20 Director of Nursing Interview Questions and Answers

A director of nursing (DON) in a nursing home runs every part of resident care that nurses and aides touch: staffing, clinical quality, survey compliance, MDS accuracy, and the nursing budget. Federal rules require every certified nursing home to have a registered nurse serving as DON full time, unless the facility has a waiver.

Administrators and regional clinical leaders use the interview to find out 3 things. Do you know your numbers? Can you keep the building survey-ready without a scramble? And will nurses and aides stay for you?

The questions below are written for long-term care and skilled nursing. For a hospital or assisted living role, keep the answer structure and swap in that setting's metrics and regulators.

Director of nursing at a glance

Item	Details
Closest BLS occupation	Medical and health services managers
Median pay	$123,860 overall; $100,520 in nursing and residential care facilities (BLS, May 2025)
Job outlook	24% growth from 2025–2035, about 62,300 openings a year (BLS, all health services managers)
License	Active RN license in the state (or a multistate compact license where accepted)
Education	ADN or BSN; many operators prefer a BSN plus prior ADON or unit manager experience
Optional certification	AAPACN's Director of Nursing Services-Certified (DNS-CT)
Key regulations	42 CFR Part 483 (F-tags), state licensing rules, CMS survey process
Key systems	EHR such as PointClickCare or MatrixCare, MDS software, Payroll-Based Journal (PBJ)
Interview format	Administrator interview, then a panel with regional clinical staff; often a building tour

How the interview usually works

Each operator runs its own process. DON hiring commonly follows this pattern.

1. Phone screen. A recruiter or the administrator checks your license, your survey history, and your pay range.
2. Administrator interview. Expect questions on quality measures, staffing costs, and how you'd work together. The administrator is licensed separately by the state and shares survey accountability with you.
3. Regional or corporate clinical panel. A regional director of clinical services or nurse consultant digs into survey results, plans of correction, MDS, and QAPI.
4. Tour and staff meeting. Many facilities walk you through the units and let a few nurses or the ADON meet you.

Before any of these, look up the facility on Medicare's Care Compare. You'll see the overall star rating, the separate health inspection, staffing, and quality measure ratings, and recent inspection reports.

General and background questions

1. Why do you want to be a director of nursing in long-term care?

Why they ask: Replacing a DON is expensive. They want to know you chose this setting on purpose.

How to answer: Connect a specific experience to the work, and show you know the parts of the job beyond bedside care: surveys, budgets, and staffing.

Sample answer: I spent 6 years as a floor nurse and then unit manager on a 40-bed long-term care unit, and what kept me there was the residents who stay for years. As ADON for the last 3 years, I took over scheduling, ran our fall committee, and led our team through 2 annual surveys. I like fixing the process so the next nurse doesn't repeat a mistake. I want to be accountable for the whole building's care, including the budget and the survey results.

2. Why are you leaving your current position?

Why they ask: They're checking for problems you might bring with you and whether you'll speak about your employer professionally.

How to answer: Give a real, specific reason without attacking anyone, then explain why this facility fits.

Sample answer: I've been DON at my current building for 4 years and I'm proud of the results, including a deficiency-free complaint survey last spring. The building needs a nurse call system replacement and a second shower room, and I've made the case to ownership twice with incident data. Both times the capital budget went elsewhere. Your facility has put money into a wound care program and therapy space in the last 2 years, and your quality measure rating has gone from 3 stars to 4. That tells me clinical requests get a fair hearing here.

3. What are your current quality numbers?

Why they ask: A DON who can't recite their metrics probably isn't managing them.

How to answer: Give the key measures from memory with a trend, and name the one you're working to fix.

Sample answer: At my 120-bed facility, falls with major injury for long-stay residents are at 2.8%, down from 4.1% 2 years ago. Our long-stay antipsychotic use is 9.2%. Pressure ulcers for high-risk long-stay residents are at 5%. Short-stay rehospitalization is our weak spot at 22%, and about a third of those readmissions are heart failure. So we've started daily weights with a call parameter, a cardiology NP visit every 2 weeks, and a 72-hour post-admission huddle for every CHF admission. Nursing turnover is 48% a year, down from 65%, and agency hours are 6% of nursing hours, down from 22%.

4. What would your first 90 days here look like?

Why they ask: A new DON can calm a building or unsettle it. They want to hear a plan that starts with learning.

How to answer: Split the time into listening, analyzing data, and a short list of priorities. Avoid promising a reorganization.

Sample answer: Weeks 1 to 3, I'd work every shift at least once, including nights and a weekend, and help with med passes and call lights. Meanwhile I'd review 12 months of quality measures, survey reports, incident logs, PBJ data, turnover, and agency spend. Weeks 4 to 8, I'd meet one-on-one with every nurse manager and hold short sessions on each shift with 2 questions: what should never change here, and what makes your shift harder than it needs to be. By week 12, I'd bring you no more than 3 priorities with the data behind each.

Role-specific questions

5. A surveyor walks in unannounced tomorrow. How ready are you?

Why they ask: Surveys are unannounced and can start any day, including weekends. They want to hear a daily readiness system.

How to answer: Describe routine audits, mock surveys, and your most recent results. Mention the survey cycle.

Sample answer: Ready, because we treat readiness as daily work. State surveyors have to come back within 15 months of the last standard survey, so I plan around a window, and a complaint survey can happen any day. My unit managers do daily rounds on the F-tags cited most in our state: infection control, care plans, and accidents. I audit 10 charts a week for current care plans, orders matching the MAR, and dated wound measurements. We run a full mock survey every quarter with a nurse consultant from a sister building. Our last annual survey had 3 deficiencies, all at scope and severity level D or below.

6. Walk me through how you write a plan of correction.

Why they ask: Every DON gets citations. An acceptable plan of correction keeps remedies off the table and fixes the actual cause.

How to answer: Cover the deadline, the 4 parts of a strong plan, and how you monitor it through QAPI.

Sample answer: The plan of correction is due within 10 calendar days of receiving the CMS-2567, so I start the day we get it. For each deficiency I address 4 things: what we did for the residents named in the citation, how we identified other residents at risk, what system change prevents it from happening again, and how we'll monitor it, with who audits, how often, and for how long. Last year we got an F689 citation for a resident who fell during an unassisted transfer. We reassessed all 38 residents on 2-person transfers, retrained every CNA with return demonstration, and audited 10 transfers a week for 12 weeks, reporting results to QAPI.

7. How do you run QAPI and the QAA committee?

Why they ask: Federal rules require a QAPI program, and surveyors look at whether it finds and fixes real problems.

How to answer: Describe committee members, meeting frequency, how you choose projects, and one project with results.

Sample answer: Our QAA committee meets monthly, more often than the quarterly minimum, and includes me, the medical director, the infection preventionist, the administrator, and our MDS coordinator. We review a standing dashboard: falls, pressure injuries, infections, antibiotic starts, psychotropic use, readmissions, and grievances. Anything trending the wrong way for 2 months becomes a performance improvement project with a root cause analysis and a named owner. Our most recent project looked at UTI antibiotic starts. We found half didn't meet our criteria for treatment, so we added a nurse SBAR form and a pharmacist review, and antibiotic starts for UTIs fell by 40% in 6 months.

8. How do you make sure MDS assessments are accurate and on time?

Why they ask: The MDS drives care plans, quality measures, star ratings, and Medicare and Medicaid payment. Errors cost money and credibility.

How to answer: Show you know the timelines, the RN signature requirement, and how you audit accuracy against the chart.

Sample answer: The comprehensive assessment is due within 14 days of admission, with quarterly reviews at least every 3 months, an annual assessment, and a significant change assessment within 14 days of identifying a change. An RN signs that each assessment is complete, and federal rules carry civil money penalties for falsifying one. I meet weekly with our MDS coordinator on the assessment calendar and any late items. Each month I pull 5 assessments and compare the coding to nursing notes, especially function, falls, and pressure ulcers, since those feed quality measures. When I found our ADL coding didn't match CNA documentation, we retrained aides on documenting self-performance, and our coding accuracy improved on the next audit.

9. How do you reduce falls without restraining residents?

Why they ask: Falls are a top citation area, and restraints and overused alarms bring their own citations and harm.

How to answer: Show a process that investigates each fall, finds patterns, and uses individual interventions.

Sample answer: Every fall gets a huddle on the same shift: what the resident was doing, what they needed, the time, footwear, lighting, and recent medication changes. Then I look for patterns across the building. At my current facility, 40% of falls happened between 5 a.m. and 7 a.m. during unassisted trips to the bathroom. We moved toileting rounds to 4:30 a.m. for residents at risk, and falls dropped by a third in 4 months. We also do pharmacy reviews for sedating drugs, PT screens after any fall, and low beds where they fit. We use alarms only for residents where staff can actually respond, and we've removed most of them.

10. How do you approach antipsychotic reduction for residents with dementia?

Why they ask: The long-stay antipsychotic measure is public on Care Compare, and unnecessary psychotropics are a frequent citation.

How to answer: Mention gradual dose reductions, behavioral approaches, the PRN rules, and teamwork with pharmacy and prescribers.

Sample answer: It starts with behavior. When a resident with dementia is agitated, we look for pain, constipation, infection, hunger, or noise before anyone calls for a medication. Every resident on an antipsychotic has a documented diagnosis, target behaviors tracked each shift, and a gradual dose reduction attempt unless the prescriber documents why it's contraindicated. PRN psychotropic orders are limited to 14 days, and a PRN antipsychotic can't be renewed without the prescriber evaluating the resident. Our consultant pharmacist's monthly review goes to me and the medical director. Over 18 months, those steps took our long-stay rate from 17% to 9%.

11. How do you prepare for and manage an infection outbreak?

Why they ask: Norovirus, influenza, COVID-19, and scabies move fast in congregate care. They want to hear a plan that starts before the outbreak.

How to answer: Cover surveillance, the infection preventionist's role, staff and resident measures, reporting, and communication with families.

Sample answer: Before any outbreak, our infection preventionist tracks infections on a line list every day and flags clusters, like 3 residents on the same hall with vomiting within 48 hours. When we hit that, we start contact precautions, test per the health department's guidance, notify the local health department, and pause group activities on the affected unit. I make sure PPE stock covers at least 2 weeks. We cohort staff so the same aides work the affected hall. Families get a call the same day for affected residents and a building-wide update. During a norovirus outbreak last winter, we held it to 11 residents on one unit, with no cases on the other 2.

12. How do you retain nurses and CNAs?

Why they ask: Turnover drives agency costs, staffing ratings, and care quality. Most administrators hire a DON partly to fix it.

How to answer: Base your answer on what exit interviews told you, then describe concrete changes and results.

Sample answer: When I started, exit interviews showed nurses were leaving over unsafe assignments, last-minute schedule changes, and feeling ignored, with pay fourth. So I started posting schedules 4 weeks out and let staff self-schedule about 70% of shifts before I fill gaps. We set an assignment limit per aide, and when we can't meet it, managers or I take an assignment. Every new hire gets 30-, 60-, and 90-day check-ins and an annual stay interview. I also use market wage data at budget time and got 2 raises approved. Turnover went from 65% to 48% in 2 years.

13. How do you manage PBJ staffing data and the staffing star rating?

Why they ask: CMS uses Payroll-Based Journal data for staffing measures on Care Compare. Bad data can cost a star even when staffing is fine.

How to answer: Show you know the submission deadline and how you check the data before it goes in.

Sample answer: PBJ submissions are due 45 days after each quarter ends, and our business office manager and I review the file 2 weeks before that. I check that every nurse and aide is coded to the right job category, that agency hours are included, and that the DON and admin nurse hours aren't counted as direct care. Early on I found our MDS coordinator's hours coded as floor RN hours, which inflated one quarter and then made the next quarter look like a drop. I also watch weekend staffing, since it's shown separately on Care Compare. We moved 2 part-time nurses to every-weekend schedules with a differential to fix a gap there.

14. What's your working relationship like with the medical director and attending physicians?

Why they ask: The DON and medical director share responsibility for clinical policy and quality. Friction between them shows up in care.

How to answer: Describe a structure for meetings, how you raise provider concerns, and how you support nurses who call physicians.

Sample answer: My medical director and I meet every month with a set agenda: quality data, difficult cases, policy updates, and any concerns about provider practice in either direction. When a physician's response times or orders create risk, I bring specific cases with dates and times. I also back my nurses. A nurse who calls a provider at 2 a.m. about a real change in condition won't get criticized by me. In return, I make sure nurses call with a clear SBAR and the vitals and labs in front of them.

Behavioral questions

15. Tell me about a time you had to discipline or terminate a nurse.

Why they ask: DONs have to hold standards with long-tenured, well-liked staff. They want fairness, documentation, and awareness of reporting duties.

How to answer: Describe the performance issue, the support you offered, the progressive steps, and any board or state reporting.

Sample answer: A night nurse with 15 years at the facility started having documentation gaps, then 2 medication errors in a month, including a controlled substance waste nobody co-signed. We followed progressive discipline with retraining and a modified assignment. I also asked her directly and privately whether something was going on, including substance use, and gave her information on our state's nurse assistance program. When the errors continued, HR and I terminated her, with each step documented. I checked our state board's reporting requirements and filed the required report. Afterward, I told staff in a meeting that a colleague had left and that our medication standards apply to everyone, without sharing details.

16. Tell me about a time you changed a practice that nurses resisted.

Why they ask: DONs change routines all the time. They want to see you get buy-in instead of just issuing a memo.

How to answer: Explain the reason for the change, how you involved staff, and the measurable result.

Sample answer: Our 6 a.m. med pass had 140 residents getting meds in a 2-hour window, and nurses were waking people up to finish on time. I wanted to move non-time-sensitive meds to after breakfast, and the night nurses pushed back hard because they worried the day shift would blame them for late meds. I asked 2 night nurses and 2 day nurses to redesign the pass with our pharmacist. They moved 60% of 6 a.m. doses to 9 a.m. and wrote the new schedule themselves. Night shift finished their pass 45 minutes earlier, late-med reports dropped from about 12 a week to 3, and residents slept later.

Situational questions

17. It's 3 p.m., and 2 nurses just called off for evening shift. What do you do?

Why they ask: Call-offs happen every week. They want a fast, safe sequence.

How to answer: Walk through incentives, reassignment, leadership coverage, agency, and how you track patterns.

Sample answer: Within the first 30 minutes, I text our per-diem pool and off-duty staff with the pre-approved bonus rate for short shifts, so I don't need to wait for sign-off. At the same time I look at the units: can a hall with lighter acuity lend a CNA, and can my ADON or I take a med cart? I keep my own skills current for that reason. If we're still short, I call one of the 2 agencies we keep credentialed. No unit gets an unsafe assignment without a plan. I also log every call-off, since 3 short Tuesdays in a row usually means the schedule needs fixing.

18. Your administrator wants overtime cut 20%, and your units say they're overwhelmed. What do you do?

Why they ask: DONs sit between budget pressure and floor reality. They want to see you use data and find a solution both sides accept.

How to answer: Analyze where the overtime is, separate incidental from scheduled overtime, offer options with costs, and state where you won't cut.

Sample answer: I'd start with the overtime report. At my last facility, 60% of overtime was on 2 units, and half of that was people clocking out 20 to 40 minutes late because shift report ran long. We moved to a walking bedside report with a printed handoff sheet and cut that overtime without touching a scheduled hour. Scheduled overtime from open positions is a hiring issue, so I showed the administrator the cost of overtime against 2 more CNA positions, and hiring was cheaper. If a cut would push staffing below what our acuity and facility assessment support, I'd say so in writing with census and acuity data. That's happened once, and we changed the target.

19. A resident's daughter is yelling at your CNAs every visit. How do you handle it?

Why they ask: Family conflict can drive staff away and turn into complaints to the state. They want you to protect staff while taking the concern seriously.

How to answer: Meet early, separate the concern from the behavior, set clear expectations, and document.

Sample answer: I'd meet with her myself within a day, listen first, and find the concern under the anger. Often it's fear plus one real dropped ball, like a missed shower or a lost hearing aid. That concern gets a specific answer and a follow-up date. Then I'd be clear about conduct: we want to hear every concern, and yelling at aides isn't acceptable. If it continues, we'd hold a care conference with social services and document an agreement about how she raises concerns. If it ever became threatening, the administrator and I would set a formal visiting agreement. I'd also tell the CNAs directly to walk away and call a nurse or me.

20. At 10 p.m., a CNA tells the charge nurse a coworker was rough with a resident. What happens next?

Why they ask: Abuse allegations have strict federal reporting deadlines, and mistakes here lead to serious citations.

How to answer: Protect the resident, remove the accused staff member, report within the deadline, investigate, and follow up within 5 working days.

Sample answer: The charge nurse assesses the resident right away and makes sure they're safe, and the accused aide is removed from resident care and sent home pending investigation. The charge nurse calls me and the administrator immediately. Because it's an abuse allegation, it has to be reported to the administrator and the state survey agency within 2 hours, so we file it that night, along with any other reports state law requires. We notify the resident's physician and representative. The next morning I start interviews, check other residents that aide cared for, and review the schedule. Results go to the state within 5 working days, and any retraining goes through QAPI.

Questions to ask the interviewer

• What did the last annual survey and any complaint surveys find, and where does the plan of correction stand?
• What are the current turnover and agency usage numbers for nurses and CNAs?
• Is there an ADON, and how many unit managers, MDS coordinators, and staff development staff report to the DON?
• How involved is the regional clinical team, and how often do they visit?
• Who owns the nursing budget, and what flexibility does the DON have on incentive pay?
• Why did the last DON leave, and how long were they here?
• Which 1 or 2 quality measures does ownership most want improved in the first year?

How to prepare

• Read the facility's Care Compare page. Note the overall rating, the 3 sub-ratings, staffing and turnover figures, and recent inspection results.
• Read the last 3 inspection reports. Know the F-tags cited and be ready to say how you'd address each.
• Memorize your metrics. Falls with major injury, pressure ulcers, antipsychotic use, rehospitalizations, turnover, agency hours, and survey results with dates.
• Review key federal rules. Nursing services (483.35), resident assessment (483.20), abuse reporting (483.12), pharmacy services (483.45), QAPI (483.75), and infection control (483.80).
• Know the current staffing rules. CMS repealed the 2024 minimum staffing standards in an interim final rule effective February 2, 2026. The federal requirement is again an RN for at least 8 consecutive hours a day, 7 days a week, plus a full-time RN DON, and your state may require more.
• Check your state's rules. Confirm DON qualifications, state staffing minimums, and incident reporting requirements for the state where you're interviewing.
• Bring a 90-day plan. One page, with the data you'd review and the first meetings you'd hold.
• Consider DNS-CT. AAPACN's certification is open to RNs and requires passing its course exams with a score of 80% or higher.

To prepare for panel questions from nurse leaders below you, review the assistant nurse manager interview questions. DONs work closely with case management and utilization review, so the RN case manager and utilization review nurse guides show how those roles approach discharge planning and payer rules. Your consultant pharmacist relationship matters too; see the clinical pharmacist interview questions. If you're hiring aides, point applicants to the certified nursing assistant cover letter guide.