Leading with Impact: The Director of Nursing’s Essential Role in Value-Based Care

This article is sponsored by Real Time Medical Systems and was originally featured in Skilled Nursing News.

As value-based care (VBC) continues to redefine reimbursement models and quality standards in skilled nursing facilities (SNFs), the Director of Nursing (DON) plays a central role — driving clinical excellence, operational efficiency and financial performance. With hospitals, health plans and VBC programs increasingly viewing SNFs as strategic partners, the DON’s influence is just as vital in broader care discussions as it is within the facility.

Lindsey Ford, RN, has seen this leadership first-hand: the SNF DON actively making rounds, engaging with staff and staying closely connected to every detail of care. The DON knows each patient’s name, their family members and the daily challenges their teams face. Far from being a regulatory requirement or symbolic title defined by CMS, the DON is a hands-on leader whose expertise drives both internal operations and external partnerships.

“When a patient needs something, the DON doesn’t hesitate – they respond immediately,” says Ford, Network Program Manager at Real Time Medical Systems (Real Time). “They don’t delegate – they’re present, boots on the ground, actively supporting their team and patients.”

While the DON has always been central to skilled nursing care, the role has expanded to meet the demands of VBC. They lead coordinated, interdisciplinary efforts — ensuring care delivery aligns with provider goals and that the facility’s clinical voice is represented in strategic conversations.

“Value-based care shifts the focus from individual efforts to a collaborative approach, and the DON is the one guiding that team,” says Cheryl Scalzo, RN, Customer Success Manager at Real Time. “Their leadership ensures seamless communication across departments and care partners, ultimately improving outcomes and quality.”

DONs are more than clinical supervisors. They are strategic leaders, hands-on caregivers, patient advocates and operational decision-makers. Their decisions — grounded in clinical insight and data — directly impact performance metrics, patient satisfaction and financial sustainability. These same capabilities make them indispensable in VBC partnerships.

Empowering DONs with real-time data to prevent hospitalizations

Success in VBC hinges on the ability to act quickly and proactively — yet many SNFs lack access to timely, actionable data. Without it, facilities struggle to meet benchmarks or demonstrate measurable improvements in care quality.

To overcome this challenge, DONs need tools that support proactive care management and hospitalization prevention. Real Time’s interventional analytics solution meets this need by integrating directly with post-acute EHRs. It analyzes existing clinical documentation in real time, without adding to staff workload. The system’s proprietary algorithms identify patients at high risk of rehospitalization and deliver timely alerts and actionable insights, enabling DONs to take immediate clinical action and intervene quickly.

“There’s no extra work for staff,” Ford explains. “Real Time pulls data, establishes patient baselines and continuously monitors for changes. You can instantly see which patients are trending in the wrong direction.”

Scalzo describes Real Time’s tools as a “crystal ball,” offering DONs early warnings that help prevent avoidable hospital readmissions and adverse events.

“DONs have told us that when Real Time sends an alert or calls about a patient, they act immediately,” Ford adds. “Otherwise, within 48 hours, that patient could be re-hospitalized.”

This level of visibility not only strengthens facility care but also demonstrates to hospitals and payers that the SNF can deliver the quality-based outcomes VBC models demand — reinforcing the DON’s role in partnership discussions.

The DON’s expanding role in VBC partnerships

While bedside nurses juggle many responsibilities — including caregiving, emotional support and data collection — the DON sees the bigger picture. They interpret data, anticipate risks and coordinate interventions that align with VBC objectives.

“Real Time’s data analytics give the DON that broader view,” Ford says. “Alerts and condition changes allow SNFs to intervene earlier and prevent readmissions.”

In a VBC environment, cross-functional collaboration is key. The DON acts as the quarterback of this interdisciplinary team — aligning nursing, therapy, intake, administrative and family engagement to ensure cohesive care planning.

“The DON starts that coordination even before admission,” Ford notes. “Whether ensuring timely IV antibiotics or preventing delays in care, these seemingly small actions can have a major impact on a patient’s journey and VBC outcomes.”

Just as they unify internal teams, DONs also represent the SNF in external discussions with hospitals, health plans and VBC partners. Their firsthand knowledge of patients, staff and care processes is too valuable to leave out of decision-making.

“By staying connected to the culture of their facility,” Scalzo concludes, “the DON sets the tone for everything, from bedside care to leadership strategy.”

To learn more about Real Time’s Interventional Analytics solution, visit realtimemed.com.

You may view this article on the Skilled Nursing News website, here.