Nursing Environment Survey

After reading the following statements, mark your response using the categories of strongly disagree, disagree, agree or strongly agree.

These questions relate to hospital characteristics that affect nursing. / Strongly Disagree / Disagree / Agree / Strongly Agree
  1. Revenue changes in your hospital have negatively affected the Department of Nursing.
/ 1 / 2 / 3 / 4
  1. Support from the governing board of your hospital has positively affected the department of nursing.
/ 1 / 2 / 3 / 4
  1. Patient-centered care is valued by all within the organization.
/ 1 / 2 / 3 / 4
  1. Patient-centered care is widely shared by all within the organization.
/ 1 / 2 / 3 / 4
  1. The medical staff shares patient-centered common goals & philosophies with nursing.
/ 1 / 2 / 3 / 4
  1. A strong multi-disciplinary climate is evident in your rural hospital.
/ 1 / 2 / 3 / 4
  1. There is a high level of shared decision-making between nurses and physicians on clinical issues.
/ 1 / 2 / 3 / 4
  1. Teams in your rural hospital work collaboratively to focus on common goals.
/ 1 / 2 / 3 / 4
  1. CEO turnover is a significant issue for your rural hospital.
/ 1 / 2 / 3 / 4
  1. Patients served by your rural hospital use the Internet for healthcare information.
/ 1 / 2 / 3 / 4
These questions relate to hospital quality and safety. / Strongly Disagree / Disagree / Agree / Strongly Agree
  1. Revenue changes have negatively affected the quality of care in your hospital.
/ 1 / 2 / 3 / 4
  1. Nurses in your hospital are involved in safety teams.
/ 1 / 2 / 3 / 4
  1. Physicians in your hospital are involved in safety teams.
/ 1 / 2 / 3 / 4
  1. The shortage of the appropriate number of clinically competent nurses has affected the delivery of quality patient care.
/ 1 / 2 / 3 / 4
  1. There are enough nurses to provide quality patient care.
/ 1 / 2 / 3 / 4
  1. JCAHO standards have a positive influence on quality in your rural hospital.
/ 1 / 2 / 3 / 4
  1. Core measures have a positive influence on quality in your rural hospital.
/ 1 / 2 / 3 / 4
  1. Professional organizations have a positive influence on quality in your rural hospital.
/ 1 / 2 / 3 / 4
  1. Managed care has a positive influence on quality in your rural hospital.
/ 1 / 2 / 3 / 4
  1. Proximity to higher education institutions has a positive influence on quality in your rural hospital.
/ 1 / 2 / 3 / 4
  1. Are you in close proximity to a higher education institution?
____ No ___Yes (number of miles away____) / 1 / 2 / 3 / 4
  1. JCAHO Patient Safety Goals have a positive influence on safety in your rural hospital.
/ 1 / 2 / 3 / 4

These questions relate to forces outside of the hospital that affect nursing.

Strongly Disagree / Disagree / Agree / Strongly Agree
  1. The physical isolation of your rural hospital affects the nurse’s work environment.
/ 1 / 2 / 3 / 4
  1. The physical isolation of your rural hospital affects patient outcomes.
/ 1 / 2 / 3 / 4
  1. The professional isolation of your rural hospital affects the nurses’ work environment.
/ 1 / 2 / 3 / 4
  1. The professional isolation of your rural hospital affects patient outcomes.
/ 1 / 2 / 3 / 4

These questions relate to Balanced Budget Act of 1997 (BBA), The Balanced Budget Refinement Act of 1999 (BBRA), and the Benefits Improvement and Protection Act of 2000 (BIPA).

Strongly Disagree / Disagree / Agree / Strongly Agree
  1. Regulations resulting from this legislation have negatively affected nursing in your rural hospital.
/ 1 / 2 / 3 / 4
If you agree or strongly agree - can you provide some examples?
  1. The financial impact of these regulations has negatively affected nursing in your rural hospital.
/ 1 / 2 / 3 / 4
If you agree or strongly agree - can you provide some examples?

These questions relate to the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA)

Strongly Disagree / Disagree / Agree / Strongly Agree
  1. The financial impact of the MMA has positively affected nursing in your rural hospital.
/ 1 / 2 / 3 / 4
If you agree or strongly agree - can you provide some examples?
  1. Your rural hospital proactively planned for the financial impact of the MMA.
/ 1 / 2 / 3 / 4
If you agree or strongly agree - can you provide some examples?

These questions relate to nursing issues that are important to nursing in your hospital.

How important are the following issues to nursing in your rural hospital? The response categories are; Extremely Important, Moderately Important, Somewhat Important, or Not Important.

Extremely Important / Moderately
Important / Somewhat Important / Not Important
  1. Legislation that affects rural hospitals.
/ 4 / 3 / 2 / 1
  1. Quality and safety initiatives.
/ 4 / 3 / 2 / 1
  1. Staying up to date with technology.
/ 4 / 3 / 2 / 1
  1. Emergency preparedness.
/ 4 / 3 / 2 / 1
  1. Physician recruitment.
/ 4 / 3 / 2 / 1
  1. Compliance with legislation.
/ 4 / 3 / 2 / 1
  1. Leadership turnover.
/ 4 / 3 / 2 / 1
  1. Nurse recruitment.
/ 4 / 3 / 2 / 1
  1. Evidence-based practice.
/ 4 / 3 / 2 / 1
  1. Educational preparation of staff.
/ 4 / 3 / 2 / 1
  1. Nursing ratios.
/ 4 / 3 / 2 / 1
  1. Continuity of care.
/ 4 / 3 / 2 / 1
  1. Acuity of patients.
/ 4 / 3 / 2 / 1
  1. Low volumes of high-risk patients or procedures.
/ 4 / 3 / 2 / 1

The following questions are about challenges to you in fostering Evidence-based Practice (EBP). How much of a problem are the following issues to you in your rural hospital? The response categories are; Big Problem, Moderate Problem, Small Problem, or No Problem.

Big Problem / Moderate Problem / Small Problem / No Problem
  1. Education of staff.
/ 4 / 3 / 2 / 1
  1. Availability of expert.
/ 4 / 3 / 2 / 1
  1. Availability of educator.
/ 4 / 3 / 2 / 1
  1. Availability of mentors.
/ 4 / 3 / 2 / 1
  1. Wearing many hats.
/ 4 / 3 / 2 / 1
  1. Lack of familiarity with EBP.
/ 4 / 3 / 2 / 1
  1. No time.
/ 4 / 3 / 2 / 1

The following questions are about challenges to you in fostering the professional practice of nursing. How much of a problem are the following issues to you in your rural hospital? The response categories are; Big Problem, Moderate Problem, Some Problem, No Problem.

Big Problem / Moderate Problem / Small Problem / No Problem
  1. Enabling evidence-based practice
/ 4 / 3 / 2 / 1
  1. Maintaining competency of staff
/ 4 / 3 / 2 / 1
  1. Fostering ongoing continuing education
/ 4 / 3 / 2 / 1
  1. Staff nurse academic education (AA, BS, MS)
/ 4 / 3 / 2 / 1

Within the last three years, which of the following strategies have you implemented to enhance revenues and contain costs?The response categories are yes or no.

Yes / No
  1. Reduce nursing hours.
/ Yes / No
  1. Cut services.
/ Yes / No
  1. Redesign services.
/ Yes / No
  1. Implement swing beds.
/ Yes / No
  1. Increased focus on philanthropy.
/ Yes / No
  1. Implement productivity measures.
/ Yes / No
  1. Renegotiate contracts.
/ Yes / No
  1. Increased number of beds.
/ Yes / No
  1. Network or system membership.
/ Yes / No
  1. Shift inpatient procedures to outpatient.
/ Yes / No
  1. Change Nursing Skill Mix.
/ Yes / No
  1. . Other______.
/ Yes / No
These questions relate to Physician Staffing.
  1. Do you have a physician house staff or attendings in residence 24 hours a day?
/ Yes / No
  1. Do you have a hospitalist on staff?
/ Yes / No
What type of technologies do you currently use in your hospital?
  1. Telemedicine.
/ Yes / No
  1. Teleconferencing.
/ Yes / No
  1. Electronic/Computer based patient record. In progress
/ Yes / No
  1. Infusion Pumps (“Smart pumps”)
/ Yes / No
  1. Computerized physician order entry. In progress
/ Yes / No
  1. Medication systems. In progress
/ Yes / No
  1. Other______
/ Yes / No
Yes / No
  1. Do you benchmark your quality outcomes?
/ Yes / No
  1. a) If yes, which benchmarks of quality outcomes do you use?
/ Your system or network
StateHospital Association
Private service.
What is the name of the private service used? ______
NDNQI
CMS
VHA
Other______
  1. Have your staff experienced a problem with cultural differences or conflict?
/ Yes / No
  1. a) If yes, do these cultural differences affect the nurses’ work environment?
/ Yes / No
  1. b) What is the nature of these cultural differences?
/ Foreign doctors recruited to rural settings
Population diversity
Nursing characteristics
Other______
  1. Are nurses in your hospital represented by a union?
/ Yes / No
  1. Do you have a clinical ladder?
/ Yes / No
  1. Do nurses in your hospital float across units?
/ Yes / No
  1. Do you consider your wages competitive?
/ Yes / No

These questions relate to your rural hospital.

  1. Does your rural hospital serve a special patient population?
/ Yes / No
  1. a) If yes, what special population is served by your rural hospital?
/ Migrant workers
Indian Reservations
Prisons
Industry
Other______
  1. What percentage of the people that live in your community generally stay in the community for health care services?
/ ______%
  1. Of the nurses in your rural hospital, what is the percent distribution of their highest educational degree
/ ____AA (or Diploma)
____BSN
____MS
____100%
Does this include you? _____Yes _____ No
  1. What is your average length of employment for an RN?
/ _____years
  1. How many total years have you been a CNO?
/ _____years
  1. How many years have you been a CNO in this hospital?
/ _____years
  1. How many years have you been employed by the hospital?
/ _____years
  1. Are you currently Magnet accredited?
/  Yes  No
If no- Are you considering Magnet accreditation?
 Yes  No
  1. What is your official title?

  1. Are you working toward Magnet accreditation?
/  Yes  No
If yes, how many FTE’s are committed to this effort?
______FTE’s
These questions relate to registered nurses (RN) employed as direct care providers more than 50% of the time for your last fiscal year.
  1. What are the dates of your last fiscal year?
/ ______through ______
M/D/Y M/D/Y
  1. What was the average total number of RNs employed?
/ _____ Nurses
  1. Is this a change in comparison to the prior two fiscal years?
/  Yes  No
If yes:
___In the last fiscal year, there were fewer nurses employed.
___In the last fiscal year, there were more nurses employed.
  1. What was the total number of RNs who left the organization during your last fiscal year?
/ _____ Nurses
  1. Was this a change in comparison to the prior two fiscal years?
/  Yes  No
If yes:
___In the last fiscal year, fewer nurses left the organization.
___In the last fiscal year, more nurses left the organization.
  1. What was the average total number of vacant RN FTEs during your last fiscal year?
/ _____ RN FTEs
  1. Is this a change in comparison to the prior two fiscal years?
/  Yes  No
If yes:
___In the last fiscal year, there were fewer vacant RN FTEs.
___In the last fiscal year, there were more vacant FTEs.
  1. What were your direct RN hours during your last fiscal year?
/ ______Direct RN hours