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pdf2022 NATIONAL
SAMPLE SURVEY OF REGISTERED NURSES
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Respond online today at: https://respond.census.gov/nssrn
OR
Complete this form and mail it back as soon as possible.
The 2022 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 eleventh 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 addp.nssrn@census.gov.
Section A.
Licensure and Certification
A1.
A2.
What U.S. state(s) ISSUED the active RN license(s)
that you held on December 31, 2021? Do not
include APRN licenses.
State
State
State
State
A3.
Were you living in the U.S. on December 31, 2021?
Mark (X) No if you were living in a U.S. territory.
On December 31, 2021, did you have an ACTIVE
LICENSE to practice as a Registered Nurse (RN)
or Advanced Practice Registered Nurse (APRN)
in the U.S.?
Yes, I am licensed as an RN, but not an APRN.
Yes, I am licensed as both an RN and an
APRN ➔ Continue to Question A2. We will
ask about your APRN in a later section.
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.
Yes
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.
FORM NSSRN (06-06-2022)
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A4.
What U.S. state issued your FIRST RN license?
A8c. Which of the following NP certifications did
you have from a NATIONAL CERTIFYING
ORGANIZATION? Mark (X) ALL that apply.
State
Family NP
A5.
In what year were you issued your FIRST U.S.
RN license?
Adult-Gerontology Primary Care NP
Adult-Gerontology Acute Care NP
Year
Pediatric Primary Care NP
A6.
Have you ever been LICENSED as a Licensed
Practical Nurse (LPN) or Licensed Vocational
Nurse (LVN) in the U.S.?
Pediatric Acute Care NP
Psychiatric-Mental Health NP
Yes
Neonatal NP
No
A7.
Women’s Health Care NP
On December 31, 2021, did you have any active
nursing certifications as a Nurse Practitioner,
Clinical Nurse Specialist, Nurse-Midwife, or
Nurse Anesthetist?
Emergency NP
Advanced Diabetes Management NP
Palliative Care NP
Yes
School NP
No ➔ SKIP to Question A12 on page 3
Other, Specify: C
A8a. On December 31, 2021, did you have any active
certification(s) as a Nurse Practitioner (NP)?
Yes
A9a. On December 31, 2021, did you have any
active certifications as a Clinical Nurse
Specialist (CNS)?
No ➔ SKIP to Question A9a
Yes
A8b. Were any of your NP certifications from a
NATIONAL CERTIFYING ORGANIZATION?
No ➔ SKIP to Question A10a on page 3
Yes
A9b. Were any of your CNS certification(s) from
a NATIONAL CERTIFYING ORGANIZATION?
No ➔ SKIP to Question A9a
Yes
No ➔ SKIP to Question A10a on page 3
2
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A11b. Was your Nurse Anesthetist certification from a
NATIONAL CERTIFYING ORGANIZATION?
A9c. Which of the following CNS certifications did
you have from a NATIONAL CERTIFYING
ORGANIZATION? Mark (X) ALL that apply.
Yes
Acute Care or Critical Care
No
Adult Health
A12. On December 31, 2021, which of the following
skill based certifications did you have?
Mark (X) ALL that apply.
Community Health or Public Health
Diabetes Management
Gerontological
No certifications
Home Health
Ambulatory Care Certification
Hospice and Palliative Care
Critical Care Certificate (CCRN)
Medical-Surgical
Emergency Medicine or Nursing
(EMT, ENPC, etc.)
Oncology
Life Support (BLS, ACLS, BCLS, etc.)
Pediatric
Resuscitation (CPR, NRP, etc.)
Psychiatric-Mental Health - Adult
Trauma Nursing (TNCC, ATCN, ATN, etc.)
Psychiatric-Mental Health - Child or Adolescent
Other, Specify: C
Psychiatric-Mental Health - Family
Other, Specify: C
Section B.
Education
A10a. On December 31, 2021, did you have an active
certification as a Nurse-Midwife?
B1.
Which type of nursing degree qualified you for
your FIRST U.S. RN license? Mark (X) ONE box only.
Yes
Diploma
No ➔ SKIP to Question A11a
Associate
A10b. Was your Nurse-Midwife certification from a
NATIONAL CERTIFYING ORGANIZATION?
Bachelor’s
Master’s
Yes
Doctorate – PhD
No
Doctorate – DNP
A11a. On December 31, 2021, did you have an active
certification as a Nurse Anesthetist?
Other, Specify: C
Yes
No ➔ SKIP to Question A12
B2.
In what year did you graduate with your first
RN degree?
Year
3
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B3.
B4.
What percent of the courses for this degree
was completed online or through distance
learning? Do not include clinicals.
B6.
What post-high school degree(s) did you receive
BEFORE starting your first RN degree?
Mark (X) ALL that apply.
0%
None
1%-49%
Associate
50%-99%
Bachelor’s
100%
Master’s
Doctorate
Where was this program located? If the program
was 100% online, report the college or university
location.
Other, Specify: C
In the U.S.
Print state abbreviation:
B7.
Outside the U.S.
Print name of foreign country or
U.S. territory: C
Were you ever employed in any of the following
health-related jobs before completing your first
RN degree? Mark (X) Yes or No for EACH item.
Yes
No
a. Nursing aide or nursing assistant
b. Home health aide or assistant
B5.
c. Licensed Practical or Vocational
Nurse
How did you pay for your first RN degree? Include
the cost of tuition, room and board, fees, books, and
supplies. Mark (X) ALL that apply.
d. Community health worker
Self-paid (including gifts from parents, spouse,
or other family members or friends)
e. Midwife
f. Emergency Medical Technician
(EMT) or paramedic
Money borrowed from parents, spouse, or other
family members or friends, with the expectation
of paying it back
g. Medical assistant
Federally-assisted student loan
h. Dental assistant
Other type of student loan
i. All other health technologists
and technicians
Employer tuition reimbursement plan
j. Manager in health care setting
Department of Veterans Affairs employer
tuition plan
k. Clerk in health care setting
Health Resources and Services Administration
Support (e.g., National Health Service Corps,
Nurse Corps Loan Repayment, Faculty Loan
Repayment)
l. Other health-related job, Specify: C
Other federal traineeship, scholarship, or grant
State or local government scholarship or grant
Non-government scholarship or grant
Other resources, Specify: C
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B8.
As of December 31, 2021, did you complete any ADDITIONAL nursing degrees or certificates AFTER acquiring your
first RN degree that you described in Question B1? Do not include degrees or certificates you are currently working towards.
Yes ➔ Complete all rows of the table below for each nursing degree or certificate you earned as of December 31, 2021.
No ➔ SKIP to Question B9a on page 6
Additional Nursing Degrees & Certificates
Second Nursing
Degree or Certificate
B8a. What type
of degree or
certificate is this?
Mark (X) ONE
box only.
Third Nursing
Degree or Certificate
Fourth Nursing
Degree or Certificate
Fifth Nursing
Degree or Certificate
Associate
Associate
Associate
Associate
LVN-to-RN
Program
LVN-to-RN
Program
LVN-to-RN
Program
LVN-to-RN
Program
Bachelor’s
Bachelor’s
Bachelor’s
Bachelor’s
Master’s
Master’s
Master’s
Master’s
Post-Master’s
Certificate
Post-Master’s
Certificate
Post-Master’s
Certificate
Post-Master’s
Certificate
Doctor of Nursing
Practice
Doctor of Nursing
Practice
Doctor of Nursing
Practice
Doctor of Nursing
Practice
Research Doctorate
(PhD, DNS, etc.)
Research Doctorate
(PhD, DNS, etc.)
Research Doctorate
(PhD, DNS, etc.)
Research Doctorate
(PhD, DNS, etc.)
Other
Other
Other
Other
In the U.S. Print
state abbreviation
In the U.S. Print
state abbreviation
In the U.S. Print
state abbreviation
In the U.S. Print
state abbreviation
Outside the U.S.
Outside the U.S.
Outside the U.S.
Outside the U.S.
Nurse Practitioner
Nurse Practitioner
Nurse Practitioner
Nurse Practitioner
Clinical Nurse
Specialist
Clinical Nurse
Specialist
Clinical Nurse
Specialist
Clinical Nurse
Specialist
Nurse-Midwife
Nurse-Midwife
Nurse-Midwife
Nurse-Midwife
Nurse Anesthetist
Nurse Anesthetist
Nurse Anesthetist
Nurse Anesthetist
None of these
None of these
None of these
None of these
0%
0%
0%
0%
1%-49%
1%-49%
1%-49%
1%-49%
50%-99%
50%-99%
50%-99%
50%-99%
100%
100%
100%
100%
B8b. In what year
did you receive
this degree or
certificate?
B8c. Where was
this program
located?
If the program
was 100% online,
report the college or
university location.
B8d. Did this
degree or
certificate
qualify you to
be any of the
following?
B8e. What percent
of the courses for
this degree or
certificate were
completed online
or through
distance learning?
Do not include
clinicals.
B8f. What was the
primary focus of
this degree or
certificate?
Enter the
two-digit
code listed
below.
Enter the
two-digit
code listed
below.
Enter the
two-digit
code listed
below.
Enter the
two-digit
code listed
below.
Primary Focus of Nursing Degree or Certificate
01 Clinical Practice
02 Clinical Nurse Leader
03 Administration/Business Management
04 Education
5
05 Public Health/Community Health
06 Research
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08 No Primary Focus
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B10b. As of December 31, 2021, what was the HIGHEST
non-nursing degree you received?
B9a. For ANY of the nursing degrees you had completed
as of December 31, 2021, did you borrow any
money? Include the cost of tuition, room and board,
fees, books, and supplies.
Associate
Yes
Bachelor’s
No ➔ SKIP to Question B10a
Master’s
Doctorate
B9b. As of December 31, 2021, approximately how
much debt from your nursing degree(s) did you
still owe? Include all sources of debt.
Other, Specify: C
$0
$1 - $10,000
B10c. In what year did you receive your highest
non-nursing degree?
$10,001 - $20,000
$20,001 - $30,000
Year
$30,001 - $40,000
B10d. What was the primary focus of your highest
non-nursing degree? Mark (X) ONE box only.
$40,001 - $50,000
$50,001 - $60,000
Clinical Practice
$60,001 - $70,000
Administration or Business Management
$70,001 - $80,000
Education
$80,001 - $90,000
Public Health or Community Health
$90,001 or more
Law
Biological or Physical Sciences
B10a. As of December 31, 2021, did you have any
NON-NURSING academic degrees? Do not include
degrees you are currently working towards.
Humanities, Liberal Arts, or Social Sciences
Information Technology or Informatics
Yes
Research
No ➔ SKIP to Question B11a on page 7
Other health field
Other non-health field
6
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B11a. During the FALL TERM OF 2021, were you
enrolled in a formal education program
leading to an academic degree or certificate?
B12. As of December 31, 2021, were you planning to
continue your formal nursing education leading
to an academic degree or certificate? Do not
consider degrees or certificates you were working
towards in 2021.
Yes, in nursing
Yes, in a non-nursing field
Yes
No ➔ SKIP to Question B12
No
I was undecided at that time
B11b. Were you a full-time or part-time student?
Full-time student
B13a. Have you completed an RN residency or transitionto-practice program?
Part-time student
Yes ➔ Year completed
B11c. What percent of the courses for this degree or
certificate were completed online or through
distance learning, excluding clinicals?
No ➔ SKIP to Question B14
B13b. Did you have a preceptor assigned to you during
this residency or transition-to-practice program?
0%
1%-49%
Yes
50%-99%
No
100%
B14. Within the past year, have you received or
provided emergency preparedness training in
any of the following areas specifically related to
patient care or medical response to these
emergencies? Mark (X) Yes or No for EACH item.
B11d. What type of degree or certificate were you working
towards in this program? Mark (X) ONE box only.
Certificate or Award
Yes
Associate Degree
a. Chemical accident or attack
Bachelor’s Degree
b. Biological accident or attack
Master’s Degree
c. Nuclear or radiological accident
or attack
Post-Master’s Certificate
d. Infectious disease epidemics
Doctorate – PhD
e. Natural disaster
Doctorate – DNP
f. Other public health emergencies
No
Doctorate – Other
7
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Section C.
Employment
C1.
Questions C6-C28 ask about your experiences in 2021 only.
C6.
On December 31, 2021, were you employed or
self-employed in the United States in any type
of nursing position (LVN, LPN, RN, or APRN)?
Employed includes working for pay, even if on
temporary leave.
Yes
RN
No ➔ SKIP to Section G on page 22
APRN, Nurse Practitioner
APRN, Clinical Nurse Specialist
Questions C2-C30 ask about your primary nursing
position. If you had multiple nursing positions, the
primary nursing position is the one you held on
December 31, 2021 in which you spent the largest share
of your working hours.
C2.
In 2021, which of the following state licensures,
certifications, or recognitions were you required
to maintain for the primary nursing position you
held on December 31, 2021? Mark (X) ALL that
apply.
APRN, Nurse-Midwife
APRN, Nurse Anesthetist
None of the above ➔ SKIP to Question C8
Where was the location of the primary nursing
position you held on December 31, 2021? If you
were not employed in a fixed location, enter the
location that best reflects where you practiced.
Thinking of the primary nursing position you held on
December 31, 2021, indicate your level of agreement with
the statements in Questions C7a and C7b.
City/Town
C7a.
State
Zip
For the license required in my primary nursing position,
I could practice to the full extent of my state’s legal
scope of practice. Answer only about the year 2021.
Strongly agree
C3.
Agree
Did you work 100% remotely for the primary
nursing position you held on December 31, 2021?
Disagree
Yes
Strongly disagree
No
C4.
C5.
C7b. In my primary nursing position, I was able to
practice to the full extent of my nursing education
and training. Answer only about the year 2021.
Thinking about the primary nursing position you
held on December 31, 2021, how long had you been
working for this EMPLOYER?
Strongly agree
Less than 1 year
Agree
1 - 5 years
Disagree
More than 5 years ➔ SKIP to Question C6
Strongly disagree
How long were you actively looking for new
employment before accepting a position with this
employer? Please give your best estimate.
C8.
6 months or fewer
In your primary nursing position, did you use an
Electronic Health Record (EHR) or Electronic
Medical Record (EMR) system in 2021? Do not
include billing record systems.
Yes
7 - 12 months
No
More than a year
Don’t know
I was not actively looking for
new employment
8
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C9.
For the primary nursing position you held on
December 31, 2021, were you employed as a
traveling nurse?
C10. For the primary nursing position you held on
December 31, 2021, which of the following best
describes your employment situation in 2021?
Mark (X) ONE box only.
Yes
Employed through an employment agency
No
Employed by an organization or facility
Self-employed or independent contractor
C11. Which one of the following best describes the job title of the primary nursing position you held on
December 31, 2021? Mark (X) ONE box only.
Academic educator, professor, or instructor
in a school of nursing
Staff nurse or direct care nurse
Charge nurse or team leader
Patient care coordinator, case manager,
discharge planner, or nurse navigator
Front-line management (Nurse Manager,
Unit or Department Supervisor)
Quality improvement nurse or utilization
review nurse
Middle management or administration
(director, house supervisor, associate dean,
department head)
Infection control nurse
Advice or triage nurse
Senior management or administration (CEO,
vice president, CNO, CNE, dean)
Informatics nurse
Certified Registered Nurse Anesthetist (CRNA)
Forensics or crisis nurse
Certified Nurse-Midwife (CNM)
Transport, EMS, or Flight Nurse
Clinical Nurse Specialist (CNS)
Consultant
Nurse Practitioner (NP)
Legal nurse
Wound or ostomy nurse
Researcher
School nurse or occupational health nurse
Surveyor, auditor, or regulator
Public health nurse
No position title
Home health nurse
Other, Specify: C
Community health nurse
Patient educator
Staff educator, professional practice specialist,
or instructor in clinical setting
9
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C12. Which one of the following best describes the employment setting of the primary nursing position you held on
December 31, 2021? Mark (X) ONE box only.
Hospital (not including mental health or
rehabilitation facilities)
Outpatient, Ambulatory, or Other Clinical settings
(non-hospital based)
Hospital Inpatient Department or Unit
Urgent, Emergency Care, or Transport
(not hospital-sponsored)
Hospital Emergency Department or Transport
Occupational Health or Employee Health Services
Hospital-Sponsored Ambulatory or Outpatient Clinic
or Center (Clinic, Specialty, Surgery, etc.) (Non-ED)
Correctional Facility
Hospital-Sponsored Urgent Care
Private Practice - Medical or NP
Hospital Administration, Education, Quality, etc.
Nurse-Managed Health Clinic or Center
Hospital Nursing Home Unit
Ambulatory Surgery Center (not hospital based)
Hospital Ancillary Unit (Radiology, Lab, GI lab,
Consult Services, etc.)
Community Health Center or Federally Qualified
Health Center (FQHC)
Hospital Other, Specify: C
Hospice – Outpatient
Health Maintenance Organization or Managed Care
Federally-run Clinic (VA, Military, NIH, IHS)
Other Inpatient settings
Home Health or Day Care Services
Skilled Nursing Facility or Nursing Home
Public Clinic or Rural Health Clinic or Center
Rehabilitation, Long Term Care, or
Long Term Acute Care Facility
Retail Clinic
Hospice - Inpatient
Rehabilitation - Outpatient
Mental or Behavioral Health Facility - Inpatient
Stand-Alone Dialysis or Infusion Clinic
Substance Use Treatment Center - Inpatient
School Health Service (K-12 or Post-secondary)
Other Inpatient Setting, Specify: C
Mental or Behavioral Health Facility - Outpatient
Substance Use Treatment Center - Outpatient
Non-patient care settings
Other, Specify: C
Public Health or Community Health Agency
Local, State, or Federal Government Agency
University or College Academic Department
Insurance Company
Call Center, Telenursing Center, or Remote Nursing
Regulatory Agency or Organization
Consulting Agency or Organization
Professional Organization
Other, Specify: C
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C13. For the primary nursing position you held on
December 31, 2021, did you work full-time or
part-time in 2021? Mark (X) ONE box only. If you
worked both full-time and part-time in 2021, select
the schedule you worked for the largest portion of
the year.
C19. For the primary nursing position you held on
December 31, 2021, please estimate the percentage
of your time spent in the following activities during
a typical workweek. Do not use decimals.
Full-time (including full-time for an
academic year)
Part-time (including working only part
of the calendar or academic year)
C14. For the primary nursing position you held on
December 31, 2021, did you work EVERY week
in 2021? Include paid vacation, paid sick leave,
and military service as weeks worked.
Yes ➔ SKIP to Question C17
No
C15. For the primary nursing position you held on
December 31, 2021, how many MONTHS did you
work in 2021? Include paid vacation, paid sick leave,
and military service, and include months where you
only worked for a few hours.
a. Patient care and charting
%
b. Care coordination (including
consultation with agencies
and/or professionals)
%
c. Management, supervision, and
administrative tasks
%
d. Research
%
e. Teaching, precepting, or
orienting students or new
hires (include preparation time)
%
f. Non-nursing tasks (e.g.,
housekeeping, locating supplies)
%
g. Other
%
Total =
100%
Months worked in 2021
C16. For the primary nursing position you held on
December 31, 2021, how many WEEKS did you
work in 2021? Include paid vacation, paid sick
leave, and military service, and include weeks where
you only worked for a few hours.
Weeks worked in 2021
C17. For the primary nursing position you held on
December 31, 2021, how many hours were you
SCHEDULED to work in a typical week in 2021?
Hours scheduled per week
C18. Next, we will ask for information about how
much you WORKED in a typical week in 2021
for the primary nursing position you held on
December 31, 2021.
Hours
a. How many hours did you work
in a typical week in 2021? Include
unpaid hours and hours paid at
the base, overtime, and differential
rates. Include on-call hours except
on-call hours that were standby only.
(enter 0 if none)
Of the hours you reported above,
how many of these hours were b. Worked at the overtime pay rate?
c. Unpaid?
11
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C20.
For the primary nursing position you held
on December 31, 2021, in what level of
care or type of work did you spend most
of your time? Mark (X) ONE box only.
In questions C21-C24, the term telehealth refers to the
use of information technology to support clinical health
care, health education or administration and public
health. Telehealth methods include videoconferencing, the
internet, phone, store-and-forward imaging, streaming
media, and terrestrial and wireless communications.
General or specialty inpatient
Ambulatory care (including primary care
outpatient settings, except surgical)
C21. For the primary nursing position you held on
December 31, 2021, did your workplace use
telehealth to provide patient care? Answer only
about the year 2021.
Ancillary care (radiology, laboratory)
Care coordination/patient navigation
Yes
Critical/intensive care
No ➔ SKIP to Question C25 on page 13
Education
C22. Did you personally use some form of telehealth
in the primary nursing position you held on
December 31, 2021? Answer only about the year 2021.
Emergency
Health care management/administration
Yes
Home health/hospice
No ➔ SKIP to Question C25 on page 13
Informatics
Long-term care/nursing home
Public health/community health
Rehabilitation
Research
School nurse
Step-down, transitional, progressive,
telemetry
Sub-acute care
Surgery (including ambulatory,
pre-operative, post-operative,
post-anesthesia)
Urgent care
Other, Specify: C
12
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C23. In 2021, which type(s) of telehealth did you
personally use in the primary nursing position you
held on December 31, 2021? Mark (X) ALL that
apply.
C24. For the primary nursing position you held on
December 31, 2021, about how many hours did
you spend using telehealth during a typical week
in 2021?
Live Video-Conferencing (a two-way audiovisual
link between a patient and a care provider)
Hours per week
Telephone calls without video
C25. Did the primary nursing position you held on
December 31, 2021 include any patient care?
Answer only about the year 2021.
Text messages or live chat
Asynchronous Video-Conferencing
(transmission of a recorded health history to a
health practitioner, usually a specialist)
Yes
No ➔ SKIP to Question C29 on page 15
Remote Patient Monitoring (the use of
connected electronic tools to record personal
health and medical data in one location for
review by a provider in another location,
usually at a different time)
C26. For the primary nursing position you held on
December 31, 2021, what percent of your patient
care time was spent providing prenatal care?
Answer only about 2021. Your best estimate is fine.
mHealth (health care and public health
information provided through mobile devices;
the information may include general
educational information, targeted texts, and
notifications about disease outbreaks)
0%
1%-25%
Other, specify: C
26%-50%
51%-75%
76%-99%
100%
C27. For the primary nursing position you held on December 31, 2021, please estimate the percentage of your patient
care time spent with each population below. Answer only about the year 2021. Mark (X) ONE box only for each row.
0%
1%-25%
26%-50%
51%-75%
76%-99%
100%
a. Neonatal, Newborn, or Infant
(less than 2 years old)
b. Pediatric (2 to 11 years old)
c. Adolescent (12 to 17 years old)
d. Adult (18 to 65 years old)
e. Geriatric (more than 65 years old)
13
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C28. For the primary nursing position you held on
December 31, 2021, in what type of clinical
specialty did you spend MOST of your patient
care time in 2021? Mark (X) ONE box only.
General medical surgical
Ambulatory care – primary care
Ambulatory care – specialty care (e.g.
Dermatology, Endocrinology, Ophthalmology,
Otolaryngology)
Cardiac or cardiovascular care
Chronic care
Community or public health
Critical care or intensive care
Emergency or trauma care
Gastrointestinal
Home health or hospice
Infectious or communicable disease
Continue on next page
Labor and delivery or neonatal care
Neurological
Obstetrics and Gynecology
Occupational health
Oncology
Orthopedics
Psychiatric or mental health
Pulmonary or respiratory
Rehabilitation
Renal or dialysis
School health service (K-12 or post-secondary)
Substance use disorder
Surgery, pre-op, post-op, PACU, or anesthesia
Other specialty, Specify: C
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C29. Thinking of the primary nursing position you held on December 31, 2021, to what extent did you...
Answer only about 2021. Mark (X) ONE box only for each row.
A great
extent
Somewhat
Very little
Not at all
a. Participate in evidence-based care (evidence-based
care is care that utilizes best practices and clinical
decisions supported by scientific research and clinical
expertise)
b. Participate in patient-centered care (care that is
responsive to patient preferences, needs and values,
and ensures that patient values guide clinical decisions)
c. Participate in team-based care (comprehensive
health services by at least two health professionals
working collaboratively to provide safe, quality care)
d. Participate in value-based care (care that improves
health outcomes relative to the cost of care)
e. Participate in population-based health care (care
that focuses on the health status and needs of a target
population possessing similar health concerns or
characteristics)
f. Care for medically complex/special needs patients
g. Care for patients with mental health conditions
h. Care for patients with substance use disorders
i. Work on quality improvement measures or
procedures
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C30. Thinking of the primary nursing position you held on December 31, 2021, to what extent did you observe your
organization doing the following? Answer only about 2021. Mark (X) ONE box only for each row.
A great
extent
Somewhat
Very little
Not at all
Not
applicable
a. Promoting evidence-based care
(care that utilizes best practices and
clinical decisions supported by scientific
research and clinical expertise)
b. Promoting patient-centered care
(care that is responsive to patient
preferences, needs and values, and
ensures that patient values guide
clinical decisions)
c. Promoting team-based care
(comprehensive health services by at
least two health professionals working
collaboratively to provide safe, quality
care)
d. Promoting value-based care
(care that improves health outcomes
relative to the cost of care)
e. Promoting population-based health care
(care that focuses on the health status
and needs of a target population
possessing similar health concerns or
characteristics)
f. Promoting quality improvement
16
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Please answer both questions C31 and C32 thinking about any nursing position you have ever held.
Care Delivery
C31. Have you received
C32. Do you feel that
training in the following
areas through formal
education, work or
professional development?
Mark (X) Yes or No
for EACH row.
you have received
sufficient training in this
area? Mark (X) Yes, No,
or N/A for EACH row.
Yes
No
Yes
No
N/A
Yes
No
Yes
No
N/A
Yes
No
Yes
No
N/A
a. Evidence-based care (care that utilizes best practices and clinical
decisions supported by scientific research and clinical expertise)
b. Patient-centered care (care that is responsive to patient preferences,
needs and values, and ensures that patient values guide clinical
decisions)
c. Team-based care (comprehensive health services by at least two
health professionals working collaboratively to provide safe,
quality care)
d. Value-based care (care that improves health outcomes relative
to the cost of care)
Population-Focused Care
e. Population-based health care (care that focuses on the health
status and needs of a target population possessing similar health
concerns or characteristics)
f. Working in an underserved community
g. Caring for medically complex/special needs patients
h. Social determinants of health (e.g., impact of race and
socioeconomic status)
i. Caring for patients with mental health conditions
j. Caring for patients with substance use disorders
Healthcare Leadership
k. Quality improvement
l. Practice management and administration
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C38. Thinking about the primary nursing position you
held on December 31, 2021, have you EVER felt
burned-out?
Questions C33-C40 ask about your primary nursing
position.
C33. In 2021, which of the following educational benefits
did your employer offer to support employee
professional development? Mark (X) ALL that apply.
Yes
No ➔ SKIP to Question C40
Tuition reimbursement
C39. Thinking about the primary nursing position you
held on December 31, 2021, which of the following
best describes your feelings of burnout during the
coronavirus pandemic? Mark (X) ONE box only.
Loan forgiveness
Flexible scheduling
They increased during the coronavirus
pandemic
Other, Specify: C
They decreased during the coronavirus
pandemic
They did not change during the coronavirus
pandemic
None
C40. Have you left the primary nursing position you
held on December 31, 2021?
C34. Please estimate your 2021 pre-tax annual earnings
from your primary nursing position. Include overtime
and bonuses, but exclude sign-on bonuses.
$
Yes ➔ Continue to Section D on page 19
.00
No ➔ SKIP to Section E on page 20
C35. In 2021, were you represented by a labor union or
collective bargaining unit in the primary nursing
position you held on December 31, 2021?
Yes
No
C36. How satisfied were you with the primary nursing
position you held on December 31, 2021?
Extremely satisfied
Moderately satisfied
Moderately dissatisfied
Extremely dissatisfied
C37. Did you hold the same primary nursing position
from January 1, 2020 through December 31, 2021?
Yes
No ➔ SKIP to Question C40
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Section D. Left the Primary
Nursing Position Held on
December 31, 2021
D1.
D2.
Did you continue to work in nursing after leaving
this position?
Yes
No ➔ SKIP to Section F on page 21
Which of the following reasons contributed to your
decision to LEAVE the primary nursing position you
held on December 31, 2021? Mark (X) ALL that apply.
D3.
Better pay or benefits
Burnout
How long do you plan to work in NURSING in the
geographic area of the primary nursing position
you held on December 31, 2021?
Already left the geographic area
Career advancement or promotion
Less than a year
Career change
1-2 years
Disability or illness
3-5 years
Family caregiving
More than 5 years
High risk working conditions
Not sure
Inability to practice to the full extent
of my license
D4.
Inadequate staffing
Approximately when do you plan to retire from
nursing?
Already retired
Interpersonal differences with colleagues
or supervisors
Within a year
Lack of advancement opportunities
In 1-2 years
Lack of collaboration or communication
between health care professionals
In 3-5 years
Lack of good management or leadership
More than 5 years from now
Length of commute
Undecided
Physical demands of job
SKIP to Section F
Relocation to different geographic area
Retirement
Scheduling (inconvenient hours, too many
hours, or too few hours)
School or educational program
Spouse’s or partner’s employment opportunities
Stressful work environment
Underlying health condition(s) that may
increase risk of severe illness due to
Coronavirus (self or family)
Unsatisfactory safety protocols
Workplace harassment or violence
Other, Specify: C
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Section E. Remained in the
Primary Nursing Position Held
on December 31, 2021
E1.
E6.
Which of the following reasons would contribute
to your decision to LEAVE your primary nursing
position? Mark (X) ALL that apply.
Better pay or benefits
Have you ever considered leaving the primary
nursing position you held on December 31, 2021?
Burnout
Career advancement or promotion
Yes
Career change
No ➔ SKIP to Question E7 on page 21
Change in child’s school
E2.
E3.
E4.
Have you considered leaving this position in the
past year?
Disability or illness
Yes
Family caregiving
No
High risk working conditions
Inability to practice to the full extent
of my license
When do you plan to leave this position?
Less than one year from now
Inadequate staffing
1-3 years from now
Interpersonal differences with colleagues
or supervisors
More than 3 years from now
Lack of advancement opportunities
Not sure
Lack of collaboration or communication
between health care professionals
Do you plan to work in nursing after you leave
this position?
Lack of good management or leadership
Length of commute
Yes
Patient population
No
Physical demands of job
Not sure
Relocation to different geographic area
E5.
How long do you plan to work in NURSING in the
geographic area of the primary nursing position
you held on December 31, 2021?
Retirement
Scheduling (inconvenient hours, too many
hours, or too few hours)
Less than a year
School or educational program
1-2 years
Spouse’s or partner’s employment opportunities
3-5 years
Stressful work environment
More than 5 years
Underlying health condition(s) that may
increase risk of severe illness due to
Coronavirus (self or family)
Not sure
Unsatisfactory safety protocols
Workplace harassment or violence
Other, Specify: C
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E7.
E8.
What factors contribute to your decision to
REMAIN in your primary nursing position?
Mark (X) ALL that apply.
Approximately when do you plan to retire from
nursing?
Already retired
Ability to provide full scope of services
Within a year
Adequate staffing
In 1-2 years
Availability of loan repayment financial support
In 3-5 years
Availability of resources to do my job well
More than 5 years from now
Availability of training opportunities
Undecided
Balanced schedule or hours
Commitment to underserved communities
Section F. Secondary
Employment in Nursing
Cost of living
Difficulty finding another job
Experience at site
The questions in this section (Questions F1-F8) will ask
about your "secondary nursing position." This is any
nursing position(s) you held on December 31, 2021 in
addition to your primary nursing position. This can be
any position that required an LVN, LPN, RN, or APRN
license.
Length of commute
Liking the job
Opportunities for advancement
F1.
Proximity to desirable school district
Proximity to extended family, parents, or siblings
Proximity to spouse’s or partner’s employment
opportunities
In addition to your primary nursing position,
were you working for pay in nursing in any
OTHER positions on December 31, 2021?
Do not report any positions where you worked
outside the United States or in a U.S. territory.
Yes
Salary and benefits
No ➔ SKIP to Section G on page 22
Satisfactory safety protocols
Questions F2-F8 ask about your experience in 2021 only.
Sense of community with peers
F2.
Use of Electronic Health Records
Use of telehealth
For any other nursing position(s) you held on
December 31, 2021, were you employed as a
traveling nurse?
Yes
Other, Specify: C
No
F3.
For the other position(s) you held on
December 31, 2021, which of the following best
describes your employment situation(s) in 2021?
Mark (X) ALL that apply.
Employed through an employment agency
Employed by an organization or facility
Self-employed or independent contractor
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F4.
F8.
What type of work setting best describes where you
worked for the other position(s) held on December
31, 2021. Answer only about the year 2021. If you
have more than one additional position, answer about
the position where you spend the most time.
Please estimate your 2021 pre-tax annual earnings
from all of the nursing positions that you reported
about in THIS SECTION. Include overtime and
bonuses, but exclude sign-on bonuses. Do NOT
include earnings from your primary nursing position.
$
Hospital
.00
Nursing home or extended care facility
Section G.
Nurse Practitioners
Academic education program
Home health setting
G1a. On December 31, 2021, did you have an active
certification, license, or other legal recognition
to practice as a Nurse Practitioner (NP) from a
STATE BOARD OF NURSING?
Public health or community health setting
Rehabilitation or long-term care facility
Mental or behavioral health setting
Yes
School or college health service
No ➔ SKIP to Section H on page 25
Occupational health or employee health services
G1b. What U.S. state(s) issued the active NP license(s),
certification(s), or recognition(s)? List up to 8.
Physician practice (individual or group)
State
State
State
State
Ambulatory care clinic or surgical center
Insurance company
Telehealth, telenursing, or call center
Hospice care setting
G2.
Do you have a National Provider Identifier (NPI)
number?
Government agency
Yes
Consulting, regulatory urgent, retail, or
convenience clinic
No ➔ SKIP to Question G4
Substance abuse setting
F5.
G3.
Across all of the other nursing positions you held
on December 31, 2021, how many weeks did you
work in 2021? Enter a number from 1-52. Do not
include weeks where you only worked your primary
nursing position.
Yes
No
Don’t know
Weeks in 2021
F6.
G4.
Across all of the other nursing positions you
held on December 31, 2021, on average how
many hours per week did you work in 2021?
Do not include hours worked in your primary
nursing position.
To what extent did your education prepare you to
be a Licensed Independent Practitioner (LIP)?
An LIP is permitted to provide care and services
without supervision from a physician.
I do not practice independently
Hours
F7.
Do you or have you ever billed under your NPI
number?
A great extent
Across all of the other nursing positions you
held on December 31, 2021, in what state was
most of the work done in 2021?
Somewhat
Very little
Not at all
State
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G5.
Did you complete an NP post-graduate residency
or fellowship program?
G11. On December 31, 2021, were you employed in an
NP position that required state certification,
licensure, or recognition?
Yes
Yes
No
No ➔ SKIP to Question G30 on page 25
G6.
Have you ever precepted any NP students?
G12. In any of the NP position(s) you held on
December 31, 2021, did you provide patient care?
Answer only about the year 2021.
Yes
No ➔ SKIP to Question G11
G7.
Yes
When did you precept the NP student(s)?
Mark (X) ALL that apply.
No ➔ SKIP to Question G22 on page 24
G13. Across ALL of the NP positions you held on
December 31, 2021, about how many patients did
you see in a typical day in 2021? If none, enter zero.
Prior to March 2020
During or after March 2020
Patients per day
Questions G8-G20 ask about your experiences in 2021 only.
Questions G14-G22 ask about your primary NP position.
If you had multiple NP positions, the primary NP
position is the one you held on December 31, 2021 in
which you spent the largest share of your NP working
hours.
G8a. In 2021, how many NP students did you precept?
If you did not precept NP students in 2021, enter 0
and SKIP to Question G11.
Students
G14. Did the primary NP position you held on
December 31, 2021, include any patient care?
Answer only about the year 2021.
G8b. In 2021, how many hours of YOUR TIME did you
spend precepting students to meet their clinical
requirements?
Yes
No ➔ SKIP to Question G22 on page 24
Hours
G9.
G15a. In 2021, was a physician required to SIGN OFF
ON ANY of the patients you saw in your primary
NP position?
Did you receive any remuneration (e.g. money,
tuition reduction, free CEs, etc.) to precept NP
students in 2021?
Yes
Yes
No ➔ SKIP to Question G16a
No ➔ SKIP to Question G11
G15b. In 2021, was a physician required to SIGN OFF
ON ALL of the patients you saw in your primary
NP position?
G10. Which of the following types of remuneration did
you receive from precepting students in 2021?
Mark (X) ALL that apply.
Yes
Money C
No
How much money did you receive in 2021?
$
G16a. In 2021, was a physician required to SEE ANY of
the patients you saw in your primary NP position?
.00
Yes
Tuition reduction
No ➔ SKIP to Question G17 on page 24
Free CEs
G16b. In 2021, was a physician required to SEE ALL of
the patients you saw in your primary NP position?
Other, Specify: C
Yes
No
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G17. In the primary NP position you held on
December 31, 2021, what percentage of your
patients were from racial or ethnic minority groups
in 2021? Your best estimate is fine.
G22. In the primary NP position that you held on
December 31, 2021, did you have the title
Hospitalist in 2021?
Yes
%
Don’t know
No
G18. In the primary NP position you held on
December 31, 2021, what percentage of your
patients had limited English proficiency in 2021?
Your best estimate is fine.
%
G23. Did you have hospital admitting privileges on
December 31, 2021?
Yes
Don’t know
No
G19. Thinking about the primary NP position you held
on December 31, 2021, please estimate the
percentage of your patients that were covered by
the following types of insurance in 2021.
Your best estimate is fine.
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
%
Uninsured
%
Other
%
G24. Were you covered by malpractice insurance on
December 31, 2021?
Yes
No ➔ SKIP to Question G26
G25. Who paid for your malpractice insurance?
Self
Total =
Employer
Both
G26. Did you have FULL prescriptive authority on
December 31, 2021?
Yes ➔ SKIP to Question G29 on page 25
No
G27. Did you have an x-waiver on December 31, 2021?
An x-waiver allows outpatient use of buprenorphine
to treat opioid use disorder.
Yes
100%
No
Don’t know
G28. Why didn’t you have FULL prescriptive authority?
Mark (X) ALL that apply.
G20. In the primary NP position you held on
December 31, 2021, 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. Answer only
about the year 2021.
Was in the process of applying
MD or other NP wrote all of my prescriptions
Yes
State scope of practice regulations
No ➔ SKIP to Question G22
Not required
G21. In the primary NP position you held on
December 31, 2021, on average, about how
many patients were on your panel in 2021?
Your best estimate is fine.
Other, Specify: C
Patients
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Section H.
Nurses Not Working in Nursing
G29. On December 31, 2021 did you have a personal
Drug Enforcement Administration (DEA) number?
Yes ➔ SKIP to Section I on page 26
If you were working for pay in nursing on December 31,
2021, please SKIP to Section I.
No ➔ SKIP to Section I on page 26
G30. What are the reasons that you were not employed
in an NP position that required state certification,
licensure, or recognition? Mark (X) ALL that apply.
H1.
What are the primary reasons you were not
working in a nursing position for pay on
December 31, 2021? Mark (X) ALL that apply.
Overall lack of NP job opportunities
Burnout
Lack of NP job opportunities in desired
location
Career change
Lack of NP job opportunities in desired
specialty
Difficulty finding a nursing position
Disability or illness
Lack of NP job opportunities in desired
type of facility
Family caregiving
Limited scope of practice for NPs in the
state where practice was desired
High risk working conditions
Lack of experience or qualification
Inability to practice nursing on a
professional level
Inadequate salary or benefits
Inadequate staffing
Working outside the field of nursing
Lack of advancement opportunities
Family caregiving
Disability or illness
Lack of collaboration or communication
between health care professionals
Chose not to work
Lack of good management or leadership
Retirement
Liability concerns
Other, Specify: C
Physical demands of job
Retirement
Salaries too low or better pay elsewhere
Scheduling (inconvenient hours, too many
hours, or too few hours)
School or educational program
Skills are out-of-date
Stressful work environment
Underlying health condition(s) that may
increase risk of severe illness due to
Coronavirus (self or family)
Unsatisfactory safety protocol
Workplace harassment or violence
Other, Specify: C
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H2.
Section I.
Prior Nursing Employment
What are your intentions regarding paid work in
nursing? Mark (X) ONE box only.
Actively looking for work in nursing
I1.
Plan to return to nursing in the future, not
looking for work now ➔ SKIP to Question H5
H3.
No future intention to work for pay in
nursing ➔ SKIP to Question H6a
0 - 5 years
Undecided at this time ➔ SKIP to Question H6a
6 - 10 years
Have returned to nursing since
December 31, 2021 ➔ SKIP to Section I
11 - 20 years
21 - 30 years
How long have you been actively looking for paid
work in nursing? Enter zero if less than one month.
31 or more years
Month(s)
H4.
H5.
How many years have you worked in nursing since
receiving your first U.S. RN license? Count only the
years in which you worked at least 6 months.
I2.
Are you looking for a position that is full-time or
part-time?
Have you left work in nursing since becoming
an RN?
No
Full-time ➔ SKIP to Question H6a
Yes, for less than a year
Part-time ➔ SKIP to Question H6a
Yes, for 1 - 2 years
Either ➔ SKIP to Question H6a
Yes, for 3 - 5 years
Yes, for more than 5 years
When do you plan to return to paid work in
nursing? Enter zero if less than one year.
Questions I3 - I9 ask about your employment in 2020.
Year(s)
I3.
Don’t know
Were you employed in nursing on December 31,
2020?
Yes
H6a. Have you ever been employed or self-employed in
nursing?
No ➔ SKIP to Section J on page 29
Yes
I4.
No ➔ SKIP to Section I
H6b. In what year were you last employed or
self-employed as a nurse? Enter 4-digit year below.
For the primary nursing position you held on
December 31, 2020, did you work full-time or
part-time in 2020? Mark (X) ONE box only. If you
worked both full-time and part-time in 2020, select
the schedule you worked for the largest portion of
the year.
Full-time (including full-time for an
academic year)
Year
Part-time (including working only part
of the calendar or academic year)
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I5.
How would you describe the primary nursing
position you held on December 31, 2020?
I8.
Same position and same employer as primary
nursing position on December 31, 2021 ➔ SKIP
to Section J on page 29
Better pay or benefits
Burnout
Different position but same employer
as primary nursing position held on
December 31, 2021
I6.
What were the primary reason(s) for your
employment change? Mark (X) ALL that apply.
Career advancement or promotion
Different employer, same position as primary
nursing position held on December 31, 2021
Career change
Different employer, different position
than primary nursing position held on
December 31, 2021
Family caregiving
Was not working in a nursing position on
December 31, 2021
Inability to practice to the full extent
of my license
High risk working conditions
Inadequate staffing
What was the location of the primary nursing
position you held on December 31, 2020? If you
were not employed in a fixed location, enter the
location that best reflects where you practiced.
Interpersonal differences with colleagues
or supervisors
Lack of advancement opportunities
In the U.S. C
Lack of collaboration or communication
between health care professionals
City/Town
Lack of good management or leadership
State
Length of commute
Zip
Patient population
Physical demands of job
Outside the U.S. - Print name of foreign country
or U.S. territory: C
Relocation to different geographic area
Retirement
Scheduling (inconvenient hours, too many
hours, or too few hours)
I7.
Did you work 100% remotely for the primary
nursing position you held on December 31, 2020?
School or educational program
Yes
Spouse’s or partner’s employment opportunities
No
Stressful work environment
Underlying health condition(s) that may
increase risk of severe illness due to
Coronavirus (self or family)
Unsatisfactory safety protocol
Workplace harassment or violence
Other, Specify: C
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I9.
Which one of the following best describes the employment setting of the primary nursing position you held on
December 31, 2020? Mark (X) ONE box only.
Hospital (not including mental health or
rehabilitation facilities)
Outpatient, Ambulatory, or Other Clinical settings
(non-hospital based)
Hospital Inpatient Department or Unit
Urgent, Emergency Care, or Transport
(not hospital-sponsored)
Hospital Emergency Department or Transport
Occupational Health or Employee Health Services
Hospital-Sponsored Ambulatory or Outpatient Clinic
or Center (Clinic, Specialty, Surgery, etc.) (Non-ED)
Correctional Facility
Hospital-Sponsored Urgent Care
Private Practice - Medical or NP
Hospital Administration, Education, Quality, etc.
Nurse-Managed Health Clinic or Center
Hospital Nursing Home Unit
Ambulatory Surgery Center (not hospital based)
Hospital Ancillary Unit (Radiology, Lab, GI lab,
Consult Services, etc.)
Community Health Center or Federally Qualified
Health Center (FQHC)
Hospital Other, Specify: C
Hospice – Outpatient
Health Maintenance Organization or Managed Care
Federally-run Clinic (VA, Military, NIH, IHS)
Other Inpatient settings
Home Health or Day Care Services
Skilled Nursing Facility or Nursing Home
Public Clinic or Rural Health Clinic or Center
Rehabilitation, Long Term Care, or
Long Term Acute Care Facility
Retail Clinic
Hospice - Inpatient
Rehabilitation - Outpatient
Mental or Behavioral Health Facility - Inpatient
Stand-Alone Dialysis or Infusion Clinic
Substance Use Treatment Center - Inpatient
School Health Service (K-12 or Post-secondary)
Other Inpatient Setting, Specify: C
Mental or Behavioral Health Facility - Outpatient
Substance Use Treatment Center - Outpatient
Non-patient care settings
Other, Specify: C
Public Health or Community Health Agency
Local, State, or Federal Government Agency
University or College Academic Department
Insurance Company
Call Center, Telenursing Center, or Remote Nursing
Regulatory Agency or Organization
Consulting Agency or Organization
Professional Organization
Other, Specify: C
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Section J. Nursing During the
Coronavirus Pandemic
J3b.
Which of the following reasons contributed to why
you left work in nursing between March 1, 2020
and December 31, 2021? Mark (X) ALL that apply.
Unsatisfactory safety protocol(s)
Questions J1 - J3c ask about the time period between
March 1, 2020 and December 31, 2021.
J1.
High-risk working conditions
Were you employed in nursing at any time between
March 1, 2020 and December 31, 2021?
Underlying health conditions (self or family)
Floating to unfamiliar units or departments
Yes
Caring for family members
No ➔ SKIP to Question J9a on page 30
Inadequate staffing
J2.
Between March 1, 2020 and December 31, 2021,
which of the following did you experience DUE
TO THE CORONAVIRUS PANDEMIC?
Mark (X) ALL that apply.
Overworked or burned-out
Other, Specify: C
Furloughed WITH pay
Furloughed WITHOUT pay
J3c.
Forced to take my own PAID time off
Did you intend to return to work in nursing?
Yes
Forced to take UNPAID time off
No
Laid off from work with intent to return
to nursing
I was not sure if I would return or not
Delayed retirement
J4.
Changed employer but remained in nursing
How often did you feel burned-out by your work in
nursing in 2019, 2020, and 2021?
Changed role(s) from patient care to
non-patient care
Did not
work in
nursing
Changed role(s) from non-patient care to
patient care
Never
A few
times a
year or
less
A few
times a
month
A few
times a
week
Every
day
2019
Temporarily floated to a different unit or
department within my employer, within
the same state
2020
2021
Temporarily floated to a different unit or
department within my employer, outside
home state
J5.
Temporarily left my employer to assist with
pandemic response, within the same state
Temporarily left my employer to assist with
pandemic response, outside home state
At any point in 2020 or 2021, were you required
to receive a COVID-19 test to conduct your work
in nursing? If you were only required to receive a
test to return to work after being infected with
COVID-19, mark No.
Yes
None of the above
No
J3a.
At any time between March 1, 2020 and December
31, 2021, did you decide to leave work in nursing
DUE TO THE CORONAVIRUS PANDEMIC?
J6.
Yes, I retired earlier than I had planned
As of December 31, 2021, had you ever been tested
for COVID-19? Do not include antibody tests.
Yes
Yes, I left work in nursing but did not retire
No
No ➔ SKIP to Question J4
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J7.
Have you ever tested positive for COVID-19 or
had a health care provider tell you that you had
COVID-19? Include antibody tests.
K2.
Yes
Yes
No ➔ SKIP to Question K5
No ➔ SKIP to Question J9a
J8.
Have you EVER been reported to the NPDB?
K3.
As of December 31, 2021, had you ever been
hospitalized due to COVID-19?
Who submitted the report(s)?
Mark (X) ALL that apply.
State licensing board
Yes
Medical malpractice payer, such as an
insurance company
No
Hospital
J9a.
J9b.
As of December 31, 2021, had you received at
least one dose of a COVID-19 vaccine?
Yes
Unknown
No ➔ SKIP to Question J10
Other, Specify: C
When did you receive your first dose of a COVID-19
vaccine?
Month
J10.
Federal agency
K4.
Year
At any point in 2020 or 2021, were you required to
have received at least one dose of a COVID-19
vaccine to conduct your work in nursing?
Did the NPDB report impact your career?
Mark (X) ALL that apply.
No, the report did not impact my career
Yes, the report had a negative impact on
my position (e.g., reprimand, termination)
Yes
Yes, the report made it difficult to obtain
employment
No
Yes, other
Section K.
National Practitioner Data Bank
K1.
Don’t know
K5.
The National Practitioner Data Bank (NPDB), is
a nationwide repository of negative actions
taken against health care professionals. Its
primary function is to aid employers in
making well-informed hiring decisions.
Currently, certain entities are required to
query the NPDB on physicians and dentists,
prior to making decisions on hiring and clinical
privileges.
When making hiring decisions, do you feel that
health care employers should consider prior
negative health care related actions taken against
prospective employees?
Yes, they should consider prior negative
actions
No, they should not consider prior negative
actions
K6.
Do you think the query requirement should
be expanded to other health care
professions?
Yes, it should be expanded to all
health care professions
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 physicians.
Do you feel the NPDB should also collect
reports on adverse actions against a Nurse
Practitioner that could affect their clinical
privileges?
Yes, it should be expanded to some but
not all health care professions
No, it should not be expanded
Yes, they should be reported
I am unfamiliar with the National
Practitioner Data Bank ➔ SKIP to Section L
on page 31
No, they should not be reported
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K7.
Section L.
General Information
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?
L1.
The same reporting requirements as
physicians
City/Town
Less strict reporting requirements for
Nurse Practitioners who are supervised by
a physician
More strict reporting requirements for
Nurse Practitioners who are supervised by
a physician
K8.
Where did you live on December 31, 2021?
This information is critical for producing state
estimates of the nursing workforce.
State
Zip
Do you have clinical privileges at a hospital or
some other healthcare facility?
L2.
Yes
No
Where did you live on December 31, 2020?
This information is critical for producing state
estimates of the nursing workforce.
Same address reported in Question L1
Don’t know
In the U.S. C
City/Town
State
Zip
Outside the U.S. - Print name of foreign country
or U.S. territory: C
L3.
What is your sex?
Male
Female
L4.
What is the year of your birth?
Year
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L7.
NOTE: Answer BOTH Question L5 about Hispanic
origin and Question L6 about race. For this survey,
Hispanic origins are not races.
L5.
L6.
What languages do you speak fluently, other than
English? Mark (X) ALL that apply.
No additional languages
Are you of Hispanic, Latino, or Spanish origin?
No, not of Hispanic, Latino, or Spanish origin
Spanish
Yes, Mexican, Mexican American, Chicano
Filipino language (Tagalog, other Filipino
dialect)
Yes, Cuban
Chinese language (Cantonese, Mandarin,
other Chinese language)
Yes, Puerto Rican
Russian
Yes, another Hispanic, Latino, or Spanish origin
Korean
What is your race? Mark (X) one or more boxes.
Vietnamese
White
American Sign Language
Black or African American
Other language(s), Specify: C
American Indian or Alaska Native
Asian Indian
L8.
Chinese
What is your marital status?
Married or in a domestic partnership
Filipino
Widowed, divorced, or separated
Japanese
Never married
Korean
L9.
Vietnamese
Other Asian
Have you ever served on active duty in the
U.S. Armed Forces, Reserves, or National Guard?
Mark (X) ONE box only.
Never served in the military
Native Hawaiian
Only on active duty for training in the
Reserves or National Guard
Guamanian or Chamorro
Now on active duty
Samoan
On active duty in the past, but not now
Other Pacific Islander
L10. Which of the following best describes the
dependents (children, parents, etc.) who either
live at home with you or for whom you provide
A SIGNIFICANT AMOUNT OF CARE?
Mark (X) ALL that apply.
Child(ren) less than 6 years old at home
Child(ren) 6 to 18 years old at home
Other adults at home (e.g., parents or
dependents)
Others living elsewhere (e.g., children,
parents, or dependents)
None
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L11. Including employment earnings, investment
earnings, and other income of all household
members, what was your 2021, pre-tax annual
total household income? Mark (X) ONE box only.
$25,000 or less
$25,001 to $35,000
$35,001 to $50,000
$50,001 to $75,000
$75,001 to $100,000
$100,001 to $150,000
$150,001 to $200,000
More than $200,000
Thank you for your participation.
Please return this survey in the enclosed, postage-paid envelope.
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| File Type | application/pdf |
| Author | OneFormUser |
| File Modified | 2022-07-18 |
| File Created | 2022-07-18 |