Nursing homes (NHs) are increasingly recognized as critical components of the long-term care continuum. Acute care systems have come to recognize the need for high-quality and easily accessible post-acute and long-term care avenues, a niche NHs have embraced over the past several years. Indeed, post-acute patients receiving NH rehabilitation account for more than 2.2 million Medicare-covered stays across 15,000 facilities. The quality of care in NHs remains inconsistent and, in many respects, suboptimal. Although NH quality is dependent on a number of workforce factors, directors of nursing (DONs) and their relationships with staff, including attending physicians, are likely an important part of the equation.