Form ns1

2008 National Sample Survey

of Registered Nurses

DRAFT – FOR REVIEW

OMB No. 0915-0276

Exp. Date:

The 2008 National Sample Survey of Registered Nurses (NSSRN) is being conducted by the Health Resources and Services Administration of the U.S. Department of Health and Human Services and is the ninth cycle of the survey. All information will be kept private and your name will not be identified.

Instructions

How do I complete the survey electronically?

On your Web browser, log onto https://xxxplaceholderxxx and type in your unique Access Code that is printed in the box below. If you complete the survey online, you do not need to return this paper questionnaire.

What if I received more than one questionnaire?

We may not have been able to eliminate all of the duplicates in our list of nurses. Please complete only one questionnaire but return any extra copies you receive, preferably in the same envelope as your completed survey. Please write "DUPLICATE" at the top of these blank surveys. By returning extra surveys, we can avoid unnecessary follow-up mailings to you.

What if I have questions about this survey?

If you have any questions about this survey or about how to complete it electronically, please call (toll-free) 1-888-XXX-XXXX, or send an e-mail to xxxplaceholderxxx.

Please correct any errors in the name/address information and States where you are actively licensed.

[First Name M.I. Last Name]

[Street Address]

[City, State ZIP Code]

State(s) Where Actively Licensed:

[State 1, State 2, State 3]

Web site URL: https://xxxplaceholderxxx

Access Code: [XXXXXX]

Quex # [X]

Corrections to First Name Corrections to M.I.

Corrections to Last Name

Corrections to Number and Street

Corrections to City/Town

Corrections to State Corrections to ZIP Code

If there are any corrections to the “STATE” in the box above, please
re-list ALL of the states where you are actively licensed

OMB No.: 0915-0276 Expiration Date: x/xx/200X

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0915-0276. The time required to complete this information collection is estimated to average 20 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

Please mark an [X] in the box corresponding to your answer for each question, or supply the requested information.  Use blue or black ink.

EXAMPLE

RIGHT WAY WRONG WAY

[X] [9] [8] [X] [9] [8]

Section A. Eligibility and Education

1. On March 10, 2008, were you actively licensed to practice as a registered nurse (RN) in any U.S. State or the District of Columbia (whether or not you were employed in nursing at that time)?

1 Yes If Yes Go to Question 2.

2 No  If No, you do not need to complete this questionnaire. Please mark “no” and return this questionnaire so we know you are not eligible.

2. In what U.S. State, Territory, or District of Columbia were you issued your first RN license?

State/Territory code:   Year:

3. Which type of degree or credential qualified you for your first U.S. RN license? Mark one box only

1 Diploma Program 2 Associate Degree 3 Bachelor’s Degree

4 Master’s Degree 5 Doctorate 6 Other (specify) _______________

4. In what month and year did you graduate from this program?

Month:                  Year:

5. In which U.S. State (including the District of Columbia), U.S. Territory, or foreign country was this program located?

US: State/Territory code (Specify: ___________)

Other country: 1 Philippines 2 Australia 3 Canada 4 England/Ireland/Scotland 5 Other (Specify: ___________)

6. Please indicate all post-high-school degrees you received before starting your initial RN educational program. Mark all that apply.

0 None  If None, Go to Question 8

1 Associate Degree

2 Bachelor’s Degree

3 Master’s Degree

4 Doctorate

5 Other (Specify:_______________________)

7. What was the field of study for your highest degree identified in Question 6?
Mark one box only.

1 Health-related field

or

Non-Health related field

2 Biological or Physical Science

3 Business or Management

4 Education

5 Liberal Arts, Social Science, or Humanities

6 Law

7 Computer Science

8 Social Work

9 Other non-health-related field

(Specify: )

8. Have you ever been licensed as a licensed practical nurse (LPN) or licensed vocational nurse (LVN) in the U.S.?

1 Yes

2 No

9. Before completing your initial RN educational program, please indicate if you ever were employed as any of the following:
Mark all that apply.

  1 Nursing Aide/Nursing Assistant

  2 Home health aide/assistant

  3 Licensed Practical/Vocational Nurse

  4 Emergency Medical Technician (EMT) or Paramedic

  5 Medical assistant

  6 Dental assistant

  7 Allied Health technician/technologist (such as, radiological technician, laboratory technician)

  8 Manager in health care setting

  9 Clerk in health care setting

10 Military medical corps

11 Medical doctor

12 Midwife

13 Another type of health-related position

(Specify: )

14 No health-related job before RN education

10. How did you finance your initial RN education?

Mark all that apply.

  1 Earnings from your health-care-related employment

  2 Earnings from your non-health-care-related employment

  3 Earnings from other household members

  4 Personal household savings

  5 Other family resources (parents or other relatives)

  6 Employer tuition reimbursement plan (including Veterans Administration employer tuition plan)

  7 Federal traineeship, scholarship, or grant

  8 Federally-assisted loan

  9 Other type of loan

10 State/local government scholarship, or grant

11 Non-government scholarship, or grant

12 Other resources

11. Since January 2001, please indicate if you have received, or provided training, in recognizing or responding to the following disasters or emergencies.
Mark all that apply.

0 None  If None, Go to Question 12, page 4

2 Chemical accident or attack

3 Nuclear/radiological accident or attack

4 Infectious disease epidemics

5 Biological accident or attack

6 Natural disaster

7 Other public health emergencies

11a. If you have marked any of the above types of training, then please specify the TOTAL number of hours spent in the above training(s) since January 2001.

Hours of training received

Hours of training provided

11b. Pertaining to the training in the area in which you are best prepared, how prepared are you to effectively participate in a response to such an emergency?

1 Very prepared 2 Somewhat prepared

3 Poorly prepared 4 Not at all prepared

11c. How well do you know the disaster/emergency plan at your place of employment?

1 Full understanding of disaster/emergency plan

2 Some understanding of disaster/emergency plan

3 No understanding of disaster/emergency plan

4 No plan exists at my place of employment

5 Not employed or self-employed

12. Did you earn any additional academic degrees AFTER graduating from your initial registered nurse education program that you described in Question 3? Do not include degrees you are currently working towards.

1 Yes Please complete all columns of the following table for each degree you earned.

2 No  If No, Go to Question 13, page 5

A

B

C

D

E

F

Type of Degree

Did you receive this degree?

Mark all that apply.

What was the primary focus of this degree?

Enter two-digit code from table below.

Has this degree been related to your career in nursing?

In what year did you receive the degree?

In what state or country did you receive this degree?

Was this degree program undertaken through a distance-based learning program? (more than 50% of coursework through correspondence or online)

Nursing degrees

a. Associate Degree in nursing

01

Yes

No

b. Bachelor’s degree in nursing

01

Yes

No

c. Master’s in nursing

Yes

No

d. Another Master’s in nursing

Yes

No

e. Doctorate in nursing (such as PhD, ScD, DNS, ND, DNP)

Yes

No

Non-nursing degrees

f. Associate Degree in non-nursing field

Yes

No

Yes

No

g. Bachelor’s degree in non-nursing field

Yes

No

Yes

No

h. Master’s in non-nursing field

Yes

No

Yes

No

i. Another Master’s in non-nursing field

Yes

No

Yes

No

j. Doctorate in non-nursing (such as Ph.D., J.D., M.D., Ed.D.)

Yes

No

Yes

No



For Column B, enter the two-digit code for your

Bachelor’s (other), Master’s, or Doctorate degree above.

Primary Focus of Degree
01 Clinical Practice 02 Administration/Business/Management 03 Education 04 Public health/community health 05 Law 06 Biological or Physical Sciences	07 Humanities, Liberal Arts, or Social Sciences 08 Informatics 09 Computer Science 10 Research 11 Social Work 12 Other health field 13 Other non-health field

13. Since graduating from the initial nursing program you described in Question 3, have you completed a formal educational program preparing you as a nurse practitioner, clinical nurse specialist, nurse-midwife or nurse anesthetist?

1 Yes Please complete questions 12a-f for each specialty you have obtained.

2 No  If No, Go to Question 14, Page 6

	A	B	C	D
Information on preparation and credentials	Nurse Practitioner (NP)	Clinical Nurse Specialist (CNS)	Nurse-Midwife (NM)	Nurse Anesthetist (NA)
13a. Did you receive preparation as a …? Mark each column if yes.
13b. What was the length of the program? 1. Less than 8 months 2. 8 -12 months 3. 13-36 months 4. 37 months or more	(Mark one) 1 2 3 4	(Mark one) 1 2 3 4	(Mark one) 1 2 3 4	(Mark one) 1 2 3 4
13c. What was the highest credential you received in that program? 1. Certificate/Award 2. Bachelor’s degree 3. Master’s degree 4. Post-Master’s Certificate 5. Doctorate	(Mark one) 1 2 3 4 5	(Mark one) 1 2 3 4 5	(Mark one) 1 2 3 4 5	(Mark one) 1 2 3 4 5
13d. In what year did you receive this credential?
13e. Do you have certification from a national certifying organization for this specialty? IF YES: 13e-2 Is this certification required by your employer for your job?	Yes No Yes No	Yes No Yes No	Yes No Yes No	Yes No Yes No
13f. Do you have certification or recognition from a State Board of Nursing for this specialty? IF YES: 13f-2. Is this certification or recognition required by your employer for your job?	Yes No Yes No	Yes No Yes No	Yes No Yes No	Yes No Yes No

13g. Which specialties were the focus of your studies ? Mark all that apply.

1Critical Care 2Acute Care 3Adult Health 4General Medical Surgical 5Anesthesia 6Cardiac Care 7Community Health 8Family care

9 Geriatric/Gerontology 10Maternal-Child Health 11Neonatal 12Nurse-Midwifery 13Obstetric/Gynecology 14Oncology 15Pediatrics 14Psychiatric/Mental Health

16Rehabilitation 17Occupational Health 18Home Health 19Palliative Care 20School Health 21Women’s Health 22Other (Specify:____________________)

14. As of March 10, 2008, were you enrolled in a formal education program leading to an academic degree or certificate?

1 Yes

2 No  If No, Go to Section B

15. Was this formal education program…?
Mark one box only.

1 In nursing

2 In a non-nursing field to enhance your career/employment in nursing

3 In a non-nursing field to allow you to pursue career/employment opportunities outside of nursing

4 In an area of personal interest without regard to future employment

16. Were you a full-time or part-time student?

1 Full-time student

2 Part-time student

16a. What percent of your coursework was distance-based (online or correspondence)?

1 0%

2 1-25% 

3 26-50%

4 51-75%

5 76-100%

17. What type of degree or award have you been working toward in this program?
Mark one box only.

1 Associate Degree

2 Bachelor’s Degree

3 Master’s Degree

4 Doctorate

5 Post-Master’s Certificate

6 Other Certificate

Section B. Principal Nursing Employment

For this section, employment means receiving pay from nursing work, even if on a temporary leave of absence from your nursing position; on vacation; on sick leave; or working through an employment service or practicing private duty nursing and not on a case at the moment

18. On March 10, 2008, were you employed or self-employed in nursing?

1 Yes

2 No  If No Go  to Section D on Page11

For all the questions in this section (Questions 19 through 31), your principal nursing position is the nursing position in which you spent the largest share of your working hours, as of March 10, 2008.

19. Are you required to maintain an active RN license in order to hold your principal nursing position?

1 Yes

2 No

20. Where was the location of your principal nursing position on March 10, 2008? This information is critical for developing State employment estimates and supply and demand projections. (If you are not employed in a fixed location, enter the location that best reflects where you practice.)

City/Town: 

County:  

State (or country if not USA):  

ZIP+4 code: -

(if available)

21. In your principal nursing position on March 10, 2008, were you…
Mark one box only

1 An employee of the organization or facility where you were working?

2 Employed through an employment agency, but not as a traveling nurse?

3 Employed through an employment agency as a traveling nurse?

4 Self-employed, per diem, or working as-needed ?

22. Which one of the following best describes the employment setting of your principal nursing position on March 10, 2008? Mark one box only

Hospital (including all types of care at a hospital location) Community hospital or medical center, non-Federal, short stay 111Inpatient unit 112Nursing home unit in hospital 113Outpatient clinic/medical practice owned by a hospital 114Outpatient clinic/medical practice located at a hospital but not owned by the hospital 115Other administrative or functional area Specialty hospital, Non-Federal (such as children’s, heart, cancer) 121Inpatient unit 123Outpatient clinic/medical practice owned by a hospital 124Outpatient clinic/medical practice located at a hospital but not owned by the hospital 125Other administrative or functional area Long-term hospital, Non-psychiatric, Non-Federal 131Inpatient unit 132Nursing home unit in hospital 135Other administrative or functional area Psychiatric hospital, Non-Federal 141Inpatient unit 142Nursing home unit in hospital 143Outpatient clinic/medical practice owned by a hospital 144Outpatient clinic/medical practice located at a hospital but not owned by the hospital 145Other administrative or functional area Federal Government hospital (such as Military, VA, NIH or IHS-supported) 151Inpatient unit 152Nursing home unit in hospital 153Outpatient clinic/medical practice located at a hospital 155Other administrative or functional area Hospital unit in an institution or part of university or correctional facility 160 All types Other Type of hospital 171Inpatient unit 172Nursing home unit in hospital 173Outpatient clinic/medical practice owned by a hospital 174Outpatient clinic/medical practice located at a hospital but not owned by the hospital 175Other administrative or functional area (Specify: ____________________________) Nursing Home/Extended Care Facility 210Nursing home/extended care facility (not in a hospital) 220Facility for mentally retarded or developmentally disabled 230Residential care/assisted living facility 240Other type of extended care facility (Specify: ____________________________) Academic Education Program 310LPN/LVN program 320Diploma program (RN) 330Associate degree RN program 340Bachelor’s and/or higher degree RN program 350Associate degree RN and LPN/LVN program 360Associate degree RN and BSN program 370Other education program, not patient education (Specify: )

Home Health Setting 410Visiting nurse service (VNS/VNA) 420Home health service unit (hospital-based) 430Home health agency (non-hospital based) 440Private duty in a home setting 450Hospice 460Other home health setting Public or Community Health Setting 510State Health or Mental Health Agency 520City or County Health Department 530Correctional Facility (non-hospital) 540Community mental-health organization or clinic 550Substance abuse center/clinic 560Other community setting (Specify: _________________________________) School Health Service 610School or school system (K-12) 620College or university 630Other school health setting Occupational Health (Employee Health Service) 710Private industry 720Government occupational health services 730Other occupational health setting Ambulatory Care Setting, not located in a hospital 810Medical/physician practice 820Nurse practice 830In-store or retail clinic 840Community health center 850Federal clinic (such as Military, VA, NIH or IHS-supported) 860Federally-supported clinic (not a community health center) 870Hospital-owned off-site clinic or surgery center 880Ambulatory surgical center, not hospital-owned 890Urgent care 900Dialysis center or clinic, not in a hospital 905Other ambulatory setting (Specify: _________________________________) Insurance Claims/Benefits/Utilization Review 910Government insurer/benefits department: federal, state, or local 920Insurance company or other private claims/benefits/utilization review organization Other 930Policy, planning, regulatory, or licensing agency 940Consulting organization 950Home-based self-employment 960Telehealth, telenursing or call center 970Pharmaceutical/medical device/medical software 980Other (Specify: _________________________________)

23. Which one of the following best corresponds to the job title for your principal nursing position, as of March 10, 2008? Mark one box only.

01 Staff nurse or direct care nurse

02 Charge nurse or team leader

03First-line management (such as nurse manager, head nurse, floor supervisor)

04 Middle management/administration (such as Assistant director, House Supervisor, Associate Dean, department head)

05Senior management/administration (such as, CEO, Vice President, Nursing Executive, Dean)

06 Certified nurse anesthetist (CRNA)

07 Clinical nurse specialist

08 Certified nurse-midwife

09 Nurse practitioner

10 School nurse

11 Public health nurse

12 Community health nurse

13 Patient educator

14 Staff educator or instructor in clinical setting

15 Staff development director

16 Instructor/lecturer

17Professor

18 Patient care coordinator, case manager, discharge planner

19 Quality improvement nurse, utilization review nurse

20 Infection control

21 Advice/triage nurse

22 Informatics nurse

23 Consultant

24 Legal nurse

25 Researcher

26 Surveyor/auditor/regulator

27 No position title

28 Other (Specify:___________________________) 

24. For your principal nursing position on March 10, 2008, please estimate the percentage of your time spent in the following activities during a usual workweek. (The total should equal 100%. Do not use decimal places.)

a. Patient care, hands-on	%
b. Patient care, not hands-on (such as charting, patient education, family communication, communication with other health care providers)	%
c. Non-nursing tasks (such as housekeeping, transport, locating supplies)	%
d. Consultation with agencies and/or professionals	%
e. Supervision and management	%
f. Administration	%
g. Research	%
h. Teaching, precepting or orienting students or new hires (include preparation time)	%
i. Other	%
j. TOTAL (confirm sum is 100%)	%

25a. During a typical workweek in the principal nursing position you held on March 10, 2008, in what level of care or type of work do you spend the majority of your time? Mark one or more boxes.

01 General or specialty inpatient

02 Critical/intensive care

03 Step-down, transitional, progressive, telemetry

04 Sub-acute care

05 Emergency

06 Urgent care

07 Rehabilitation

08 Long-term care/nursing home

09 Surgery (including ambulatory, pre-operative, post-operative, post-anesthesia)

10 Ambulatory care (including primary care, outpatient settings, except surgical)

11 Ancillary care (such as radiology, laboratory)

12 Home health

13 Public health/community health

14 Education

15 Business, administration, review, case management

16 Research

17 Other (Specify:_______________________)

25b. During a typical workweek in your principal nursing position, with what patient population do you spend at least 50% of your patient care time?

01 No patient care  If No Patient Care, Go To Question 26

02 Adult

03 Geriatric

04 Pre-natal

05 Newborn or neonatal

06 Pediatric

07 Adolescent

08 Multiple age groups (no more than 50% of time spent with any of the above)

25c. During a typical workweek in your principal nursing position, in what type of clinical specialty do you spend most of your patient care time? Mark one or more boxes.

01 No patient care

02 Primary care

03 General care

04 General medical surgical

05 Cardiac or cardiovascular care

06 Chronic care

07 Dermatology

08 Emergency or trauma care

09 Gastrointestinal (GI)

10 Gynecology (including women’s health)

11 Hospice

12 Infectious/communicable disease

13 Labor and delivery

14 Obstetrics

15 Neurological

16 Occupational health

17 Oncology

18 Orthopedics

19 Psychiatric or mental health (including substance abuse and counseling)

20 Pulmonary/respiratory

21 Radiology (diagnostic or therapeutic)

22 Renal/dialysis

23 No specific area

24 Other specialty for a majority of my time (Specify one area: ________________________)

26. When you work at this principal nursing position, do you work…?
(Mark one box only.)

1 Full-time (including full-time for an academic year)

2 Part-time (including working only part of the calendar or academic year)

27. How many weeks were there in your normal work year for that principal nursing position? Include in your work year professional training and meetings, sick leave, paid vacation, training, holidays, and other administrative leave.
Enter a number from 01 to 52.

weeks

28. Please provide information about the number of hours you work in a typical workweek at that principal nursing position.

Hours

(enter 000 if none)

a. Number of hours worked in your last full workweek, including all overtime and on-call hours, except on-call hours that were stand-by only
b. Number of hours you stated above in “a” that were worked from on-call duty. Do not include stand-by hours
c. Number of hours you stated above in “a” that were paid as overtime. Include ALL overtime
d. Number of paid overtime hours you stated above in “c” that were mandatory overtime
e. Number of paid or unpaid on-call hours that were stand-by only
f. Number of stand-by hours you stated above in “e” that were paid at an on-call stand-by rate

29. Please estimate your gross annual earnings (pre-tax) from your principal nursing position this year. Include overtime and bonuses, but exclude sign-on bonuses.

$ , , .00 per year

30. Were you represented by a labor union or collective bargaining unit in the principal nursing position you held on March 10, 2008?

1 Yes

2 No

31. Do you plan to leave or have you left the principal nursing position you held on March 10, 2008?

Yes, have left or will leave within the next 12 months

Yes, in 1 year to 3 years

No plans to leave within next 3 years
 If No, Go to Question 32

Undecided If Undecided, Go to Question 32

31a. Do you plan to remain in the nursing profession after you leave that position?

Yes

No

Unsure

Section C. Secondary Employment in Nursing

32. Aside from the principal nursing position you just described, on March 10, 2008, did you hold any other positions in nursing for pay?

1 Yes

2 No  If No, Go to Section E on Page 12.

33. In your other nursing position(s), are you...?
Mark all that apply.

1 An employee of the organization or facility for which you are working?

2 Employed through an employment agency, but not as a traveling nurse?

3 Employed through a traveling agency?

4 Self-employed, per diem, or on as-needed basis?

34. What type of work settings best describe where you work for your other nursing position(s)?
Mark all that apply.

01 Hospital

02 Nursing home/Extended care facility

03 Academic education program

04 Home health setting

05 Public or community health setting

06 School health service

07 Occupational health

08 Ambulatory care setting

09 Insurance claims/benefits

10 Telehealth, telenursing or call center

11 Other (Specify: ___________________)

35. In your additional nursing position(s), please indicate how much you work, and where the job is located:

	Weeks per year	Average hours per week, during weeks of work	Location of where most of work is done (state, territory, or country)
Additional job #1
Additional job #2
All other jobs			N/A

36. Please estimate your current, gross annual earnings (pre-tax) from all your other nursing position(s). Do not include your earnings from your principal nursing position.

$

,

, , .00  per year

Section D. Nurses Not Working in Nursing

If you were working for pay in nursing on March 10, 2008, please go to Section E on Page 12

37. What are your intentions regarding work in registered nursing?

Currently seeking employment in nursing

How long have you been seeking employment in nursing?  _____ weeks

Are you looking for a position that is  ___Full-time  ___Part-time   ___either?

Plan to return to nursing in the future

___ less than one year or have returned since March 10, 2008

___ 1-2 years

___ 3-4 years

___ 5 or more years

No intention to work for pay in nursing or retired

Undecided at this time

38. If you are not working for pay in nursing, how long has it been since you last were employed or self-employed as a registered nurse?

Years (if one or more)

1 Less than one year

0 Never worked as a registered nurse

39. What are the primary reasons you are not working in a nursing position for pay?
Mark yes or no for each item.

	Yes No
a. Retired	1 2
b. Taking care of home and family	1 2
c. Burnout/stress on the job	1 2
c. Stressful work environment	1 2
d. Scheduling/inconvenient hours/too many hours	1 2
e. Physical demands of job	1 2
f. Disability	1 2
g. Illness	1 2
h. Inadequate staffing	1 2
i. Salaries too low/better pay elsewhere	1 2
j. Skills are out-of-date	1 2
k. Liability concerns	1 2
l. Lack of collaboration/communication between health care professionals	1 2
m. Inability to practice nursing on a professional level	1 2
n. Lack of advancement opportunities	1 2
o. Lack of good management or leadership	1 2
p. Career change	1 2
q. Difficult to find a nursing position	1 2
r. Travel	1 2
s. Volunteering in nursing	1 2
t. Went back to school	1 2

u. Other (Specify:________________________________)

Section E. Employment Outside Nursing

40. Are you currently employed for pay in an occupation other than nursing?

1 Yes

2 No  If No, Go to Section F

41. Is this employment with a health-related organization or in a health-related position?

1 Yes

2 No

42a. Please select from the list below the item that best describes the field of your principal position outside of nursing.

01 Computer services

02 Consulting organization

03 Emergency response (ambulance, fire, police)

04 Financial, accounting, and insurance services

05 Legal

06 Elementary and secondary education

07Food services

08Government

09 Health-related services, outside nursing

10 Pharmaceutical, biotechnology, or medical equipment

11 Real estate

12 Retail sales and services

13 Other (Specify: ___________________________)

42b. Which of the following best describes your job title for your principal position ouside of nursing?

1 Business owner or proprieter

2 Management

3 Administrative or clerical support

4 Consultant or researcher

5 Other type of employee (Specify: ______________)

43. How many weeks are there in the normal work year of this principal position outside of nursing?

weeks per year

44. What is the average number of hours you work per week in your principal position outside of nursing?

hours per week

45. Please estimate your current, gross annual earnings (pre-tax) from your principal position outside of nursing.

$

,

, , .00  per year

Section F. Prior Nursing Employment

46. For this question count only the years you worked at least 50% of the calendar year in nursing. Since receiving your first RN license how many years have you worked in nursing?

Years (if one or more)

0 Less than one year

47. Have you left work in nursing for one or more years in your career?

1 Yes    Total years (if one or more)

  0 No

99 Have not worked in nursing more than one year

48. Were you employed in nursing one year ago?

1 Yes

2 No  If No, Go to Section G, page 15.

49. In that principal nursing position, did you work…?
Mark one box.

1 Full-time (including full-time for an academic year)

2 Part-time (including working only part of the calendar or academic year)

50. How would you describe your principal nursing position on March 10, 2007?

1 Same position/same employer as principal nursing position on March 10, 2008  Go to Section G, page 15

2 Different position/same employer as current one

3 Different employer than current one

51. What was the location of your principal nursing position on March 10, 2007? (If you were not employed in a fixed location enter the location that best reflects where you practice.)

City/Town: 

County:  

State (or country if not USA):  

ZIP+4 code: -

(if available)

52. Were any of the following the primary reason(s) for your employment change?
Mark yes or no for each item.

	Yes No
a. Burnout/stress on the job	1 2
b. Stressful work environment
b. Interested in another position/job	1 2
c. Lack of advancement opportunities	1 2
d. Lack of collaboration/communication between health care professionals	1 2
e. Lack of good management or leadership	1 2
f. Career advancement/promotion	1 2
g. Inadequate staffing	1 2
h. Interpersonal differences with colleagues or supervisors	1 2
i. Physical demands of job	1 2
j. Opportunity to do the kind of nursing that I like	1 2
k. Pay/benefits better	1 2
l. Scheduling/inconvenient hours/too many hours	1 2
m. Relocated to different geographic area	1 2
n. Reorganization that shifted positions	1 2
o. Laid off/downsizing of staff	1 2
p. Sign-on bonus offered	1 2
q. Personal/family	1 21 2
r. Went back to school
s. Retired	1 2
t. Disability	1 2
u. Illness	1 2

v. Other (Specify:____________________________________)

53. Which one of the following best describes the employment setting of your principal nursing position on March 10, 2007? Mark one box only

Hospital (including all types of care at a hospital location) Community hospital or medical center, non-Federal, short stay 111Inpatient unit 112Nursing home unit in hospital 113Outpatient clinic/medical practice owned by a hospital 114Outpatient clinic/medical practice located at a hospital but not owned by the hospital 115Other administrative or functional area Specialty hospital, Non-Federal (such as children’s, heart, cancer) 121Inpatient unit 123Outpatient clinic/medical practice owned by a hospital 124Outpatient clinic/medical practice located at a hospital but not owned by the hospital 125Other administrative or functional area Long-term hospital, Non-psychiatric, Non-Federal 131Inpatient unit 132Nursing home unit in hospital 135Other administrative or functional area Psychiatric hospital, Non-Federal 141Inpatient unit 142Nursing home unit in hospital 143Outpatient clinic/medical practice owned by a hospital 144Outpatient clinic/medical practice located at a hospital but not owned by the hospital 145Other administrative or functional area Federal Government hospital (such as Military, VA, NIH or IHS-supported) 151Inpatient unit 152Nursing home unit in hospital 153Outpatient clinic/medical practice located at a hospital 155Other administrative or functional area Hospital unit in an institution or part of university or correctional facility 160 All types Other Type of hospital 171Inpatient unit 172Nursing home unit in hospital 173Outpatient clinic/medical practice owned by a hospital 174Outpatient clinic/medical practice located at a hospital but not owned by the hospital 175Other administrative or functional area (Specify: ____________________________) Nursing Home/Extended Care Facility 210Nursing home/extended care facility (not in a hospital) 220Facility for mentally retarded or developmentally disabled 230Residential care/assisted living facility 240Other type of extended care facility (Specify: ____________________________) Academic Education Program 310LPN/LVN program 320Diploma program (RN) 330Associate degree RN program 340Bachelor’s and/or higher degree RN program 350Associate degree RN and LPN/LVN program 360Associate degree RN and BSN program 370Other education program, not patient education (Specify: )

Home Health Setting 410Visiting nurse service (VNS/VNA) 420Home health service unit (hospital-based) 430Home health agency (non-hospital based) 440Private duty in a home setting 450Hospice 460Other home health setting Public or Community Health Setting 510State Health or Mental Health Agency 520City or County Health Department 530Correctional Facility (non-hospital) 540Community mental-health organization or clinic 550Substance abuse center/clinic 560Other community setting (Specify: _________________________________) School Health Service 610School or school system (K-12) 620College or university 630Other school health setting Occupational Health (Employee Health Service) 710Private industry 720Government occupational health services 730Other occupational health setting Ambulatory Care Setting, not located in a hospital 810Medical/physician practice 820Nurse practice 830In-store or retail clinic 840Community health center 850Federal clinic (such as Military, VA, NIH or IHS-supported) 860Federally-supported clinic (not a community health center) 870Hospital-owned off-site clinic or surgery center 880Ambulatory surgical center, not hospital-owned 890Urgent care 900Dialysis center or clinic, not in a hospital 905Other ambulatory setting (Specify: _________________________________) Insurance Claims/Benefits/Utilization Review 910Government insurer/benefits department: federal, state, or local 920Insurance company or other private claims/benefits/utilization review organization Other 930Policy, planning, regulatory, or licensing agency 940Consulting organization 950Home-based self-employment 960Telehealth, telenursing or call center 970Pharmaceutical/medical device/medical software 980Other (Specify: _________________________________)

Section G. General Information

54. How would you best describe your feelings about your principal job (in any field), or most recent job if you are not now working? Mark one box only.

1 Extremely satisfied

2 Moderately satisfied

3 Neither satisfied nor dissatisfied

4 Moderately dissatisfied

5 Extremely dissatisfied

6 Neither currently nor previously employed

Answers to the following questions will be used solely to statistically interpret your responses.

55. Where do you currently reside? This information is critical for producing State estimates of the nursing workforce.

City/Town:

County:

State (or country if not USA):

ZIP+4 code: -

(if available)

56. Did you reside in the same city/town a year ago?

1 Yes  If Yes, Go to Question 58

2 No

57. Where did you reside a year ago?  This information is critical for producing State estimates.

City/Town:

County:

State (or country if not USA):

ZIP+4 code: -

(if available)

58. What is your gender?

1 Male

2 Female

59 What is your year of birth?

1

9

60a. Are you Latino or Hispanic?

1 Yes

2 No

60b. Which one or more of the following you would use to describe yourself. Mark all that apply.

1 White

2 Asian

3 Black or African American

4 American Indian or Alaska Native

5 Native Hawaiian or Other Pacific Islander

61. What languages do you speak fluently other than English? Mark all that apply.

1 No other languages 2 Spanish 3 Filipino language (Tagalog, other Filipino dialect) 4 Chinese language (Cantonese, Mandarin, other Chinese language) 5 French

6 German 7 American Sign Language 8 Other (specify) 9 Other (specify) 10 Other (specify) ______________

62. Which best describes your current marital status?

1 Married or in domestic partnership

2 Widowed, divorced, separated

3 Never married

63. Describe the children/parents/dependents who either live at home with you or for whom you provide a significant amount of care.
Mark all that apply.

1 No children/parents/dependents at home

2 Child(ren) less than 6 years old at home

3 Child(ren) 6 to 18 years old at home

4 Other adults at home (i.e., parents or dependents)

5 Others living elsewhere (i.e., children, parents or dependents)

64. Including employment earnings, investment earnings, and other income of all household members, what is your current, gross annual total household income (pre-tax)? Pick one appropriate category.

1 $15,000 or less

2 $15,001 to $25,000

3 $25,001 to $35,000

4 $35,001 to $50,000

5 $50,001 to $75,000

6 $75,001 to $100,000

7 $100,001 to $150,000

8 $150,001 to $200,000

9 More than $200,000

Section H. License and Certification Detail

65. Please provide any other names for which you may have held a nursing license.

_________________________________

_________________________________

_________________________________

66. The following list has been grouped by on-the-job/functional certifications followed by national organizations that offer nursing certifications and finally other certifications you may have received. Please review the entire list and indicate what nursing certifications you have received. Mark up to Five certifications

No professional nursing certifications  If None, Go to Section I, Page 17

Functional Certifications

Advanced Cardiac Life Support (ACLS)

Pediatric Advanced Life Support (PALS)

Advanced Trauma Life Support (ATLS)

Advanced Burn Life Support (ABLS)

Neonatal Advanced Life Support (NALS)

Advanced Life Support (ALS)

Advanced Lecturing Life Support (ALLS)

Neonatal Sug/Temp/Air/BP/Lab/Emotion (STABLE)

Basic Life Support (BLS)

Basic Cardiac Life Support (BCLS)

Cardiopulmonary resuscitation (CPR)

Neuronal Ceroid Lipofuscinoses (NCLS)

Neonatal Resuscitation Provider (NRP)

Chemotherapy, without ONS ONC certification

Emergency Nursing – Pediatric Course (ENPC)

Emergency Medicine Technician (EMT)

Course in Advanced Trauma Nursing (CATN)

Trauma Nursing Course Certification (TNCC)

Advanced Trauma Care Nurse (ATCN)

Fundamental critical care support & instructor (FCCS)

Electrocardiogram (EKG)

Balloon Pump (IABP)

Red Cross Instructor

American Academy of Nurse Practitioners (AANP)

Nurse Practitioner

Council on Certification of Nurse Anesthetists

Nurse Anesthetist (CRNA)

American Midwifery Certification Board/American College of Nurse Midwives

Nurse Midwife (CNM)

American Nurses Credentialing Center (ANCC)

Nurse Practitioner

Acute Care Nurse Practitioner

Adult Nurse Practitioner

Advanced Diabetes Management Nurse Practitioner

Family Nurse Practitioner

Family Psychiatric & Mental Health Nurse Practitioner

Gerontological Nurse Practitioner

Palliative Care Nurse Practitioner (PCM-NP)

Pediatric Nurse Practitioner

Psychiatric & Mental Health Nurse Practitioner - Adult

Psychiatric & Mental Health Nurse Practitioner - Family

School Nurse Practitioner

Clinical Nurse Specialist

Adult Health Clinical Nurse Specialist

Medical-Surgical Clinical Nurse Specialist

Advanced Diabetes Management Clinical Nurse Specialist

Community Health Clinical Specialist

Gerontological Clinical Nurse Specialist

Home Health Clinical Nurse Specialist

Palliative Care Nurse (PCM-CNS)

Pediatric Clinical Nurse Specialist

Psychiatric & Mental Health Clinical Nurse Specialist - Adult

Psychiatric & Mental Health Clinical Nurse Specialist - Child/Adolescent

Psychiatric & Mental Health Clinical Nurse Specialist - Family

Public/Community Heath Clinical Nurse Specialist

Advanced Diabetes Management

Dietician – Advanced Diabetes Management

Pharmacist- Advanced Diabetes Management

Other Specialty Nursing

Ambulatory Care Nurse

Cardiac Rehabilitation Nurse

Cardiac Vascular Nurse

Case Management Nurse

College Health Nurse

Community Health Nurse

General Nursing

Gerontological Nurse

High-Risk Perinatal Nurse

Home Health Nurse

Informatics Nurse

Medical-Surgical Nurse

Nursing Administration (CNA)

Nursing Administration, Advanced (CNAA)

Nursing Professional Development (NPD)

Pain Management Nurse

Pediatric Nurse (CPN)

Perinatal Nurse

Psychiatric Mental Health Nurse

Public/Community Health Nurse

School Nurse

American Association of Critical Care Nurses Certification Corp (AACCNCC)

Critical Care Registered Nursing (CCRN)

Cardiac Medicine (CMC)

Cardiac Surgery (CSC)

Critical Care CNS (CCNS)

Progressive Care (PCCN)

Acute Care Nurse Practitioner (ACNPC)

Pediatric Nursing Certification Board (PNCB)

Certified Pediatric Nurse (CPN)

Certified Pediatric Nurse Practitioner – Primary Care (CPNP-PC)

Certified Pediatric Nurse Practitioner – Acute Care (CPNP-AC)

National Certification Board of Pediatric Nurse Practitioners & Nurses (NCPNP/N)

Certified Pediatric Nurse Practitioner (CPNP)

Certified Pediatric Nurse (CPN)

National Certification Corporation for the Obstetric, Gynecologist, and Neonatal Nursing Specialties (NCC)

Ambulatory Women’s Health Care Nurse

Breastfeeding (RN-BC, RNC

Electronic Fetal Monitoring (EFM)

Gynecology/Reptroductive Health Care (GR)

High Risk Neonatal Nurse (HRNN

Inpatient Obstetric Nursing (INPT)

Low Risk Neonatal Nursing (LRN)

Maternal Newborn Nurse (MN)

Menopause Educator or Clinician (MC, ME)

Neonatal Intensive Care Nursing (NIC)

Neonatal Nurse Practitioner

Obstetric Nursing (OB)

Reproductive Endocrinology/Infertility Nurse

Telephone Nursing Practice (TNP)

Women’s Health Care Nurse Practitioner

Board of Certification for Emergency Nurses (BCEN)

Emergency Nurse (CEN)

Flight Nurse (CFRN)

Certification Board for Urologic Nurses & Associates

Urologic Clinical Nurse Specialist (CUCNS)

Urologic Nurse Practitioner (CUNP)

Urologic Nurse (CURN)

Oncology Nursing Certification Corporation (ONCC)

Oncology Certified Nurse  (OCN)

Certified Pediatric Oncology Nurse (CPON)

Advanced Oncology Certified Nurse Practitioner

Advanced Oncology Certified Clinical Nurse Specialist (AOCN)

Association of Perioperative Registered Nurses (AORN)

Surgical Services Management

Operating Room Nurse (CNOR)

First Assistant Nurse (CRNFA)

American Board of Perianesthesia Nursing Certification (ABPANC)

Anesthesia Nurse (CPAN)

Certified Post Anesthesia Nurse (CPAN)

Certified Ambulatory Perianesthesia Nurse (CAPA)

American Board for Occupational Health Nurses (ABOHN)

Certified Occupational Health Nurse (COHN)

Certified Occupational Health Nurse-Specialist (COHN-S)

Case Management (COHN-CM)

Safety Management (COHN-SM)

Other National Agencies and Organizations

Addictions, or Substance Abuse Nurse (CARN, CARN-AP), CDNS, NCAC)

AIDS/HIV or Immune Suppresion Nurse (ACRN or AACRN)

Assisted Living Administration

Bereavement or Grief Counselor (RTSC)

Biofeedback or Neurobiofeedback Nurse

Cardiac or Vascular Nursing (CVN)

Case Manager (CCM, CMC, NCM)

Childbirth Educator, Postnatal Educator, Perinatal Fitness (CCE, LCCE)

Clinical Aromatherapy Practitioner

Clinical Research Associate/Coordinator (CRA, CCRC CCRP)

Coder (RN Coder, CPC)

Collaborative Institutional Training Initiative for Research Ethics (CITI)

Continuity of Care (NBCCC)

Correctional Health Nurse (CHN)

Crisis Prevention Instructor (CPI)

Dermatology Nurse (DNC, DN)

Developmental Disabilities Nurse (CDDN)

Diabetes Educator (CDE)

Dialysis or Hemodialysis Nurse (CDN, CHN, CPDN)

Disability Management (CDMS, CDMSC, CIRSC)

Domestic Violence / Sexual Assault (SAFE, SANE, FNE, SANC, SAE)

Ergonomic Manager (CEM)

Enterostomal Therapy Nurse (CETN)

Emergency Nurse (CEDNAP, CEN, CFRN)

Flight Nurse, Mobile Intensive Care Nurse (MICN, NICU, CFRN)

Forensic Nurse (CFN, FN)

Gastroenterological Nurse (CGN or CGRN)

Genetics Nursing (APNG, GCN)

Healing Touch Practitioner or Health Touch Instructor (HT)

Healthcare Facility Manager, Long Term Care Director (CHFM, CNDLTC, DON)

High-Risk Obstetric Nursing (NAACOG)

Holistic Nurse (HNC, HN-BC, or AHN-BC)

Home Care Surveyor

Hospice and Palliative Care Nurse (CHPN, CRNH, or ACHPN)

Hyperbaric Nurse (CHRN, ACHN, HNC))

Infection Control Nurse (CIC)

Infusion/Intravenous Nurse (CRNI, IN)

Lactation Consultant (IBCLC, ICLA)

Legal Nurse Consultant (LNCC, LNC, CLNC)

Life Care Planner (CNLCP)

Long-Term Care (CRNL)

Managed Care Nursing (CMCN)

Massage Therapist Nurse (NMT)

Medical-Surgical RN (CMSRN)

Nephrology Nurse (CNN, CPDN)

Neuroscience Nurse (CNRN)

Nurse Educator-Academic (CNE)

Nutrition Support Nurse (CNSN, CINA)

Ophthalmic Nurse (CRNO)

Orthopedic Nurse (ONC)

Otorhinolaryngology and Head-Neck Nursing (CORLN)

Pain Management (FAAPM)

Parish and Pastoral Nursing

Perfusist, Cardiovascular Perfusionist

Perioperative Nurse (CNOR, LFRFA)

Peritoneal Dialysis Nurse (CPDN)

Plastic Surgery Nurse (CPSN)

Poison Information Specialist (CSPI)

Pre-Hospital RN (PHRN)

Quality Health Care Professional (CPHQ)

Radiologic Nurse (CRN)

Rehabilitation Nurse (CRRN or CRRN-A)

Resident Assessment Coordinator (RAC-C)

Risk Management (CPHRM)

School Nurse (CSN or NCSN)

Transplant Nurse  or Transplant Coordinator (CCTC, CPTC, CCTN)

Transcultural Nurse (CTN)

Trauma Nurse Specialist (TNS)

Urologic RN, CNS, or NP (CURN, CUCNS, CUNP)

Utilization Review or Management (CPUR, CPUM)

Wound Care (WCC, CWS, CWCA, CWCN)

Wound Ostomy Continence Nurse (WOC,WOCN, CCCN, COCN)

Other (specify)

Other (specify)

Other (specify)

Section I. Contact Information/Comments

67. If we need to contact you about any of your responses, please provide your e-mail address and telephone number, as well as the best time of day to reach you.

E-mail address:

Telephone No.: Home Work Cell ( ) -

Area Code Telephone Number

Time of day/week best to contact you by phone:

68. Do you have any recommendations for how this survey could be improved?    Please print clearly.

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