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pdf2018 NATIONAL
SAMPLE SURVEY OF REGISTERED NURSES
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Section A.
Eligibility and Education
Respond online today at:
https://respond.census.gov/nssrn
A1a.
OR
Complete this form and mail it back
as soon as possible.
The 2018 National Sample Survey of Registered
Nurses (NSSRN) is being conducted by the
United States Census Bureau on behalf of the
Health Resources and Services Administration
of the U.S. Department of Health and Human
Services and is the tenth cycle of the survey.
We appreciate your help with this important
survey. If you need help or have questions about
completing this form, please call 1-888-369-3598
or email us at NSSRN@census.gov.
On December 31, 2017, 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)?
Yes ➔ Go to Question A1b
No ➔ If No, you do not need to complete
this questionnaire. Please mark “No”
and return this questionnaire in the
envelope provided so we know you
are not eligible.
A1b.
What state(s) issued the license(s)?
List up to 4.
State
State
State
State
Check this box if you were issued a license
by more than 4 states.
FORM NSSRN
(08/09/2017) Draft 20
OMB No. 0607-0585: Approval Expires 09/30/2017
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A2.
A7.
In what state and year were you issued your
first U.S. RN license?
State
Year
Have you ever been licensed as a Licensed
Practical Nurse (LPN) or Licensed
Vocational Nurse (LVN) in the U.S.?
Yes
No
A3.
Which type of nursing degree qualified
you for your first U.S. RN license?
Mark one box only.
A8.
Diploma
A4.
Were you ever employed in any of the
following health-related jobs before
completing your first RN program?
Mark all that apply.
Associate
Nursing aide or nursing assistant
Bachelor’s
Home health aide or assistant
Master’s
Licensed Practical or Vocational Nurse
Doctorate – PhD
Community health worker
Doctorate – DNP
Midwife
Other
Other health-related job
Not employed in any health-related jobs
before RN
In what month and year did you graduate
from this RN program?
Month
Year
A9.
How did you finance your first RN degree?
Mark all that apply.
Self-financed
A5.
Where was this program located?
Employer tuition reimbursement plan
In the U.S.
Print state abbreviation. ➔
Department of Veterans Affairs employer
tuition plan
Outside the U.S.
Print name of foreign country or
U.S. territory. C
Health Resources and Services
Administration Support (e.g., National
Health Service Corps, Nurse Corps Loan
Repayment, Faculty Loan Repayment)
Other federal traineeship, scholarship, or
grant
A6.
What post-high school degree(s) did you receive
before starting your first RN program?
Mark all that apply.
Federally-assisted loan
Other type of loan
Associate
State/local government scholarship or grant
Bachelor’s
Non-government scholarship or grant
Master’s
Other resources
Doctorate
Other
None
2
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A10.
Did you earn any additional academic degrees after acquiring your first RN degree that you described in
Question A3? Do not include degrees you are currently working towards.
Yes ➔ Please complete all rows of the table below for each degree you earned
No ➔ SKIP to Question A11 on page 4
Nursing Degrees
Associate
in nursing
A10a.
In what year did
you receive this
degree?
A10b.
In what U.S. state
or foreign country
was this program
located?
A10c.
Was 50% or more
of the coursework
for this degree
online or through
correspondence?
A10d.
What was the
primary focus of
this degree? Enter
two-digit code from
the table at the
bottom of the page.
Bachelor’s
in nursing
Another
Master’s
in nursing
Master’s
in nursing
Doctorate in
nursing (PhD, ScD,
DNS, ND, DNP)
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
N A
N A
Non-nursing Degrees
A10e.
In what year did
you receive this
degree?
A10f.
In what U.S. state
or foreign country
was this program
located?
A10g.
Was 50% or more
of the coursework
for this degree
online or through
correspondence?
Doctorate in
non-nursing field
Associate
(Non-nursing)
Bachelor’s
(Non-nursing)
Master’s
(Non-nursing)
Another
Master’s
(Non-nursing)
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
(PhD, JD, MD, EdD)
A10h. What was the
primary focus of
this degree? Enter
two-digit code from
the table below.
Primary focus of degree
01
02
03
04
Clinical Practice
Clinical Nurse Leader
Administration/Business Management
Education
05
06
07
08
Public Health/Community Health
Law
Biological or Physical Sciences
Humanities, Liberal Arts, or Social Sciences
3
09
10
11
12
Information Technology/Informatics
Research
Other health field
Other non-health field
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A11.
After acquiring your first RN degree, which you described in Question A3, have you completed a formal
U.S. education program preparing you to be a Nurse Practitioner, Clinical Nurse Specialist, Nurse Midwife,
or Nurse Anesthetist?
Yes
No ➔ SKIP to Question A12a
Nurse
Practitioner
A11a.
Did you receive preparation
as a...? Mark each column if yes.
A11b.
What was the highest credential
you received in that program?
Clinical Nurse
Specialist
Nurse-Midwife
Nurse
Anesthetist
1. Certificate/Award
2. Bachelor’s Degree
3. Master’s Degree
4. Post-Master’s Certificate
5. Doctorate – PhD
6. Doctorate – DNP
7. Doctorate – other
A11c.
In what year did you receive
this credential?
A12a.
During the Fall term of 2017, were you enrolled
in a formal education program leading to an
academic degree or certificate?
A12b.
A12c.
A12d.
What type of degree or certificate were
you working toward in this program?
Mark one box only.
Yes, in nursing
Certificate/Award
Yes, in a non-nursing field
Associate Degree
No ➔ SKIP to Section B on page 5
Bachelor’s Degree
Were you a full-time or part-time student?
Master’s Degree
Full-time student
Post-Master’s Certificate
Part-time student
Doctorate – PhD
Doctorate – DNP
What percentage of your coursework in this
program was distance-based (online or
correspondence)?
Doctorate – other
≤ 50%
> 50%
Continue to Section B
4
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Section B.
Principal Nursing Employment
B1.
B5.
Yes
On December 31, 2017, were you employed or
self-employed in nursing? Employed in nursing
includes working for pay in nursing, even if on
temporary leave.
No ➔ SKIP to Question B7
B6.
Yes
No ➔ SKIP to Section F on page 13
Did you have a preceptor assigned to you
during this orientation program?
Yes
No
For all the questions in this section (Questions
B2 - B28), your principal nursing position is the
nursing position, on December 31, 2017, in which
you spent the largest share of your working hours.
B2.
Did you go through an orientation program for
the principal nursing position you held on
December 31, 2017?
B7.
Where was the location of the principal
nursing position you held on December 31,
2017? If you were not employed in a fixed
location, enter the location that best reflects
where you practiced.
Were you required to maintain an active RN
license for the principal nursing position
you held on December 31, 2017?
Yes
No
B8.
City/Town
County
In your principal nursing position did you
use an Electronic Health Record (EHR) or
Electronic Medical Record (EMR) system?
Do not include billing record systems.
Yes
No
State (or country if not U.S.A.)
Don’t know
B9.
Zip
B3.
B4.
What type(s) of training have you received
to facilitate team-based care? Team-based care
refers to comprehensive health services by at least
two health professionals working collaboratively
to provide safe, quality care. Mark all that apply.
Formal classroom training at your
college or university
Thinking about the principal nursing position
you held on December 31, 2017, had you been
working for this employer for less than 5 years?
Formal classroom training offered
by your place of employment
Yes
Online educational videos offered by
your place of employment
No ➔ SKIP to Question B7
Informal training (e.g., on the job)
No training at all
How long were you actively looking for new
employment before accepting a position with
this employer?
Other, Specify: C
1 - 6 months
7 - 12 months
More than a year
5
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B10.
B11.
For the principal nursing position you held
on December 31, 2017, which of the following
best describes your employment situation?
Mark one box only.
Full-time (including full-time for an
academic year)
Employed through an employment agency
as a traveling nurse
Part-time (including working only part
of the calendar or academic year)
Employed through an employment agency,
but not as a traveling nurse
B12.
Employed by the organization or facility at
which you were working
Self-employed, per-diem, or working
as-needed
B13.
For the principal nursing position you held
on December 31, 2017, did you work
full-time or part-time? Mark one box only.
For the principal nursing position you held
on December 31, 2017, how many months
did you normally work per year?
months per year
Which one of the following best describes the employment setting of the principal nursing position you
held on December 31, 2017? Mark one box only.
Hospital (not mental health)
Clinic/Ambulatory
Critical Access Hospital
Nurse managed health center
Inpatient unit, not Critical Access Hospital
Private medical practice (clinic, physician
office, etc.)
Emergency Department, not Critical Access Hospital
Public clinic (Rural Health Center, FQHC,
Indian Health Service, Tribal Clinic, etc.)
Hospital sponsored ambulatory care
(outpatient, surgery, clinic, urgent care, etc.)
School health service (K-12 or college)
Hospital ancillary unit
Outpatient mental health/substance abuse
Hospital nursing home unit
Urgent care (not hospital based)
Hospital administration
Ambulatory surgery center (free standing)
Hospital other, Specify: C
Other, Specify: C
Other inpatient setting
Other types of settings
Nursing home unit NOT in hospital
Home health agency/service
Rehabilitation facility/long-term care
Occupational health or employee health
service
Inpatient mental health/substance abuse
Public health or community health agency
(not a clinic)
Correctional facility
Government agency other than public/
community health or correctional facility
Inpatient hospice
Outpatient dialysis center
Other inpatient setting, Specify: C
University or college academic department
Insurance company
Call center/telenursing center
Other, Specify: C
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B14.
Next, we will ask for information about how
much you worked in a typical week for the
principal nursing position you held on
December 31, 2017. Include on-call hours
except on-call hours that were standby only.
B16.
For the principal nursing position you held
on December 31, 2017, in what level of
care or type of work did you spend most
of your time? Mark all that apply.
General or specialty inpatient
Hours
(enter 0 if none)
Ambulatory care (including primary care
outpatient settings, except surgical)
a. Number of hours
scheduled in a typical week:
Ancillary care (radiology, laboratory)
b. Number of hours worked
in a typical week:
Care coordination/patient navigation
Critical/intensive care
c. Number of hours paid at the
following rates in a typical week:
Education
1. Regular hourly rate or salary
Emergency
2. Overtime
Health care management/administration
Home health/hospice
d. Number of hours unpaid
in a typical week
Informatics
B15.
For the principal nursing position you held
on December 31, 2017, please estimate
the percentage of your time spent in the
following activities during a typical
workweek. Do not use decimals.
Long-term care/nursing home
Public health/community health
Rehabilitation
a. Patient care and charting
%
b. Care coordination (including
consultation with agencies
and/or professionals)
%
c. Management, supervision,
and administrative tasks
%
d. Research
%
Research
Step-down, transitional, progressive,
telemetry
Sub-acute care
Surgery (including ambulatory,
pre-operative, post-operative,
post-anesthesia)
Urgent care
e. Teaching, precepting or
orienting students or new
hires (include preparation
time)
%
f. Non-nursing tasks
(e.g. housekeeping, locating
supplies)
%
g. Other
%
Total =
Other, Specify: C
100%
7
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B17a.
Did the principal nursing position you held on
December 31, 2017, include any
patient care?
B17c.
Yes
For the principal nursing position you held
on December 31, 2017, in what type of
clinical specialty did you spend most of
your patient care time? Mark one box only.
General medical surgical
No ➔ SKIP to Question B18 on page 9
Ambulatory care
B17b. For the principal nursing position you held
on December 31, 2017, please estimate the
percentage of your patient care time spent
with each population below.
Do not use decimals.
Cardiac or cardiovascular care
Chronic care
Critical care
Pre-natal
%
Newborn or Neonatal
(less than 2 years old)
%
Dermatology
Emergency or trauma care
Endocrinology
Pediatric
(2 to 11 years old)
%
Adolescent
(12 to 17 years old)
%
Adult
(18 to 65 years old)
%
Geriatric
(more than 65 years old)
%
Gastrointestinal
Gynecology (women’s health)
Home health/hospice
Total =
Infectious/communicable disease
Labor and delivery
Neurological
100%
Obstetrics
Occupational health
Oncology
Ophthalmology
Orthopedics
Otolaryngology (ear, nose and throat)
Primary care
Psychiatric or mental health
(substance abuse and counseling)
Pulmonary/respiratory
Radiology (diagnostic or therapeutic)
Renal/dialysis
Other specialty, Specify: C
8
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B18.
Thinking about the principal nursing position you held on December 31, 2017, to what extent did you...
A great
extent
Somewhat
Very little
Not at all
Participate in team-based care?
Feel confident in your ability to effectively
practice in interprofessional teams?
Effectively use Health Information technology
in your practice to manage the health of your
patient population?
B19.
For the principal nursing position you held on December 31, 2017, to what extent did you observe your
organization emphasizing the following?
A great
extent
Somewhat
Very little
Not at all
Care coordination
Discharge planning
Team-based care
Evidence-based care
B20.
What training topics would help you do your
job better? Mark all that apply.
In the following questions, the term telehealth refers
to communication technology, such as remote
conferencing through phone and video, used to
connect geographically dispersed practitioners.
Evidence-based care
Patient-centered care (care that is
responsive to patient preferences, needs
and values, and ensures that patient
values guide clinical decisions)
B21.
For the principal nursing position you held on
December 31, 2017, did your workplace use
telehealth?
Team-based care
Yes
Practice management and administration
No
Social determinants of health, (e.g. impact
of race and social-economic status)
B22.
Working in an underserved community
Did you personally use some form of telehealth
in the principal nursing you held on
December 31, 2017?
Yes
Caring for medically complex/
special needs patients
No ➔ SKIP to Question B24 on page 10
Population-based health
Quality improvement
Value-based care
Continue on next page
None of the above
9
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B23.
Section C. Left the Principal
Nursing Position Held on
December 31, 2017
Which type(s) of telehealth did you use in the
principal nursing position you held on
December 31, 2017? Mark all that apply.
Provider to provider consults
C1.
RN to patient direct calls (e.g. care
management/home monitoring) by
phone or video
NP primary care e-visits
Which of the following reasons contributed to
your decision to leave the principal nursing
position you held on December 31, 2017?
Mark all that apply.
Better pay/benefits
Other, Specify: C
Burnout
Career advancement/promotion
B24.
B25.
Career change
How satisfied were you with the principal
nursing position you held on December 31,
2017?
Change in child’s school
Extremely satisfied
Disability/Illness
Moderately satisfied
Family caregiving
Moderately dissatisfied
Inability to practice to the full extent
of your license
Extremely dissatisfied
Inadequate staffing
Interpersonal differences with colleagues
or supervisors
In that principal nursing position, were you
able to practice to the full extent of your
knowledge/education/training?
Lack of advancement opportunities
Yes
Lack of collaboration/communication
between health care professionals
No
B26.
Lack of good management or leadership
Please estimate your 2017, pre-tax annual
earnings from your principal nursing position.
Include overtime and bonuses, but exclude
sign-on bonuses.
Length of commute
Patient population
Physical demands of job
$
B27.
B28.
,
.00
Relocation to different geographic area
Were you represented by a labor union or
collective bargaining unit in the principal
nursing position you held on December 31,
2017?
Retirement
Scheduling/inconvenient hours/too many
hours/too few hours
Yes
School/educational program
No
Sign-on bonus offered
Spouse’s employment opportunities
Have you left the principal nursing position
you held on December 31, 2017?
Stressful work environment
Yes ➔ Skip to Section C
Other, Specify: C
No ➔ Skip to Section D on page 11
10
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C2.
Did you continue to work in nursing after
leaving this position?
D3.
Which of the following reasons would contribute
to your decision to leave your principal nursing
position? Mark all that apply.
Yes
Better pay/benefits
No ➔ SKIP to Section E on page 13
C3.
Burnout
Approximately when do you plan to retire
from nursing?
Career advancement/promotion
Already retired ➔ SKIP to Section E
on page 13
Career change
Within a year
Change in child’s school
In 1-2 years
Disability/Illness
In 3-5 years
Family caregiving
More than 5 years from now
Inability to practice to the full extent
of your license
Undecided
C4.
Inadequate staffing
How long do you plan to work in the geographic
area of the principal nursing position you held
on December 31, 2017?
Interpersonal differences with colleagues
or supervisors
Lack of advancement opportunities
Already left the geographic area
Lack of collaboration/communication
between health care professionals
Less than a year
Lack of good management or leadership
1-2 years
Length of commute
3-5 years
Patient population
More than 5 years
Physical demands of job
Not sure
Relocation to different geographic area
Skip to Section E
Retirement
Section D. Remained in the
Principal Nursing Position
Held on December 31, 2017
Scheduling/inconvenient hours/too many
hours/too few hours
School/educational program
Sign-on bonus offered
D1.
Have you ever considered leaving the principal
nursing position you held on December 31,
2017?
Spouse’s employment opportunities
Stressful work environment
Yes
Other, Specify: C
No ➔ SKIP to Question D7 on page 12
D2.
Have you considered leaving this position
in the past year?
Yes
No
11
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D4.
When do you plan to leave this position?
D7.
Less than one year from now
D5.
What factors contribute to your decision to
remain in your principal nursing position?
Mark all that apply.
1-3 years from now
Ability to provide full scope of services
More than 3 years from now
Availability of loan repayment financial
support
Not sure
Availability of resources to do my job well
Do you plan to work in nursing after you leave
this position?
Availability of training opportunities
Balanced schedule/hours
Yes
Commitment to underserved communities
No
Cost of living
Not sure
Difficulty finding another job
D6.
How long do you plan to work in the
geographic area of the principal nursing
position you held on December 31, 2017?
Experience at site
Length of commute
Less than a year
Opportunities for advancement
1-2 years
Proximity to desirable school district
3-5 years
Proximity to extended family/parents/
siblings
More than 5 years
Proximity to spouse’s employment
opportunities
Not sure
Salary and benefits
Sense of community with peers
Use of Electronic Health Records
Use of telehealth
Other, Specify: C
D8.
Approximately when do you plan to retire
from nursing?
Already retired
Within a year
In 1-2 years
In 3-5 years
More than 5 years from now
Undecided
Continue to Section E
12
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Section E. Secondary
Employment in Nursing
E1.
E4.
In your other nursing position(s) held on
December 31, 2017, please indicate how much
you worked, and where the job was located:
Aside from the principal nursing position
you just described, did you hold any other
positions in nursing for pay on
December 31, 2017?
Weeks
per
year
Average
hours per
week,
during
weeks of
work
Location where
most work was done
(state or country)
Yes
Additional
job #1
No ➔ SKIP to Section F
E2.
Which of the following best describes your
employment with the other nursing
position(s) held on December 31, 2017?
Mark all that apply.
Additional
job #2
Employed through an employment agency
as a traveling nurse
N/A
All other jobs
Employed through an employment agency,
but not as a traveling nurse
Employed by the organization or facility at
which you are working
E5.
Self-employed, per diem, or working as
needed
E3.
What type(s) of work setting(s) best describe
where you worked for the other nursing
position(s) held on December 31, 2017?
Mark all that apply.
Please estimate your 2017, pre-tax annual
earnings from all of the nursing positions that
you reported in Question E4. Do not include
earnings from your principal nursing position.
$
,
.00
Continue to Section F
Hospital
Section F.
Nurse Practitioners
Nursing home/extended care facility
Academic education program
Home health setting
F1a.
Public or community health setting
Rehabilitation facility/long-term care
On December 31, 2017, did you have an active
certification, licensure, or other legal recognition
from a State Board of Nursing to practice as a
Nurse Practitioner (NP)?
Yes
Mental health/substance abuse
No ➔ SKIP to Section G on page 17
School health service
F1b.
Occupational health
What state(s) issued the
license/certification/recognition? List up to 4.
State
Physician practice (individual or group)
State
State
State
Ambulatory care clinic
Insurance claims/benefits
Check this box if you were issued
certification/licensure/recognition by
more than 4 states.
Telehealth, telenursing or call center
Other, Specify: C
13
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F2.
On December 31, 2017, in which area(s) were
you certified by a national certifying
organization for NPs? Mark all that apply.
F7.
On December 31, 2017, were you employed in
any positions that required state certification/
licensure/recognition to practice as an NP?
Acute Care, adult
Yes
Acute Care, pediatric
No ➔ SKIP to Question F26 on page 16
F8.
Adult
Family
Gerontology
Thinking about the main NP position you held
on December 31, 2017, what type of professional
relationship did you have with the physician(s)
you worked with? Mark all that apply.
In my main NP position, there were no
physicians on site
Neonatal
I collaborated with a physician at another site
Pediatric
I collaborated with a physician on site
Psychiatric & Mental Health
I was considered an equal colleague to the
physician(s) I worked with
Women’s Health
I was accountable to a physician who
served as a medical director
Other, Specify: C
I was supervised by a physician, and I had to
accept his/her clinical decision about the
patients I saw
F3.
To what extent did your master’s or doctoral
training prepare you to be a licensed
independent practitioner?
A physician saw and signed off on the
patients I saw
Other, Specify: C
A great extent
Somewhat
Very little
F9.
Thinking of all the NP positions you held on
December 31, 2017, indicate your level of
agreement with the following statements.
F9a.
In my NP position(s), I could practice to the
fullest extent of my state’s legal scope of
practice.
Not at all
F4.
Did you complete an NP post-graduate
residency or fellowship program?
Yes
Strongly agree
No
Agree
F5.
Do you have a National Provider Identifier
(NPI) number?
Disagree
Yes
Strongly disagree
No ➔ SKIP to Question F7
F6.
F9b.
Do you or have you ever billed under your NPI
number?
In my NP position(s), my NP education is was
fully utilized.
Strongly agree
Yes
Agree
No
Disagree
Don’t know
Strongly disagree
14
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F10.
F17.
In the NP position(s) you held on December 31,
2017, did you provide patient care?
Please estimate the percentage of your patient
panel that was covered by the following types
of insurance. Do not use decimals.
Yes
No ➔ SKIP to Question F19
F10a.
Across all of the NP positions you held on
December 31, 2017, about how many
patients did you see in a typical week?
If none, enter zero.
Patients
F11.
Were you providing patient care as an NP in
2013?
Yes
No ➔ SKIP to Question F13
F12.
Did your overall patient population size
increase, decrease, or stay the same since 2013?
Private insurance
%
Medicare, for people 65 and
older, or people with certain
disabilities
%
Medicaid, Medical Assistance,
or any kind of governmentassistance plan for those with
low incomes or a disability
%
TRICARE or other military
health care
%
VA
%
Indian Health Service
%
Self-pay/uninsured
%
Other
%
Increased
Decreased
Total =
Stayed the same
100%
Don’t know
Don’t know
F18.
F13.
Across all NP positions you held on
December 31, 2017, did you have a panel of
patients that you managed, where you were the
primary provider? A panel is a group of patients
that you see across a period of time.
Fee-for-service
(e.g. PPO and Original Medicare)
Capitated fees per patient (e.g. HMO)
Yes
Other
No ➔ SKIP to Question F19
F14.
Don’t know
Across all of your NP positions, on average,
about how many patients were on your panel?
F19.
Patients
F15.
How were medical expenses reimbursed
for the majority of your panel of patients?
Mark one box only.
Did you have hospital admitting privileges
on December 31, 2017?
Yes
What percentage of your panel were patients
from racial/ethnic minority groups?
No
F20.
%
Were you covered by malpractice insurance
on December 31, 2017?
Yes
F16.
What percentage of your panel were
patients with limited English proficiency?
No ➔ SKIP to Question F22 on page 16
%
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F21.
F26.
Who paid for your malpractice insurance?
Self
F22.
Employer
Overall lack of NP job opportunities
Both
Lack of NP job opportunities in desired
location
Did you have prescriptive authority?
Lack of NP job opportunities in desired
specialty
Yes ➔ SKIP to Question F24
Lack of NP job opportunities in desired
type of facility
No
F23.
What are the reasons that you were NOT
working as an NP on December 31, 2017?
Mark all that apply.
Limited scope of practice for NPs in the
state where practice is desired
Why didn’t you have prescriptive authority?
Mark all that apply.
Lack of experience or qualification
Was in the process of applying
Inadequate salary/benefits
MD or other NP wrote all of my
prescriptions
Working outside the field of nursing
State scope of practice regulations
Family caregiving
Other, Specify: C
Disability/illness
Chose not to work
Retirement
F24.
On December 31, 2017 did you have a
personal Drug Enforcement Administration
(DEA) number?
Other, Specify: C
Yes
No
F25.
In any of your NP positions, did you have
the title Hospitalist?
Yes ➔ SKIP to Section H on page 17
No ➔ SKIP to Section H on page 17
Continue on next page
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Section G.
Nurses Not Working in Nursing
G6.
Burnout
If you were working for pay in nursing on
December 31, 2017, please SKIP to Section H.
G1.
Career change
What are your intentions regarding paid work
in nursing? Mark one box only.
Difficult to find a nursing position
Disability/illness
Actively looking for work in nursing
Family caregiving
Plan to return to nursing in the future,
not looking for work now ➔ SKIP to
Question G4
Inability to practice nursing on a
professional level
No future intention to work for pay in
nursing ➔ SKIP to Question G5a
Inability to practice to the full extent
of your license
Undecided at this time ➔ SKIP to
Question G5a
Inadequate staffing
Have returned to nursing since
December 31, 2017 ➔ SKIP to Section H
G2.
Lack of advancement opportunities
Lack of collaboration/communication
between health care professionals
How long have you been actively looking
for paid work in nursing?
Enter zero if less than one month.
Lack of good management or leadership
Liability concerns
Month(s)
G3.
What are the primary reasons you were not
working in a nursing position for pay on
December 31, 2017? Mark all that apply.
Physical demands of job
Are you looking for a position that is
full-time or part-time?
Retirement
Full-time ➔ SKIP to Question G5a
Salaries too low/better pay elsewhere
Part-time ➔ SKIP to Question G5a
Scheduling/inconvenient hours/too many
hours/too few hours
Either ➔ SKIP to Question G5a
School/educational program
G4.
When do you plan to return to paid work
in nursing? Enter zero if less than one year.
Skills are out-of-date
Stressful work environment
Year(s)
G5a.
Other, Specify: C
Have you ever been employed or selfemployed in nursing?
Yes
Continue to Section H
No ➔ SKIP to Question G6
G5b.
Section H.
Prior Nursing Employment
How long has it been since you were last
employed or self-employed as a nurse?
Enter zero if less than one year.
H1.
Year(s)
Since receiving your first U.S. RN license,
how many years have you worked in
nursing? Count only the years in which
you worked at least 6 months.
Enter zero if less than one year.
Year(s)
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H2.
H7.
Have you left work in nursing for one or
more years since becoming an RN?
What were the primary reason(s) for your
employment change? Mark all that apply.
Better pay/benefits
Yes ➔ For how many years?
Burnout
No
Career advancement/promotion
H3.
H4.
Next, we are going to ask about your
employment approximately one year ago.
Were you employed in nursing on
December 31, 2016?
Career change
Change in child’s school
Yes
Disability/Illness
No ➔ SKIP to Section I on page 20
Family caregiving
Inability to practice to the full extent
of your license
For the principal nursing position you held
on December 31, 2016, did you work
full-time or part-time? Mark one box only.
Inadequate staffing
Full-time (including full-time for an
academic year)
Interpersonal differences with colleagues
or supervisors
Part-time (including working only part
of the calendar or academic year)
H5.
Lack of advancement opportunities
Lack of collaboration/communication
between health care professionals
How would you describe the principal
nursing position you held on
December 31, 2016?
Lack of good management or leadership
Same position and same employer as
principal nursing position on December 31,
2017 ➔ SKIP to Section I on page 20
Length of commute
Different position but same employer as
principal nursing position held on
December 31, 2017
Physical demands of job
Patient population
Relocation to different geographic area
Different employer than principal nursing
position held on December 31, 2017
H6.
Retirement
What was the location of the principal
nursing position you held on December 31,
2016? If you were not employed in a fixed
location, enter the location that best reflects
where you practiced.
Scheduling/inconvenient hours/too many
hours/too few hours
School/educational program
Sign-on bonus offered
City/Town
Spouse’s employment opportunities
Stressful work environment
County
Other, Specify: C
State (or country if not U.S.A.)
Zip
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H8.
Which one of the following best describes the employment setting of the principal nursing position you
held on December 31, 2016? Mark one box only.
Hospital (not mental health)
Clinic/Ambulatory
Critical Access Hospital
Nurse managed health center
Inpatient unit, not Critical Access Hospital
Private medical practice (clinic, physician
office, etc.)
Emergency Department, not Critical Access Hospital
Public clinic (Rural Health Center, FQHC,
Indian Health Service, Tribal Clinic, etc.)
Hospital sponsored ambulatory care
(outpatient, surgery, clinic, urgent care, etc.)
School health service (K-12 or college)
Hospital ancillary unit
Outpatient mental health/substance abuse
Hospital nursing home unit
Urgent care (not hospital based)
Hospital administration
Ambulatory surgery center (free standing)
Hospital other, Specify: C
Other, Specify: C
Other inpatient setting
Other types of settings
Nursing home unit NOT in hospital
Home health agency/service
Rehabilitation facility/long-term care
Occupational health or employee health
service
Inpatient mental health/substance abuse
Public health or community health agency
(not a clinic)
Correctional facility
Government agency other than public/
community health or correctional facility
Inpatient hospice
Outpatient dialysis center
Other inpatient setting, Specify: C
University or college academic department
Insurance company
Call center/telenursing center
Other, Specify: C
Continue on next page
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Section I.
National Practitioner Data Bank
I1.
I5.
The National Practitioner Data Bank
(NPDB), which includes the Healthcare
Integrity and Protection Data Bank (HIPDB),
is a nationwide repository of negative
actions taken against healthcare professionals.
Its primary function is to aid employers in
making wellinformed hiring decisions.
Currently, certain entities are required to query
the NPDB on physicians and dentists, prior to
making decisions on hiring and clinical
privileges. Do you think the query requirement
should be expanded to other healthcare
professions?
Yes, they should consider prior
negative actions
No, they should not consider negative
prior actions
I6.
Yes, it should be expanded to all
healthcare professions
Yes, it should be expanded to some but
not all healthcare professions
No, they should not be reported
Have you been reported to the NPDB or the
HIPDB?
I7.
Yes
No ➔ SKIP to Question I5
I3.
The NPDB collects reports on adverse
actions taken against a physician that
affect that physician’s clinical privileges.
Many nurse practitioners currently perform
job functions similar to primary care
physicians. Do you feel the NPDB should
also collect reports on adverse actions
against a nurse practitioner that could
affect their clinical privileges?
Yes, they should be reported
No, it should not be expanded
I2.
When making hiring decisions, do you
feel that healthcare employers should
consider prior negative healthcare related
actions taken against prospective
employees?
Do you think nurse practitioners who are
supervised by a physician should be
subject to the same reporting requirements
as physicians, less strict reporting requirements,
or more strict reporting requirements?
The same reporting requirements as
physicians
Who submitted the report(s)?
Mark all that apply.
Less strict reporting requirements for
nurse practitioners who are supervised by
a physician
State licensing board
Medical malpractice payer, such as an
insurance company
More strict reporting requirements for
nurse practitioners who are supervised by
a physician
Hospital
Federal agency
Unknown
Other, Specify: C
I4.
Did the NPDB report impact your career?
Mark all that apply.
Continue on next page
Yes, the report had a negative impact on
my position (e.g., reprimand, termination)
Yes, the report made it difficult to obtain
employment
No, the report did not impact my career
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Section J.
General Information
J1.
J5.
Are you of Hispanic, Latino or Spanish origin?
Yes
No
Where did you reside on December 31,
2017? This information is critical for
producing state/county estimates of the
nursing workforce.
J6.
What is your race? Mark all that apply.
White
City/Town
Black or African American
Asian
County
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
State (or country if not U.S.A.)
Some other race
J7.
Zip
What languages do you speak fluently,
other than English? Mark all that apply.
No other languages
Spanish
J2.
Where did you reside on December 31,
2016? This information is critical for
producing state/county estimates.
Filipino language (Tagalog, other Filipino
dialect)
Chinese language (Cantonese, Mandarin,
other Chinese language)
Same address reported in Question J1
Russian
City/Town
Korean
Vietnamese
County
American Sign Language
Other language(s)
State (or country if not U.S.A.)
J8.
What is your marital status?
Married or in domestic partnership
Zip
Widowed, divorced, separated
Never married
J3.
What is your sex?
Male
Female
J4.
Continue on next page
What is the year of your birth?
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J9.
Section K.
License and Certification Detail
Have you ever served on active duty in the
U.S. Armed Forces, Reserves, or National
Guard? Mark one box only.
K1.
Never served in the military
Only on active duty for training in the
Reserves or National Guard
Please provide any other names under
which you may have held a nursing license.
If none, leave blank.
First name
M.I.
Now on active duty
On active duty in the past, but not now
J10.
Last name
Which of the following best describes 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.
First name
M.I.
Child(ren) less than 6 years old at home
Last name
Child(ren) 6 to 18 years old at home
Other adults at home (e.g., parents or
dependents)
K2.
Others living elsewhere (e.g., children,
parents or dependents)
None
J11.
On December 31, 2017, which of the
following skill-based certifications did
you have? Mark all that apply.
No skill-based certifications
Including employment earnings, investment
earnings, and other income of all household
members, what was your 2017, pre-tax annual
total household income? Mark one box only.
Ambulatory Care Certification
Critical Care Certificate
$25,000 or less
Emergency Medicine/Nursing
(EMT, ENPC, etc.)
$25,001 to $35,000
Life Support (BLS, ACLS, BCLS, etc.)
$35,001 to $50,000
Resuscitation (CPR, NRP, etc.)
$50,001 to $75,000
Trauma Nursing (TNCC, ATCN, ATN, etc.)
$75,001 to $100,000
Other, Specify: C
$100,001 to $150,000
$150,001 to $200,000
K3.
More than $200,000
On December 31, 2017, did you have any
active national nursing certifications as
a Clinical Nurse Specialist, Nurse Midwife,
or Nurse Anesthetist?
Yes
No ➔ SKIP to Section L on page 23
22
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K4a.
On December 31, 2017, did you have an
active certification as a Clinical Nurse
Specialist (CNS)?
K5a.
On December 31, 2017, did you have an active
certification as a Nurse-Midwife?
Yes
Yes
No ➔ SKIP to Question K6a
No ➔ SKIP to Question K5a on page 23
K4b.
K5b.
Was this certification required by your
employer for your job?
Yes
Yes
No
No
K4c.
K5c.
Was this certification from a national
certifying organization?
Was this certification from a national
certifying organization?
Yes
Yes
No
No
K4d.
Was this certification required by your employer
for your job?
K6a.
Which of the following Clinical Nurse Specialist
(CNS) certifications did you have?
Mark all that apply.
On December 31, 2017, did you have an active
certification as a Nurse Anesthetist?
Yes
No ➔ SKIP to Section L
Acute Care/Critical Care
K6b.
Adult Health
Was this certification required by your employer
for your job?
Community Health/Public Health
Yes
Diabetes Management
No
K6c.
Gerontological
Home Health
Was this certification from a national certifying
organization?
Yes
Hospice and Palliative Care
No
Medical-Surgical
Section L.
Contact Information
Oncology
Pediatric
L1.
Psychiatric & Mental Health - Adult
Psychiatric & Mental Health - Child/
Adolescent
Please provide your e-mail address and
telephone number. This information will
only be used in the event that we need to
contact you about any of your responses.
E-mail address:
Psychiatric & Mental Health - Family
Other, Specify: C
Telephone number: (Mark one box only)
Area Code + Number
Home
23
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Work
Cell
§<#q;¤
Use the space below to correct any errors in your name/address information.
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
Thank you for your participation.
Please return this survey and any duplicate surveys in the enclosed, postage-paid envelope.
We estimate that it will take about XX minutes per person to collect the information. This includes time for reviewing the instructions
and completing and reviewing your answers. You may send comments regarding time estimates or any other aspect of this data
collection process, including suggestions for reducing this burden, to Paperwork Reduction Project XXXX-XXXX, U.S. Census Bureau,
4600 Silver Hill Road, Room 7H054, Washington, DC 20233. You may also e-mail comments to DEMO.Paperwork@census.gov; use
"Demo Survey Comments XXXX-XXXX" as the subject.
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date is XX/XX/XXXX. Displaying this number shows that the Census Bureau is authorized to conduct this survey. If this number were
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24
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| File Type | application/pdf |
| File Modified | 2017-08-09 |
| File Created | 2017-08-09 |