Hospital nurse practitioner interview questions

What this hire must get done

Write the scorecard before you interview, then hire against it. Set the bracketed targets from your own numbers.

What to tell candidates before the interview

Say the hard parts plainly. People who wouldn't stay drop out early, and the ones who stay knew what they signed up for.

• Say plainly that on nights they may be the sole provider on site, with a physician reachable [by phone or telehealth], and name the backup you have, such as [a tele-emergency service, a transfer center agreement and a house supervisor].
• Explain the practice setup: [independent practice, a collaborative agreement or supervision, as your state requires], the privileges you'll grant at the start, how orientation works, and which physician reviews their inpatient charts.
• Give the real schedule and pay plan: [24-hour ER shifts, clinic days, or both], with nights, weekends and holidays, and how extra shifts are paid.
• List what happens after an offer and before the first shift: license and DEA checks, medical staff credentialing and privileges, payer enrollment, and [your background check, run after the offer where fair-chance rules say so]. Credentialing here takes [your usual timeline], so give a realistic start date.

How to run the interview

1. Same questions, same order. Ask every candidate the questions below and the same follow-ups. It is the only way to compare people fairly.
2. Two interviewers. An owner or manager and someone who does the work. Take notes on what the candidate says, not on how you feel about them.
3. Score right after each answer. 5 sounds like the strong answer, 3 like the mixed one, 1 like the weak one. Use 2 and 4 for answers in between.
4. Rate alone, then compare. Compare candidates question by question, and talk only after everyone has scored. Big gaps are worth a conversation.

1. Situational · Solo night judgment

   At [2] a.m. you're the sole provider on site. An ambulance brings in a man with crushing chest pain, and a minute later the floor nurse calls about a swing bed patient who is newly confused. Walk me through your next half hour.

   It shows how they split themselves between two patients, and whether they call for help early or after the fact.

   Follow-ups

   • Who do you call first, and at what point?
   • What do you ask the floor nurse to do and tell you while you're in the ER?
   • What would make you call the on-call physician in?

   5Strong

   Goes to the ER patient, gets nurses started on the standing orders, and calls the transfer center and the on-call physician early. Has the floor nurse give a full SBAR, sets a time for a callback, then sees the swing bed patient. Charts decision times.

   3Mixed

   Handles the ER patient well, calls the transfer center early and gives the floor nurse orders by phone, but sets no callback time and doesn't tell the on-call physician that two patients need them at once.

   1Weak

   Finishes the whole workup before calling about a transfer, or ignores the floor call until the ER is quiet.

2. Behavioral · Knowing the limits

   Tell me about a patient you decided needed more than you or your hospital could safely give. What told you, and when?

   A transfer started late is hard to undo. You want the NP who recognized the limit early and can explain what told them.

   Follow-ups

   • What was the first thing that made you uneasy?
   • Who did you call, and what did you say?
   • Looking back, would you call sooner, later or at the same time?

   5Strong

   Names a specific case, the findings or the hospital limits that drove the decision, who they called and in what order, how the move went, and what they charted. Reflects honestly on whether the timing was right.

   3Mixed

   Has a real case with sound timing, but credits the call to a colleague's push or the monitor, and can't say what they'd watch for next time.

   1Weak

   Can't name a case, says they've never needed help, or blames the receiving hospital for every delay.

3. Technical · Knowing the limits

   Before your first solo night here, how would you work out what you'll handle alone, when you'll phone the physician, and what means a transfer?

   It tests whether they know their state's practice rules, how privileges work, and what a small hospital can and can't do at night.

   Follow-ups

   • What in your state's rules or your collaborative agreement shapes the answer?
   • Which procedures would you want watched or signed off first?
   • What would you want to know about our night resources, like imaging, blood and specialist access?

   5Strong

   Starts from their state's practice rules and any collaborative agreement, the privileges granted here, and what the hospital has at night. Wants written lists agreed with the medical director and names procedures they want proctored first.

   3Mixed

   Knows their license and state rules well, but hasn't thought about what this hospital can and can't do at [2] a.m.

   1Weak

   Says their license covers it, or that they'll figure it out as cases come.

4. Technical · Transfers and EMTALA

   Before a patient leaves our ER, by discharge or by transfer, what must the medical screening exam settle, and what has to be in place?

   EMTALA mistakes come from treating triage as the screening exam, or moving a patient before the paperwork and the accepting hospital are in place.

   Follow-ups

   • What is different about a transfer when the patient isn't stable?
   • With no physician in the building, who signs the transfer certification, and what does it say?
   • When does insurance come up, if at all?

   5Strong

   The exam, by someone your bylaws name as qualified, decides if an emergency condition exists. If so, the patient is stabilized here or transferred: an accepting hospital with room, a certification a physician signs or later countersigns after a phone consult, and records sent. Never delays care over payment.

   3Mixed

   Knows the basics of screening and transfer, but blurs triage with the screening exam or isn't sure who signs the certification.

   1Weak

   Brings up insurance or bed space before the exam, or would send a patient without an accepting hospital.

5. Behavioral · Transfers and EMTALA

   Tell me about a time a receiving hospital or specialist turned down a patient you believed needed to go. What did you do?

   Rural transfers get refused or stall. The NP has to keep caring for the patient while finding another way out.

   Follow-ups

   • How did you present the case on that call?
   • If that hospital had the service your patient needed and room for them, what did you do?
   • What did you chart about the refusal, and who did you tell?

   5Strong

   Gave a short, clear case presentation, brought in the on-call physician, tried another hospital and kept treating within the hospital's capability. Charted each call with times and names and told the administrator on call. Knows a hospital with the needed specialized service and room generally can't refuse an appropriate transfer.

   3Mixed

   Kept calling until one hospital accepted and charted the calls, but didn't bring in the on-call physician or tell anyone the first hospital refused.

   1Weak

   Accepted the refusal and admitted the patient without telling anyone, or argued on the phone without new facts.

6. Situational · Safe prescribing

   A patient you've never seen asks for an early refill of their opioid pain medicine in the ER, saying their clinic is closed until Monday. How do you handle it?

   It shows whether they assess before deciding, follow your hospital's policy, the state monitoring program and DEA rules, and treat the patient with respect either way.

   Follow-ups

   • Before you give an answer, what do you review?
   • What would make you say yes, and what would make you say no?
   • What do you say to the patient if the answer is no?

   5Strong

   Assesses the patient, then follows your ER prescribing policy, the state prescription monitoring program's rules and DEA rules, looking up the patient's history there as required. Offers only what the policy allows, plans how the patient reaches their own prescriber, charts the reasoning and stays respectful.

   3Mixed

   Follows the policy and the monitoring program lookup, but treats it as a yes-or-no on the refill, with no plan for reaching the regular prescriber.

   1Weak

   Says no without assessing, or prescribes without the monitoring program lookup your state or policy requires.

7. Behavioral · Working with the medical staff

   Tell me about chart review or peer review feedback you disagreed with at first. What did you do with it?

   Physicians will review this NP's inpatient charts and cases. The answer shows whether review makes them better or defensive.

   Follow-ups

   • What was the case, and what did the reviewer say?
   • How did you respond to the reviewer?
   • What do you do differently now, if anything?

   5Strong

   Names the case and the feedback, went back to the record honestly, talked with the reviewer, and either changed a practice or explained with evidence. Can say what's different now.

   3Mixed

   Accepted the feedback without argument, but can't say anything that changed in how they practice.

   1Weak

   Calls peer review politics, or can't recall any feedback on their work.

8. Situational · Leading the night team

   You're leading a code at night with two nurses, a respiratory therapist and the lab tech. Walk me through how you run the room.

   In a small hospital the NP often leads the code. You're testing how they lead people under pressure, not their clinical steps.

   Follow-ups

   • How do you hand out roles?
   • How do you make sure an order was heard and done?
   • What happens after it's over?

   5Strong

   Says out loud that they're leading, gives each person a role, uses closed-loop talk, asks the team what they're seeing, calls the on-call physician and transfer early, has someone with the family, and holds a short debrief after.

   3Mixed

   Gives clear orders, but runs it alone without asking the team what they see, and skips the debrief.

   1Weak

   Does hands-on tasks while no one runs the room, or can't describe leading a code.

9. Situational · Leading the night team

   A nurse calls you at [4] a.m. about a patient you saw at midnight. The nurse is worried but can't point to one number that changed. What do you do?

   Night nurses notice changes before the numbers do. An NP who waits for proof teaches nurses to stop calling.

   Follow-ups

   • What do you ask on the phone?
   • What would make you go see the patient right away?
   • How do you close the call with the nurse?

   5Strong

   Takes the worry as a finding, asks for an SBAR and what's different, goes to see the patient, thanks the nurse for calling, and charts it.

   3Mixed

   Goes to see the patient and handles it, but treats the call as a numbers check, without asking what the nurse noticed or thanking them for calling.

   1Weak

   Brushes the nurse off, or gives orders without asking what changed.

Work exercise: oral case review with a physician

Present [two] made-up ER cases on paper, such as an older adult on a blood thinner who fell and a school-age child with belly pain. In [20] minutes, finalists talk through what worries them most, who they'd call and when, and whether the patient stays or goes. A physician on your medical staff plays the on-call doctor and scores only the clinical reasoning. You or HR score the rest. Someone plays the transfer center. No real patients or charts.

Use made-up materials, never real customer work, and keep it to the time shown. Follow your own safety rules for anything hands-on.

Reference check questions

Tell finalists you'll call a former manager, and get their permission first. Ask about what they did, not whether they were nice.

• When nurses called them at night, how did they respond? Did nurses keep calling?
• Tell me about a patient they transferred or asked for help on. Was the timing right?
• What did chart review or peer review find in their work, and how did they take it?
• Would you have them back on your medical staff, and for which shifts?

Questions to skip, and what to ask instead

Ask only what the job needs. Questions that touch age, health, family or pay history can break federal, state or local law, even when you mean well.

• SkipDo your kids make it hard to cover 24-hour shifts?

  AskThis role is [24-hour ER shifts, including nights, weekends and holidays]. Can you work that schedule?

• SkipWhat's your current salary or shift rate?

  AskTell them the pay, [the salary or per-shift rate and how extra shifts are paid], and ask what number would bring them here.

• SkipHave you ever been treated for drug or alcohol problems?

  AskAsk whether any license, DEA registration or hospital privileges have ever been limited, surrendered or investigated, then check through the state board, Nursys and the National Practitioner Data Bank. Save disability-related questions, including any health questions on your medical staff application, for after a conditional offer.

Common mistakes when hiring a hospital nurse practitioner

• Letting a non-clinician grade clinical answers

  The CEO often hires the NP, and few CEOs can judge an ER case. Have a physician on your medical staff score the case review and the clinical questions, and score the leadership and reference parts yourself.

• Hiring the NP who has never been alone

  An NP from a busy ER or urgent care may be skilled but has always had a physician down the hall. Ask about their first solo shift, or plan for it: paired shifts first, then days, then nights.

• Starting credentialing after the start date is set

  Privileges, the data bank query, DEA checks and payer enrollment take time. Start them the day the offer is signed, or a good hire sits waiting while you pay for locum coverage.

Hospital nurse practitioner interview FAQ