Example Customer Survey - BHPr

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Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

Example Customer Survey - BHPr

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[SURVEY PREVIEW MODE] Graduating NPs Survey #2 	

Graduating NPs Survey #2

Page 1 of4

Exit this survey

1.
This survey is completely voluntary and should only take you 5-6 minutes to complete. All
answers will be held in strictest confidence. No personal identifying information is being
collected and all data analysis will be aggregated. Thank you for your the time you spent to
complete the survey.
School of Nursing _ _ _ _ _ _ _ _ _ _ _ __

*

1. Which nurse practitioner specialty are you completing?
;-., 	 a) Adult Primary Care
b) Pediatric Primary Care
c) Family
d) Adult Acute Care
e) Pediatric Acute Care

f) Psych Mental Health
(~) 	 g) Women's Health

h) Neonatal
i) Gerontology
Other (please specify)

* 2. What final degree will you attain this year?
a) Masters
b) DNP

c) Post Masters 

Other (please specify) 


*3. Do you have an obligation due to a scholarship to work in a federal or state designated health
professional shortage area?
,.-', 	 a) Yes - Skip to Question #15 


8) No 


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[SURVEY PREVIEW MODE] Graduating NPs Survey #2

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4. Have you actively searched for a nurse practitioner position?
a) Yes 

b) No -If no, skip to question #7. 


5. Did you have difficulty finding a nurse practitioner position you were satisfied with?
a) Yes 


b) No - Skip to Question #7 


6. What was the main reason for the difficulty in finding a satisfactory position?
a) Overall lack of jobs/practice opportunities
b) Lack of jobs/practice opportunities in desired location
;-', c) Lack of jobs/practice opportunities in desired practice setting
d) Lack of jobs/practice in desired specialty
e) Denied position due to lack of experience or qualifications
f) Inadequate salary/compensation 


Other (please specify) 


7. What are your plans for employment following graduation?
::::

a) I have accepted a position as a nurse practitioner - Please skip to question #9
b) I am still looking for a nurse practitioner position - Please skip to Question #9.
c) I have decided to stay in my current position - Please answer Question #8 and skip to Question

#15.
d) I have no plans to work at this time - Please skip to Question #17 

Other (please specify) 


8. If you plan to stay in your current position, please specify the type of position you hold and the
setting
Position
Setting
Reason staying in
current position

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[SURVEY PREVIEW MODE] Graduating NPs Survey #2

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9. In what type of setting do you expect to work as a nurse practitioner after graduation?
a) Small private practice (5 practitioners or less) 

b) Group practitioner practice (> 5 practitioners) 

c) Health Department 

d) Nurse Managed Clinic 

e) Federally Qualified Health Center 

f) Other freestanding community-based health center 


g) Long term care facility 

h) Hospital ambulatory care/ER 

i) Hospital inpatient 

Other (please specify) 


10. What is the specialty of the practice site where you will work?
a) Family Practice
b) Internal Medicine - General
c) Internal medicine subspecialty - Cardiology
d) Internal medicine subspecialty - Endocrinology
e) Internal medicine subspecialty - Renal
f) Internal medicine subspecialty - Other (please specify) _ _ _ _ _ _ _ _ __

g) Pediatrics
h) Surgical

i) Ob-Gyn

j) Acute Care
k) Psychiatry
Other (please specify)

[ Done

I

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[SURVEY PREVIEW MODE] Demographics for NP Graduating Survey #2

Demographics for NP Graduating Survey #2

Page 1 of3

Exit this survey

1.
1. What are the activities of your principle position? 

Patient care 

Teaching 

Administration 

Research 

Other (please specify)

2. In your upcoming nurse practitioner position, how many hours per week do you expect to work?
<20 hours
b) 20-30 hours
c) 30-40 hours 

d) >40 hours 


3. What is the expected salary from this position?
a) Less than $60,000
b) $60,000 - 69,999 

c) $70,000 - 79,999 

d) $80,000 - 89,999 

e) $90,000 - 99,999 

f) $100,000 -109,999 

g) $110,000 -119,999 

h) $120,000 and over 


4. Where is the employment location for this position?
a) Same city and state as educational program
b) Same state but different city as educational program 

c) Other state 


5. Where did you live prior to your educational program?

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a) Same city and same state as educational program
b) Different city but same state as educational program
c) Other state

6. Which best describes the location of the area you will be practicing in?
a) Urban
b) Suburban 

c) Rural 


7. How many months did it take to complete your NP educational program?
a) 12 -16
b)17-18
c)19-24
d) 25 - 30
e) 31 - 36

f) 37 -42
g) 43 -48 

h) > 48 months 


8. How did you attend school?
a) Full-time
b) Part-time 

c) Combination 


9. What is your gender?
a) Female 

b) Male 


10. What is your current age?
<25
25-29 

30-34 


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[SURVEY PREVIEW MODE] Demographics for NP Graduating Survey #2

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35-39 

40-44 

45-49 

50-54 

55-59 

60-64 

>64 


I Done I 

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