are a big one. A coder hits an ambiguous chart, can't make a defensible call on their own, and the question lands on the DON's desk. Multiply that by a normal chart volume, and it adds up to a steady trickle of interruptions that break up the kind of focused time leadership work actually needs.

Chart review escalations are another. Not every flagged chart needs a DON, but a lot of agencies don't have a clear enough second layer of review to filter out the ones that genuinely do, so more of them land there than should.

Then there's the training loop. New hires plateau on OASIS scoring [without fast, specific feedback](insert OASIS training plateaus blog URL), and when that feedback loop doesn't exist anywhere else in the organization, it defaults to the DON, one conversation at a time, instead of a structured process that could handle most of it without their direct involvement.

And ADR response prep deserves its own line item. Reconstructing the reasoning behind a score from months ago, when there's no clean audit trail showing why a decision was made, can eat an entire afternoon that a DON didn't plan to lose.

What this actually costs

Say a DON is spending even eight hours a week across these categories, which is a conservative estimate for a lot of agencies once you actually track it. At $50 an hour, that's $400 a week, or roughly $20,000 a year, spent on work that doesn't require a DON's specific judgment so much as it requires someone available to answer a question the workflow should have already resolved.

That number doesn't even capture the real cost, which is what the DON isn't doing during those hours. Staff development, survey prep, program strategy, the things that actually require a DON and that only a DON can do, all get pushed to whatever time is left over.

What actually reduces this

The fix isn't asking DONs to be less available. It's building a workflow where fewer of these questions reach them in the first place. A coding review layer that resolves ambiguous charts with a documented, defensible decision before it ever becomes a question. An audit trail that shows exactly why a score was reached, so ADR prep is a lookup instead of a reconstruction. A structured feedback loop for new hires that builds judgment without needing a DON in the room for every correction.

None of that removes the DON from the process. It just moves their time toward the decisions that actually need them.

See what this could look like for your team

We'd like to show you how our review workflow is built to catch these questions before they ever reach your DON's desk.