ENA 2012 Focus Group
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1
. How many years have you practiced emergency nursing?
How many years have you practiced emergency nursing?
Less than one year
1-5 years
6-10 years
11-15 years
16-20 years
More than 20 years
None of the above
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2
. In what type of hospital do you currently practice? (if you work at more than one facility, please indicate where you work most often).
In what type of hospital do you currently practice? (if you work at more than one facility, please indicate where you work most often).
Rural hospital
Community hospital
Non-academic medical center
Academic medical center
Do not practice in a hospital setting
Other (please specify)
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3
. In which region of the country do you most frequently practice?
In which region of the country do you most frequently practice?
Northeast US
Northwest US
Midwest US
Southwest US
South US
Southeast US
Do not practice nursing in the US
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4
. What is your primary level of responsibility?
What is your primary level of responsibility?
Nurse Manager/Director
Charge Nurse/Staff Nurse
Clinical Educator
Advanced Practice Nurse/Nurse Practitioner
Flight Nurse
Other (please specify)
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5
. Please provide name, phone, email & city/state where you practice. Hospital ("Company") name is optional.
Please provide name, phone, email & city/state where you practice. Hospital ("Company") name is optional.
Name:
Company:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
Email Address:
Phone Number:
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