How to Become a Nursing Home Administrator

Two NAB exams, the CORE and the NHA line-of-service test, stand between a director of nursing and the license to run a skilled nursing facility. They are the last gate, not the first. The core path runs through education, an administrator-in-training (AIT) program or qualifying experience, those exams, and a state license.

The step up is more than a title change. A DON answers for clinical operations; the licensed administrator is legally accountable for the entire facility. RN experience can shorten the route, but each state board decides by how much, so one résumé can mean a short path in one state and a long one in the next.

What a Nursing Home Administrator Does (And How It Differs From the DON Role)

Federal rules require every certified nursing home to be run by an administrator licensed by the state. That licensed nursing home administrator (NHA) is legally responsible for the entire facility: residents, staff, finances, and the building itself. The director of nursing (DON) leads nursing care. The NHA leads everything, including the nursing department, see What Do Nurse Administrators Do for a closer look at that broad scope.

Where the NHA's Accountability Reaches

• Finances: Owning the operating budget, census targets, payer mix, and cost control.
• Staffing: Overseeing hiring, retention, and scheduling across every department, not only nursing.
• Compliance and liability: Answering for regulatory performance, risk management, and legal exposure.

Survey Readiness Is Your Responsibility

When state surveyors arrive on behalf of CMS, the administrator answers for every citation. That includes a medication pass error, a kitchen sanitation finding, a life safety issue, or a resident rights complaint. The NHA signs the plan of correction and must show that fixes are working. As DON, you owned the nursing tags. As NHA, you own the whole survey report.

The Mindset Shift for Nurses

Clinical judgment asks, "What does this resident need right now?" Administrative judgment asks what the building needs to stay safe, staffed, solvent, and compliant next quarter. You'll make operational, financial, and HR decisions daily, often in departments you've never managed: dietary, maintenance and environmental services, admissions, and marketing and referral development.

Why DONs Make Strong Candidates

Directors of nursing already understand the survey process from the inside. You know how MDS assessments and care planning drive both quality and reimbursement, and you've lived with staffing shortages at 2 a.m. Those skills transfer directly to the path mapped in How to Become a Nurse Administrator. What you'll add is budgeting, labor law, and leading non-clinical managers, skills emphasized in MSN in Nursing Leadership programs.

A Week in the Job

• Monday: Review weekend incidents and census, then lead the department-head stand-up.
• Tuesday: Walk the building with maintenance and dietary leads, checking for survey risks.
• Wednesday: Go over budget variances and agency staffing costs with the business office.
• Thursday: Meet with hospital case managers to strengthen referral relationships.
• Friday: Run a mock survey or QAPI review, then approve next week's schedule.

You're also the escalation point after hours, so the phone rarely stays quiet on weekends.

Quick Answers for Nurses Considering NHA Licensure

These short answers cover the questions nurses ask most often when they first look at nursing home administrator licensure. Rules are set state by state, so treat each answer as a starting point and confirm details with your state licensing board.

Do You Need a Nursing Degree? Comparing BSN, MSN, MHA, and Other Degree Paths

No, a nursing degree or RN license is not universally required. Most states accept any accredited bachelor's degree plus required coursework or an administrator-in-training (AIT) program. RN licensure can shorten the path in some states, such as Pennsylvania, which lists an RN pathway among its educational routes. A master's degree is usually optional, but in some states it reduces AIT hours or experience requirements. Always confirm current rules with your state board.

From RN to Licensed Administrator: The Six-Step Path

Starting as an RN or DON, your degree may already satisfy step 1, and your management experience may shorten step 2 in some states. Steps 3 through 6 apply to everyone. The sections below cover each stage in detail.

Administrator-In-Training (AIT) Programs: Hours, Preceptors, and Shortcuts for DONs

For nurses, an RN to MSN in Nursing Leadership can shrink an AIT to a few hundred hours, while a bachelor's-only candidate may log well over a thousand. Your degree, more than your years at the bedside, usually sets the length of your training.

How an AIT Works

The AIT is a supervised apprenticeship. You train at a board-approved facility under a preceptor, who must be a licensed nursing home administrator. You rotate through departments you may never have managed, such as dietary, environmental services, business office, and admissions. You also file progress reports with the state board. The NAB publishes AIT and preceptor guidelines that many boards build on, and Alaska, for example, requires a preceptor who covers NAB activities and forms.¹⁸ Most candidates complete the AIT full-time, so plan for a leave of absence or a negotiated schedule.

Typical Hour Ranges

Across states, requirements commonly run from 500 to 2,000 hours.¹ The low end generally applies to candidates with relevant graduate degrees, and the high end to bachelor's-only candidates.

• Washington: 1,500 hours over nine months, or 500 hours with a master's in health administration or nursing.²³
• Florida: 2,000 hours with a bachelor's in any field, or 1,000 hours with a qualifying health care administration degree (at least 60 semester hours in required courses).⁴
• Oregon and Vermont: 960 and 1,000 hours, respectively.⁵⁶
• South Carolina: a six-month internship for those with a health care administration or related degree.⁷
• Alaska: 1,000 hours, plus at least 12 months of health care facility management experience.⁸

Do DON Years Count?

In the state rules we reviewed, no state expressly reduces AIT hours for prior director of nursing (DON) service, and there is no complete list of states that reduce them for long-term care management experience. Experience does count in other ways. Alaska requires it on top of the AIT⁸, and Mississippi counts direct nursing home management toward preceptor eligibility.¹ Treat any DON-based shortcut as something to confirm with your board in writing.

Preceptor Rules and a Practical Tip

Preceptor thresholds vary. Ohio asks for two years of in-state, full-time work (35 hours a week) plus a certificate.⁹ Washington, Oregon, New Mexico, South Carolina, and Mississippi set three years.²⁵¹⁰⁷¹ Massachusetts and Vermont require five, and Maine requires five years of experience with three of them full-time.¹¹⁶¹²

One move saves months: ask your current employer whether its administrator qualifies as your preceptor. Training in a building you already know lets you spend your hours on the departments you haven't run.

Related Articles

Passing the NAB CORE and NHA Exams, Plus the HSE Credential

How many questions are on the nursing home administrator exam, and what does it cost? The national exam is two tests taken as a pair. The CORE of Knowledge exam covers competencies shared across long-term care settings. The NHA line-of-service exam focuses on nursing homes. Both are run by NAB (the National Association of Long Term Care Administrator Boards).

Exam Format, Fees, and Attempt Limits

• CORE exam: 125 questions in 150 minutes. Only 100 are scored. The other 25 are unscored pretest items mixed in, so treat every question as if it counts.¹
• NHA exam: 75 questions in 90 minutes, with 60 scored and 15 pretest items.
• Fee: The CORE plus NHA combination costs $480 as of February 1, 2026.¹
• Attempts: Beginning January 1, 2026, you get four attempts per cycle on each exam. The cycle runs July 1 through June 30.¹

NAB's candidate handbook governs the current content outline, scoring, and retake or rescheduling fees, so download the latest version before you build a study plan. Results are reported as scaled scores. Missouri, for example, cites a scaled score of 113 for licensure by reciprocity, but confirm what your own board requires.²

The Approval Sequence

You don't register with NAB first. Your state board reviews your education and AIT documentation and approves your eligibility. Only then do you register with NAB and schedule a test date. Ask NAB whether remote proctoring is currently offered for your exam.

The HSE Credential and Moving Between States

The Health Services Executive (HSE) credential, issued by NAB, shows competence across the long-term care continuum: nursing homes, residential care and assisted living (RCAL), and home and community-based services (HCBS). The Career Pathway requires:

• A bachelor's degree or higher and an active NHA license
• At least three years as an administrator of record (or supervising administrators of record) in a nursing home setting
• Active long-term care work within the past five years
• Passing scores on the 50-item RCAL and HCBS exams, even if your state doesn't license those lines of service³

A separate Education Pathway serves graduates of HSE-accredited bachelor's programs, who complete an AIT of at least 1,000 hours.⁴

Portability is the payoff, but each state's law controls transfers. Missouri accepts HSE as one route. California won't make you retest if your license verification includes your national exam score. New York offers no reciprocity, and South Carolina issues no reciprocal license, though it allows NAB score transfers.⁵ Some states also add their own state exam.

A Study Tip for Nurses

Your nurse manager experience already covers resident care and survey readiness. Put most of your prep time into finance, budgeting, and human resources, the areas charge nurse roles rarely teach in depth.

Nursing Home Administrator Requirements by State: CA, TX, NY, PA, VA, FL, IL, OH, and MI

Every state sets its own bar for how to become a nurse administrator, so the same RN résumé can mean a short path in one state and a longer one in another. Below is a snapshot of nine large states from each board's published guidance. Where a detail is missing, the pages reviewed did not state it plainly, so confirm it with the board.

State-by-State Snapshot

• California: California Department of Public Health, Nursing Home Administrator Program. An official degree transcript is required (see Health and Safety Code section 1416.22). A certified AIT program is one route to eligibility. NAB exam plus a written state exam.
• Texas: Licensed through the state's Health and Human Services Commission. Check the agency for current education, hours, and exam rules.
• New York: New York State Department of Health, Nursing Home Administrator Licensure Program. Pass both the 125-question CORE and the 75-question NHA LOS. No separate state exam.
• Pennsylvania: Pennsylvania Department of State, State Board of Examiners of Nursing Home Administrators. Regulations offer 11 qualification options. Notes for RNs/DONs: the Board can only approve an AIT completed in a Pennsylvania nursing home.
• Virginia: Virginia Board of Long-Term Care Administrators. 60 semester hours of college credit for AIT approval. NHA and CORE both required. No state exam.
• Florida: Florida Board of Nursing Home Administrators. A bachelor's in health care or health services administration (or equivalent), or 60 semester hours in prescribed subjects. Also a 650-hour internship with a board-approved preceptor in a facility of at least 60 beds.²
• Illinois: Illinois Department of Financial and Professional Regulation (license 044). Apply to both the department and NAB, which handles CORE and NHA approval.³
• Ohio: Ohio Board of Executives of Long-Term Services and Supports. Verify requirements directly.
• Michigan: Michigan LARA, Bureau of Professional Licensing. CORE and LOS required.¹

Toughest and Easiest Routes

Of the states with confirmed details, California and Florida look most demanding for nurses moving from a nursing supervisor role. California pairs a degree with its own state exam. Florida narrows the degree to specific majors or prescribed coursework and adds a lengthy, structured internship. Virginia looks lighter on paper: 60 semester hours and no state exam. Pennsylvania's 11 options add flexibility, though you must train in-state.

California is the only state here with a confirmed state-specific exam. New York, Virginia, and Michigan rely on the NAB exams. Texas and Ohio may layer on state components, so confirm that with their boards.

Verify Before You Plan

Rules change, and AIT hour totals in particular vary by state and route. Treat this list as a starting point, then confirm current requirements with the board named above before enrolling in any program.

Questions to Ask Yourself

How Long It Takes to Become a Nursing Home Administrator, and What It Costs

Cost and timing guides for this license age quickly, and many of the figures still circulating predate the national exam fee changes that took effect February 1, 2025. The estimates below are planning ranges, not board guarantees, because states set their own rules.

Three Realistic Timelines

• RN with a BSN: Plan on roughly 9 to 18 months. That covers an AIT placement (length depends on your state and prior experience), exam scheduling, and board approval.
• DON with an MSN or other master's: Often 6 to 12 months. Many states shorten or reduce AIT requirements for experienced leaders, so check your board. If you still need the master's, compare MSN nursing administration cost before adding about two years of part-time study.
• Career-changer with an unrelated bachelor's: Often two to three years or more. You may need healthcare management coursework first, then a full-length AIT, then exams and licensing.

Itemized Licensing Costs

Expect these line items, with amounts depending on your state:

• State application fee: $40 in Pennsylvania and New York, $120 in Iowa, $125 in Alaska, and $200 in South Carolina.
• NAB exams: $480 for the CORE and NHA exams together, $320 for CORE alone, or $190 for the Line-of-Service exam.
• State exam: Listed at $210 or whatever the state dictates. California's schedule shows a much higher written state exam fee.
• License issuance: Florida charges $500 for initial licensure, South Carolina $175 for the initial licensure period, and Alaska $250.
• Background check: Fingerprinting and screening costs vary by state and vendor.
• AIT fees: Usually a separate item, not folded into licensure. California lists AIT and preceptor application fees, though its published schedules do not fully agree.

Florida posts a single total of $755 (exam, initial licensure, and a $5 unlicensed activity fee). California is the costly outlier, often $1,000 or more depending on pathway and which fee schedule applies.

Processing Times and Delays

Boards publish fees far more consistently than turnaround times, and there is no uniform national standard. Scheduling an exam slot, waiting for board approval of your AIT, and clearing a background check can each stall things. Build in an extra one to three months. Ignore online claims of a 255 to 285 week path in Illinois: that looks like a whole-pathway estimate, not board processing.

Rough Total Cost

Excluding degree tuition, a low-fee state can cost a few hundred dollars once you add the national exam, while mid-range states and California can run from about $750 to well over $1,000. AIT program fees come on top. For tuition on the degree side, compare affordable nursing administration programs.

Nursing Home Administrator Salary Compared With RN and NP Pay

BLS groups nursing home administrators inside Medical and Health Services Managers, so the approximate 2025 figures below are a proxy, not an NHA-only number. Moving from the RN median to the manager median is a jump of roughly $26,300 a year (about 27%), and the manager median sits about $8,500 above the NP median. NHA-specific surveys vary by source and method (PayScale shows a median near $111,000 and ZipRecruiter near $119,800, while Salary.com shows $134,240), and AHCA/NCAL reports NHA compensation rose 3.71% from 2025 to 2026 among repeat participants, though published tables do not break NHA pay out by experience or facility size.

Where Health Services Managers Earn the Most

Highest median annual wage for Medical and Health Services Managers among the largest metros

Job Outlook, License Renewal, and Your Next Move

Demand for Long-Term Care Leaders

Job outlook means the federal forecast for how many healthcare leadership jobs will open over the next decade, and for nursing home administrators the picture is strong. The Bureau of Labor Statistics, in its Occupational Outlook Handbook updated in August 2026, projects 23% employment growth for medical and health services managers from 2024 to 2034, with roughly 62,300 openings a year on average. That category covers more than nursing homes, but long-term care is a meaningful share of it. As an aging population drives demand for skilled nursing, rehab, and memory care, facilities need licensed leaders who understand clinical operations. Former DONs fit that profile well.

Keeping Your License Active

An NHA license is not a one-time credential. The states below renew on a two-year cycle and require continuing education, much of it from NAB/NCERS approved courses:

• California: Biennial renewal with 40 hours of approved CE, at least 10 in patient care or aging, completed in the two years before you file.¹ Certificates validated on NAB's CE Registry count toward the total.
• New York: Registration renews every two years and requires at least 48 clock hours, with content tied to at least one of the five NAB/ACHCA Domains of Practice. Your first renewal is prorated based on the month you were licensed.
• Pennsylvania: Biennial renewal with 48 clock hours, including 2 hours on child-abuse recognition and reporting and at least 12 hours in emergency preparedness and infection control. NAB-approved courses are accepted without separate board approval.

Rules in other states, including Texas and Florida, differ, so confirm current hours and cycles directly with your state board before planning your CE. Logging courses in NAB's CE Registry also makes an audit far less stressful.

Your Next-Step Checklist

If you're ready to move from the nursing station to the administrator's office, work through these in order:

• Contact your state board: Request the current licensure checklist and AIT hour requirements, and ask whether your DON experience qualifies you for reduced training.
• Choose a degree path if needed: If your state requires a bachelor's or graduate degree, compare MSN nurse administrator programs against MHA options before enrolling.
• Line up a preceptor: Find a licensed administrator willing to supervise your AIT hours. Start with administrators at your own facility or parent company.
• Register with NAB: Create your account, review exam eligibility rules, and schedule the CORE and line-of-service exams once your state approves you.

For other leadership roles worth weighing alongside this one, such as Nurse Case Manager, the career guides on nurseadministrator.org map out each path step by step.