1. How many RNs/LPNs on this unit demonstrate appropriate/competent-nursing skills?

All
Most
Some
Few
None

2. Approximately what percentage of the time do you find the patients' clipboard at the patient bedside/door?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

3. You have notified nursing that you plan to perform a certain treatment on your patient later in the day. What percentage of the time does the nurse have the needed equipment at the bedside when you return to perform the treatment?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

4. When you receive a phone call regarding a patient's condition, how often does a nurse provide you with an appropriate description of the patients' condition/status?

All of the time
Most of the time
Some of the time
None of the time

5. When you round on your patients, what percentage of the time does a nurse accompany you on rounds or make himself/herself available to you for questions/orders?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

6. Has the Nurse Manager introduced himself/herself to you and responded to concerns that you have voiced?

Yes
No

7. I feel the nurses on this shift/unit act in a professional manner in regards to:

Dress and appearance	True  |  False
Respect for patients	True  |  False
Respect for each other	True  |  False
Respect for families	True  |  False
Respect for physicians	True  |  False
Manner of response/tone of voice	True  |  False

8. Would you feel comfortable having a family member as a patient on this unit?

Yes
No

If not, why?

9. Is there a nurse that you would like to recognize as being a professional role model on this unit? (Provide name)

10. Please note any other comments you would like to share with us.

If you desire to speak to Ginger Campbell, CNO, about your concerns, please contact her at 244-3685 or provide your name and a contact number.

Optional - Please contact me:


Name:
Number: