Form CMS-10427 (GenIC#2 CMS-10427 (GenIC#2 Nursing Home Career Outreach Tracker

Nursing Home Career Outreach Tracker

Nursing Home Career Outreach Tracker

PRA Disclosure Statement

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 0938-1247 (Expires 9/30/2024).  This is a voluntary information collection. The time required to complete this information collection is estimated to average 10 minutes per survey, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.  Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Dianne Rucinski at [email protected].

Screener

SG1. Are you currently working as any of the following?

1. Certified nursing assistant (CNA) <Skip to DP2>

2. Licensed practical nurse/licensed vocational nurse (LPN/LVN) <Skip to DP2>

3. Registered nurse (RN) <Skip to DP2>

4. None of these <Go to BG1a>

9. Refused <End>

BG1a. <If SG1 = 4> Are you currently going to school or in a program to become any of the following?

1. Certified nursing assistant (CNA) <Skip to Next Section>

2. Licensed practical nurse/licensed vocational nurse (LPN/LVN) <Skip to Next Section>

3. Registered nurse (RN) <Skip to Next Section>

4. None of these <Ask BG1b>

9. Refused <End>

BG1b. <if SG1a=4> Are you thinking about going to school or taking a program to become any of the following?

1. Certified nursing assistant (CNA) <Skip to Next Section>

2. Licensed practical nurse/licensed vocational nurse (LPN/LVN) <Skip to Next Section>

3. Registered nurse (RN) <Skip to Next Section>

4. None of these <End>

9. Refused <End>

DP2. <If SG1 = 1, 2, or 3> Which of the following best describes your primary work environment?

1. Hospital

2. Emergency department

3. Urgent care

4. Clinic or office

5. Nursing home or long-term care <End>

6. Hospice

7. Home health

8. Other (Specify)

9. Refused <End>

BG1c. Have you ever worked as a <CNA/LPN or LVN/RN> in a nursing home?

1. Yes <End>

2. No

9. Refused <End>

Attitudes and Behaviors

ATG7a. Overall, in your opinion, <is/would> being a <CNA/LVN or LPN/RN> a positive or negative experience?

1. Very positive

2. Somewhat positive

3. Somewhat negative

4. Very negative

8. I don’t know

9. Refused

[RANDOMLY ROTATE ATG7b, ATG7c, ATG7d, ATG7e, ATG7f)

ATG7b. in your opinion, would being a <CNA/LVN or LPN/RN> in a hospital setting be a positive or negative experience?

1. Very positive

2. Somewhat positive

3. Somewhat negative

4. Very negative

8. I don’t know

9. Refused

ATG7c. in your opinion, would being a <CNA/LVN or LPN/RN> in a clinic or office be a positive or negative experience?

1. Very positive

2. Somewhat positive

3. Somewhat negative

4. Very negative

8. I don’t know

9. Refused

ATG7d. in your opinion, would being a <CNA/LVN or LPN/RN> in a nursing home be a positive or negative experience?

1. Very positive

2. Somewhat positive

3. Somewhat negative

4. Very negative

8. I don’t know

9. Refused

ATG7e. in your opinion, would being a <CNA/LVN or LPN/RN> in an emergency department be a positive or negative experience?

1. Very positive

2. Somewhat positive

3. Somewhat negative

4. Very negative

8. I don’t know

9. Refused

ATG7f. in your opinion, would being a <CNA/LVN or LPN/RN> in home health be a positive or negative experience?

1. Very positive

2. Somewhat positive

3. Somewhat negative

4. Very negative

8. I don’t know

9. Refused

BG10. In the past 90 days, have you looked for job openings for <CNAs/LPNs or LVNs/RNs>?

1. Yes <Go to BG10a>

2. No

9. Refused

BG10a. <If BG10=1> In the past 90 days, have you looked for nursing home job openings for <CNAs/LPNs or LVNs/RNs>?

1. Yes

2. No

9. Refused

BG8. When you look for a nursing job, how likely is it that you would consider applying for A <CNA/LPN or LVN/RN> position in a nursing home?

1. Very likely

2. Somewhat likely

3. Somewhat unlikely

4. Very unlikely

8. I don’t know

9. Refused

Awareness

AWG2. In the past 90 days have you seen, heard, or read anything about a program that pays for tuition or training for CNAs, LVNs or LPNs, and RNs for going into nursing home professions?

1. Yes

2. No <skip to AWG6>

9. Refused <skip to AWG6>

AWG5. <If AWG2=1> Where have you seen, heard or read about a program that pays for tuition or training for CNAs, LVNs or LPNs, and RNs for going into nursing home professions? Was it on (Select all that apply)

1. On television

2. On the radio

3. In a newspaper or magazine

4. On the internet

5. In the mail

6. In an email

7. From a career counselor or instructor

8. Other (Specify)

9. Refused

AWG2B. <If AWG5=1, 2, 3, or 4> Was that in an advertisement, a news story, or both?

1. Advertisement

2. News story

3. Both

9. Refused

AWG6. Here is a description an ad that you may have recently seen. The ad describes the impact of nurses who work in nursing homes. It then talks about a program that gives incentives like tuition payments or bonuses to people who choose nursing home careers. Do you recall seeing or hearing this ad recently?

1. Yes

2. No

9. Refused

ATG5. How did seeing this ad make you feel about the possibility of choosing a nursing home career? Did seeing this ad make you:

1. More likely to think about choosing a nursing home career

2. No more or less likely to think about choosing a nursing home career

3. Less likely to think about choosing a nursing home career

9. Refused

BG9. As a result of hearing about the program that gives incentives like tuition payments or bonuses to people who choose nursing home careers, what, if any, action did you take? (OPEN END)

BG8. How likely is it that you will investigate this program that gives incentives like tuition payments or bonuses to people who choose nursing home careers?

1. Very likely

2. Somewhat likely

3. Not very likely

4. Not at all likely

9. Refused

Information Sources

ISG2. Where would you expect to hear about a program that gives incentives like tuition payments or bonuses to people who choose nursing home careers?

1. A career counselor

2. A school counselor

3. A training or college program

4. An association (WHAT NURSING ASSOCIATIONS ARE THERE?)

5. On television

6. On the internet

7. In the mail

8. In an email

9. On a jobs website

10. Other (Specify)

11. Refused

Demographics

DG1. What is your gender?

1. Male

2. Female

3. Nonbinary

4. Other (Specify)

9. Refused

DG2. What is your current age? (OPEN ENDED)

DG3. Are you Hispanic, Latino/a, or Spanish origin? (One or more categories may be selected)

1. Yes

2. No

9. Refused

DG4. What is your race? (Select all that apply)

1. White

2. Black or African American

3. American Indian or Alaska Native

4. Asian

5. Native Hawaiian or other Pacific Islander

6. Other (Specify)

9. Refused

DG5. What is the highest level of education you have completed?

1. Less than high school

2. High school graduate

3. Some college

4. Community college or 2-year college graduate

5. University or 4-year college graduate

6. Post graduate

9. Refused

DG12. What is your zip code? (OPEN END)

End

Thank you for your time. Those are all the questions we have for you today.

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