Ms. Geraldine A Moore Nursing Survey School request
Answers marked with a * are required.
 
Personal Information Sheet

Please complete the following information:
 
 
 
1. Age
 
 
 
2. Highest formal education
      
 
 
 
3. Number of years as a registered nurse
 
 
 
4. I live and work in the United States
      
 
 
 
5. I live and work outside the United States,(please list your country)
 
 
 
6. Area of work
      
 
 
 
7. If you answered question 6(other) please explain what area you work in.
 
 
 
8. Number of years in this position
 
 
 
9. Please choose one method of entry into nursing
      
 
 
 
10. (If nursing is a second career, please answer this question) My previous career was
 
 
 
11. In 5 years, I see myself
 
 
 
Thank you for completing this portion, please proceed to the survey.

Your participation is completely voluntary. All responses are anonymous and data will be presented in summary form only. By completing the survey, you are agreeing to all terms and are granting permission to use the information.
 
 
 
Directions: Please read each statement and circle the response following each statement that is most appropriate for you.

Select your responses according to the following scale:
1= strongly disagree, 2- disagree, 3= somewhat disagree,
4= somewhat agree, 5= agree, 6= strongly agree
 
 
 
12. Nursing provides me with an opportunity to advance professionally.
 
 
 
13. I am concerned about layoffs
 
 
 
14. Pay compares with similar jobs in other hospitals.
 
 
 
15. Nursing provides limited opportunities for advancement
 
 
 
16. I receive recognition from my immediate supervisor.
 
 
 
17. I get along well with my colleagues.
 
 
 
18. I am compensated for working weekends
 
 
 
19. My interests are similar to my colleagues
 
 
 
20. My immediate supervisor turns one nurse against another.
 
 
 
21. I am afraid of losing my job as a nurse.
 
 
 
22. My colleagues motivate me to do better work.
 
 
 
23. Nursing provide an opportunity for promotion.
 
 
 
24. My immediate supervisor treats everyone equitably.
 
 
 
25. I am guaranteed steady employment.
 
 
 
26. I dislike the people with whom I work.
 
 
 
27. My immediate supervisor gives me assistance when I need help.
 
 
 
28. Nursing provides for a comfortable retirement.
 
 
 
1= strongly disagree, 2- disagree, 3= somewhat disagree,
4= somewhat agree, 5= agree, 6= strongly agree
 
 
 
29. My colleagues are highly critical of one another.
 
 
 
30. My immediate supervisor makes me feel uncomfortable.
 
 
 
31. I am well paid for my ability.
 
 
 
32. I do not get cooperation from the people I work with.
 
 
 
33. My current position is as high as I want to be.
 
 
 
34. I have made lasting friendships among my colleagues.
 
 
 
35. Nursing provides for a secure future.
 
 
 
36. My immediate supervisor does not back me up.
 
 
 
37. Salary was a deciding factor when I chose nursing as a profession.
 
 
 
38. My current position is much lower than where I want to be.
 
 
 
39. My colleagues provide me with suggestions or feedback about my nursing care.
 
 
 
40. Insufficient income keeps me from living the way I want to live.
 
 
 
41. My immediate supervisor is not willing to listen to suggestions.
 
 
 
42. I am afraid I will be replaced in the near future.
 
 
 
43. Salary increases are regularly scheduled
 
 
 
44. My current position is higher than where I want to be.
 
 
 
45. My immediate supervisor explains what is expected of me
 
 
 
46. Nurse income is adequate for normal expenses.
 
 
 
47. I never feel secure in my job as a nurse.
 
 
 
48. I am not getting ahead in my present position.
 
 
 
49. My current position is a little lower than where I want to be.
 
 
 
 
 

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