Occupations and Terms of Reference › Director of nursing
Universal terms of reference · POS-013 · version 1.0 · status: draft · next review 2027-10-27
Director of nursing
To lead nursing practice in the service areas, so that every patient receives safe, timely and competent nursing care, and nurses on every shift are supported.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You lead nursing in your services. You make sure staffing is safe each shift, nurses are competent and supported, nursing incidents are learned from, and nursing standards are followed.
Reports to: Chief nursing officer.
Leads or supervises: Ward managers, nurse educators and the infection prevention and control lead.
What you do on a typical day
- Review staffing and skill mix for each service each day.
- Review nursing incidents and pressure injuries with ward managers.
- Support ward managers with difficult staffing or care problems.
- Round on wards and clinics.
- Check competence and training of nurses in your services.
Working conditions and demands
- On call for staffing escalations.
- Works across several wards or clinics.
- High pressure at peak demand.
What good looks like
- Every shift has a safe skill mix.
- Nursing incidents fall and learning is visible.
- Nurses are competent and supported.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- Every decision that affects patient safety is made on evidence and recorded.
- Patient safety and quality come before financial targets; no trade-off that puts patients at risk is accepted.
- Every staff member can raise a concern without fear of reprisal, and every concern is answered.
- Legal, licensing and accreditation duties are known, owned and reviewed.
- Finances, people and information are managed openly and within the law.
- Mandatory training and policies apply to the executive as much as to frontline staff.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-013 |
| ISCO-08 | 1342 (skill level 4) |
| ESCO | to map |
| Department | Nursing |
| Facility types | Hospital, Ambulatory |
3. Reporting line and working relationships
Reports to: POS-006. Supervises: POS-079, POS-094, POS-030.
| Works with | Nature of the relationship |
|---|---|
| Chief nursing officer | Sets nursing standards; director delivers them in services. |
| Medical director | Joint care pathways and safety. |
| Chief operating officer | Staffing and patient flow. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Nursing standards | Applies nursing standards in services and checks adherence. | Audit results reviewed each quarter | Quarterly | C-01 | T-05 | POL-INC | 2 |
| Staffing | Makes sure every shift is safely staffed with the right skill mix. | Shift staffing reports; gaps escalated the same day | Daily | C-02 | T-08 | POL-EQUAL | 2 |
| Nursing safety | Leads learning from nursing incidents. | Actions closed; trend reports reviewed | Monthly | C-03 | T-05 · T-07 | POL-INC · POL-SAFEG | 2 |
| Competence | Makes sure nurses are licensed, competent and supported. | Licence and competence records complete | Quarterly | C-04 | T-08 | POL-EQUAL | 2 |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Ward-level staffing deployment within budget | Staffing shortfalls that cannot be covered safely (CNO and COO) |
| Nursing standards within organisational policy | Nursing practice concerns with legal or public impact (CNO) |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Registered nurse licence, current | Yes | per regulator |
| Q-02 | Degree in nursing or a related field | Yes | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Senior nursing experience, including management of nursing teams | 6 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | C-01 · C-03 |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | – |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | C-03 |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | C-02 · C-04 |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-01 | Immunity to vaccine-preventable diseases relevant to the setting, documented at entry | At entry or as set | essential | Documented hepatitis B status at entry |
| H-02 | Tuberculosis screening at entry, then as the national rule requires | At entry or as set | essential | Symptom screening at entry and after exposure |
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Nursing standards and care quality | Follows nursing standards | Leads standards in a service | Designs standards across services | Practice audit | Every 12 months | T-05 |
| C-02 | Staffing and skill mix | Records shift staffing | Plans staffing for a service | Plans skill mix across services | Workforce review | Every 12 months | T-08 |
| C-03 | Nursing incident learning | Reports incidents | Leads incident reviews | Leads a safety culture in nursing | Incident review audit | Every 12 months | T-05 · T-07 |
| C-04 | Leading nursing teams | Works in a team | Leads a nursing team | Leads nursing change in services | 360 feedback | Every 24 months | T-08 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Shifts meeting the agreed skill mix | 100% | rota system | Monthly |
| PI-02 | Nurses with current licence and competence assessment | 100% | HR and licence register | Quarterly |
| PI-03 | Nursing incidents reviewed with actions completed | 100% | incident register | Monthly |
| PI-04 | Pressure injuries and falls trend reported | set by facility | incident register | Monthly |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Director of nursing | 6 years (recommended) | Q-01, Q-02 | C-01 expert, C-03 practitioner | T-05 · T-07 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |