| How many years have you been an RN? |
|
|
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| Are you: |
|
| |
|
| |
|
| |
|
| Type of facility in which you are employed: |
|
| |
|
| |
|
| |
|
| |
|
| Do you work: |
|
| |
|
| |
|
| |
|
| |
|
|
Please select the description that best reflects the patient care unit in which you work: |
|
| Medical/surgical |
Intermediate care nursery |
| Critical care unit |
Labor & Delivery |
| Emergency Department |
OR/Surgical services |
| Intensive care unit (Adult) |
Pediatrics |
| Intensive care unit (peds) |
Post-anesthesia/recovery |
| Intensive care unit (neonatal) |
Postpartum and well baby nursery |
| Rehab |
Psychiatric |
| Short-stay surgery |
Step-down/telemetry |
| |
Other |
| |
|
| Is your facility accredited by Joint Commission? |
|
| |
|
| |
|
| |
|
| Does your facility hold Magnet recognition? |
|
| |
|
| |
|
| |
|
| Is your facility pursuing Magnet recognition? |
|
| |
|
| |
|
| |
|
| Which shift do you usually work? |
|
| 8-hour day shift |
Rotating 12 hour shift |
| 12-hour day shift |
Rotating 8 hour shift |
| 8-hour evening shift |
Weekend only day shift |
| 8-hour night shift |
Weekend only night shift |
| 12-hour night shift |
Other |
| |
|
| What is the average daily census on the unit on which you work? |
|
| |
|
| On the unit and shift on which you work: |
|
| How many RNs are typically scheduled to work? |
| How many LPNs are typically scheduled to work? |
| How many nursing assistants are typically scheduled to work? |
| How many unit clerks are typically scheduled to work? |
| How many other staff are typically scheduled to work? |
| Please specify what staff fit into the other? |
| |
|
| How often are agency RNs utilized? |
|
| Never |
|
| Rarely |
|
| Sometimes |
|
| Frequently |
|
| Always |
|
| |
|
| The typical staffing ratio is?.. RNs Patients |
| |
|
| How often do you engage in non-nursing activities (deliver meal trays, transfer patients, draw labs, go to pharmacy) |
| Never |
|
| Rarely (less than monthly) |
|
| Sometimes (once a month) |
|
| Frequently (once a week) |
|
| Always (every day) |
|
| |
|
| What is the average number of patient admissions / discharges you perform each day? |
| |
|
| How often are you able to take your full meal break? |
|
| Never |
|
| Rarely (less than once a month) |
|
| Sometimes (several times a month) |
|
| Frequently (at least 1-2 times a week) |
|
| Always (every day) |
|
| |
|
| On your unit in the past year, do you believe the quality of nursing care has improved, declined, or stayed the same? |
| Improved |
|
| Declined |
|
| Stayed the same |
|
| |
|
Do you believe the staffing on your unit and shift is sufficient? |
|
| Yes |
|
| No |
|
| |
|
| Would you feel confident having someone close to you receive care in the facility in which you work? |
| Yes |
|
| No |
|
| |
|
Are you currently considering leaving your position? |
|
| Yes |
|
| No |
|
| |
|
| If yes, is the reason associated with inadequate staffing? |
|
| Yes |
|
| No |
|
| N/A |
|
| |
|
| Are you currently considering leaving nursing? |
|
| Yes |
|
| No |
|
| |
|
| If yes, is the reason associated with inadequate staffing? |
|
| Yes |
|
| No |
|
| |
|
| Do you know of anyone on your unit who has left direct care nursing due to concerns about unsafe staffing? |
| Yes |
|
| No |
|
| |
|
|
Please enter your State: |
|
| Please enter your zip code (optional): |
|
| |
|
| Identify the size of your facility. |
|
| <100 beds |
|
| 101-200 beds |
|
| 201-300 beds |
|
| 301-400 beds |
|
| 401-500 beds |
|
| >500 beds |
|
| |
|
| |
|
