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Director of Nursing interview questions, and how to answer them

A DON interview is mostly about one thing: can you keep this building safe, staffed and out of trouble with the state. The administrator and the regional nurse consultant will push hard on surveys, staffing and how you handle a bad outcome. Bring stories with real details, because vague leadership talk gets you nowhere in this room.

11 questions7 minute read

Part 1

1.Walk me through the last annual survey you went through. What got cited, and what did you do about it?

Why they ask

Every DON gets cited eventually. They want to see if you own deficiencies and whether your plan of correction actually changed practice.

How to answer

  • Name the tag and the scope in plain terms, for example an infection control citation for hand hygiene during med pass
  • Explain the root cause you found, not just the finding
  • Describe the plan of correction: education, audits, who ran them and how often
  • Say how you knew it worked, such as audit results holding steady for months after

2.You find out before dawn that a nurse and a CNA both called off for day shift. What do you do?

Why they ask

Staffing crises happen weekly. They want to know your actual sequence, and whether you protect minimum staffing without burning out your team.

How to answer

  • Check the call-off policy and who's already on the schedule
  • Work the per diem list and agency contracts before asking anyone to double
  • Redistribute assignments by acuity so the heaviest residents stay covered
  • Step in yourself or send a unit manager to the floor if it comes to that
  • Follow up later on the pattern behind the call-offs

3.How do you run a falls program that actually lowers falls?

Why they ask

Falls with injury drive complaints, lawsuits and bad quality measures. They want a system, not a list of alarms.

How to answer

  • Post-fall huddle on the unit right after each fall, with the aide who knew the resident
  • Root cause tied to the person: toileting times, meds, footwear, room layout
  • Care plan updates that the floor can actually follow
  • Tracking by hall and shift in the QAPI meeting to spot patterns
4.What's your approach to reducing antipsychotic use in dementia care?

Why they ask

It's a quality measure surveyors watch closely, and it takes pharmacy, the medical director and the floor staff working together.

How to answer

  • Monthly review with the consultant pharmacist and prescribers
  • Gradual dose reduction attempts documented properly
  • Nonmedication approaches the CNAs are trained on, like consistent assignments and adjusted routines
  • Clear diagnoses and behavior monitoring behind every remaining order
5.How well do you know the MDS, and how does it connect to what you do?

Why they ask

The MDS drives reimbursement, care plans and quality measures. A DON who doesn't understand it leaves money and ratings on the table.

How to answer

  • Explain the link between accurate assessments, the care plan and reimbursement under PDPM
  • Describe how you work with the MDS coordinator on assessment timing and documentation support
  • Give an example where fixing documentation corrected a quality measure or payment

Part 2

6.A family says their mother was neglected overnight and they've called the state. Walk me through the next day.

Why they ask

Abuse and neglect allegations have strict reporting timelines and investigation steps. They want to see you'd follow them and still treat the family with respect.

How to answer

  • Make sure the resident is safe and assessed first
  • Report according to state and federal timelines and your facility policy
  • Suspend or reassign staff involved while you investigate, if policy calls for it
  • Interview staff, pull call light and charting records, and write up findings
  • Meet the family yourself and follow up with what changed
7.How do you keep your CNAs from leaving?

Why they ask

CNA turnover is the biggest threat to care quality in most buildings. They want ideas that don't just cost money.

How to answer

  • Consistent assignments so aides know their residents
  • Real orientation with a peer mentor, not a single shadow shift
  • Being visible on the floor, including nights and weekends
  • Recognition and a path to a nursing program where possible
8.Tell me about a time you had to let a nurse go.

Why they ask

DONs have to manage performance and sometimes report nurses to the board. They're checking whether you document, coach first and act when you need to.

How to answer

  • Describe the problem specifically: a med error pattern, documentation falsification, no-shows
  • Show the coaching and progressive discipline that came first
  • Explain how you partnered with HR and whether a board report was required
  • Say what you did to protect residents while it played out
9.How do you work with the administrator when you disagree?

Why they ask

The DON and administrator relationship makes or breaks a building. They want someone who pushes back on safety issues without turning it into a power struggle.

How to answer

  • Bring data, like staffing ratios by shift or incident trends
  • Separate what's a clinical safety line from what's a preference
  • Agree on a plan and present a united front to staff
10.What does your QAPI program look like?

Why they ask

Quality assurance and performance improvement is required, and surveyors review it. They want to know it's real work and not a binder on a shelf.

How to answer

  • Who attends: medical director, administrator, pharmacy, department heads
  • How you pick projects from data like falls, infections, rehospitalizations
  • A PIP you ran with a clear aim, steps and results you tracked

Part 3

11.Why do you want to be a DON, and why this building?

Why they ask

Burnout in the role is common. They want to know you understand what you're signing up for and have looked at their facility.

How to answer

  • A specific reason you want the whole building, not just a unit
  • Something you learned about their survey history, star rating or population
  • An honest word about on-call duty and how you handle it

Questions to ask them

Ask at least two. It shows you're picking them too.

  • What did your last annual survey look like, and is a plan of correction still open?
  • How long have the last few DONs stayed, and why did the last one leave?
  • Do I have an assistant director and unit managers, and are any of those roles vacant right now?
  • How much agency staffing are you using, and what's the plan to bring it down?
  • How does on-call work here, and who backs me up on weekends?

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