The 90-Day Reset: How to Stop the DON Revolving Door

You walk into a facility on Day 1 as the new Director of Nursing.

The previous DON left three weeks ago. There's no orientation binder. Half the staff doesn't know who you are. The state survey is in six weeks. And someone just called out for the PM shift.

Welcome to chaos.

This is the reality for most DONs stepping into a new role. And it's exactly why turnover in long term care is a revolving door. When leaders don't survive the first 90 days, facilities lose six figures in recruitment, lost productivity, and compliance risk.

The question isn't whether the transition is hard. The question is: do you have a system to survive it?

The Panic Phase: Days 1-30

Most DONs enter a new role in crisis mode.

You're fighting fires before you know where the extinguisher is. You're signing off on schedules you didn't create. You're answering questions about policies you haven't read yet. You're expected to "hit the ground running" when you don't even know where the ground is.

Here's what panic mode looks like in real time:

Week 1: You spend 60 hours just learning names, systems, and where things are. You discover three open grievances you inherited. The wound care nurse quits.

Week 2: You're still learning the building layout. A family calls the state. You have your first meeting with the administrator, and they ask why the Medicare census dropped.

Week 3: You realize the previous DON left no transition notes. A CNA tells you the schedule "doesn't work." You find out there's a pending complaint you weren't told about.

Week 4: You're exhausted, questioning the decision, and wondering if you made a mistake taking this role.

This is where most DONs start looking for the exit. Not because they can't do the job. But because no one gave them a bridge from chaos to clarity.

The Problem With "Figure It Out"

Most facilities operate on a "sink or swim" onboarding model.

They hand you the keys, the password, and a staff list. Then they expect you to perform like you've been there for years. It's not support. It's survival.

And here's the truth: even the best DON can't build systems while they're drowning.

Leadership in long term care requires structure. You need time to assess, understand, and lead. But when you're in panic mode, you're just reacting. Reacting to call-outs. Reacting to complaints. Reacting to the state.

That's not leadership. That's crisis management.

And crisis management doesn't retain staff. It doesn't improve outcomes. It doesn't pass surveys. It just burns you out faster.

The facilities that keep DONs aren't the ones with perfect buildings or easy staffing. They're the ones that give new leaders a framework to stabilize during the highest-risk window: the first 90 days.

The 90-Day Stabilization Framework

This isn't a motivational speech. It's a system.

The framework breaks the first three months into three distinct phases, each with clear focus areas. It doesn't eliminate the hard work. It just stops you from doing 47 things at once and hoping something sticks.

Phase 1: Stabilize (Days 1-30) Focus: Stop the bleeding. Identify immediate compliance risks. Build relationships with key staff.

You're not fixing everything. You're learning the landscape and addressing what could hurt you in a survey. This means understanding your biggest risks, meeting your charge nurses, and making sure critical processes (like medication passes and wound care) are covered.

You're also listening. A lot. The CNAs know where the problems are. The floor nurses know which systems are broken. Your job isn't to have all the answers yet. It's to gather information.

Phase 2: Assess (Days 31-60) Focus: Understand the systems. Identify gaps. Start building your leadership structure.

Now you're moving from reaction to assessment. You're reviewing your clinical programs, auditing your documentation, and understanding what's actually happening versus what's supposed to happen.

This is where you start identifying which fires are symptoms and which are root causes. A staffing crisis might actually be a scheduling problem. A documentation gap might be a training issue.

You're also starting to build trust. Staff are watching to see if you're going to stay. If you're going to follow through. If you're actually different from the last DON.

Phase 3: Execute (Days 61-90) Focus: Implement changes. Establish leadership rhythms. Move into executive mode.

By day 60, you're no longer new. You know the building. You know the staff. You know the gaps. Now you're leading.

This is where you roll out new processes, set expectations, and start holding people accountable. You're building systems that don't depend on you being in the building 70 hours a week. You're shifting from "doing everything" to "leading everything."

At the end of 90 days, you're not just surviving. You're running the department.

The Bridge: What Don 2 Don Development Provides

Most facilities don't have this framework. And even if they do, most new DONs are too overwhelmed to follow it alone.

That's where Don 2 Don Development comes in.

We don't replace your leadership. We support it. We give you a peer who's been exactly where you are and knows how to navigate the chaos without losing yourself in it.

Here's what that looks like in practice:

Weekly Check-Ins: You're not alone in the fire. We help you prioritize what actually matters in each phase so you're not trying to fix everything at once.

Real-Time Problem Solving: When a family escalates or the state shows up early, you have someone to call who's handled it before. Not in theory. In real time.

Customized Action Plans: Every facility is different. We help you build a stabilization plan based on your risks, your staff, and your compliance gaps.

Leadership Coaching: The technical skills got you the job. But leading through chaos requires a different skill set. We help you develop it.

This isn't consulting. It's peer support from someone who knows the pressure, the timelines, and the stakes.

Why the First 90 Days Matter

Here's the reality: if you don't stabilize in the first 90 days, you probably won't make it to day 180.

Staff retention in nursing homes doesn't start with CNAs. It starts with leadership stability. When DONs keep leaving, everyone suffers. The staff stops trusting leadership. The systems break down. The state shows up. The cycle repeats.

But when a DON makes it through the first 90 days with support, structure, and a clear plan, everything changes.

The staff sees consistency. The administrator sees results. The state sees compliance. And you? You move from panic mode to leadership mode.

That's not luck. That's having the right system at the right time.

The Cost of Chaos

Let's talk numbers for a second.

The average cost of DON turnover is between $100,000 and $150,000 when you factor in recruitment, lost productivity, compliance risk, and staff morale. Most facilities will cycle through two or three DONs before they realize the problem isn't the candidate. It's the lack of support during the transition.

Meanwhile, you're spending nights wondering if you made the right call. You're missing family dinners. You're second-guessing every decision because no one prepared you for this level of chaos.

The cost isn't just financial. It's personal.

And it's preventable.

What Success Actually Looks Like

At the end of 90 days with the right support system, here's what changes:

You know your building inside and out. You've identified your top three compliance risks and have action plans for all of them. Your leadership team trusts you. Your staff knows you're staying. You're no longer reacting to every crisis: you're leading through them.

Most importantly? You're not burned out. You're not job searching. You're not wondering if you can do this.

You know you can. Because you just did.

A Final Thought

The revolving door isn't about bad DONs. It's about bad systems.

If you're in the first 90 days of a new role and you feel like you're drowning, that's not a reflection of your ability. It's a reflection of the lack of structure around you.

The best leaders don't succeed because they're superhuman. They succeed because they have the right support at the right time.

You don't have to figure this out alone.