PNA 2012 Survey

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1. Please complete the following demographic information.

Please complete the following demographic information. Last Name:
First:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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2. Please indicated which nursing program you are currently enrolled in.

Please indicated which nursing program you are currently enrolled in. BSN

ADN

Diploma

*
3. Please indicate the name of your school of nursing.

Please indicate the name of your school of nursing.

*
4. Please indicate the anticipated year of your graduation

Please indicate the anticipated year of your graduation 2012

2013

*
5. Please indicate the facility(ies) and type of unit(s) you've completed any clinical rotations.

Please indicate the facility(ies) and type of unit(s) you've completed any clinical rotations.

*
6. Are you currently a Duke employee?

Are you currently a Duke employee? Yes

No

*
7. Can you work a 36-40 hour day/night rotation schedule for the entire 10 week program? (Program runs June 4th-August 12th)

Can you work a 36-40 hour day/night rotation schedule for the entire 10 week program? (Program runs June 4th-August 12th) Yes

No

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8. Please indicate if you are currently certified Nursing Care Assistant I or II. (Note- this is not required to apply. However, you will need to obtain NC NA I or NA II registry by May 18, 2012 in order to participate in the program)

Please indicate if you are currently certified Nursing Care Assistant I or II. (Note- this is not required to apply. However, you will need to obtain NC NA I or NA II registry by May 18, 2012 in order to participate in the program) NCAI

NCAII

Not currently certified but will obtain

*
9. Please indicate preferred facility. Please know that we can not guarantee your preferred facility.

Please indicate preferred facility. Please know that we can not guarantee your preferred facility. Duke University Hospital

Duke Raleigh Hospital

Either

10. Please indicate up to 3 unit preferences. Please know that we can not guarantee preferred units.

Please indicate up to 3 unit preferences. Please know that we can not guarantee preferred units. Adult Bone Marrow Transplant

Adult Critical Care

Emergency Department

Peds Med-Surg

Med-Surg

Intensive Care Nursery

Neurosciences

Oncology

Oncology Treatment Center

PACU

Pediatrics-Critical Care

Pediatrics-Outpatient

Pulmonary/Renal

Radiology

Women’s Services/Birthing Center

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11. Please respond to the following behavioral interview questions based on Duke values:

Excellence: We strive to achieve excellence in all that we do.

Give two examples of things you've done in previous jobs or in school that demonstrate excellence as an employee or student.

Please respond to the following behavioral interview questions based on Duke values: Excellence: We strive to achieve excellence in all that we do. Give two examples of things you've done in previous jobs or in school that demonstrate excellence as an employee or student.

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12. Safety: We hold each other accountable to constantly improve culture that ensures the
safety and welfare of all patients, visitors.

Tell of a time when you felt uncomfortable (or unsure) in completing an assignment or task. What did you do?

Safety: We hold each other accountable to constantly improve culture that ensures the safety and welfare of all patients, visitors. Tell of a time when you felt uncomfortable (or unsure) in completing an assignment or task. What did you do?

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13. Integrity: Our decisions, actions, and behaviors are based on honesty, trust, fairness, and the highest ethical standards.

Describe a specific time when you had to handle a tough problem which challenged fairness or ethical issues.

Integrity: Our decisions, actions, and behaviors are based on honesty, trust, fairness, and the highest ethical standards. Describe a specific time when you had to handle a tough problem which challenged fairness or ethical issues.

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14. Diversity: We embrace differences among people.

What measures have you taken to make someone feel comfortable in an environment that was obviously uncomfortable with his or her presence?

Diversity: We embrace differences among people. What measures have you taken to make someone feel comfortable in an environment that was obviously uncomfortable with his or her presence?

*
15. Teamwork: We have to depend on each other and work well together with mutual respect to achieve common goals.

Tell us about the most effective contribution you have made as part of a task group or special project team.

Teamwork: We have to depend on each other and work well together with mutual respect to achieve common goals. Tell us about the most effective contribution you have made as part of a task group or special project team.

PNA 2012
Exit this survey

1. Thank you for your interest the 2012 Summary PNA Program!

*
1. Please complete the following demographic information.

*
2. Please indicated which nursing program you are currently enrolled in.

*
3. Please indicate the name of your school of nursing.

*
4. Please indicate the anticipated year of your graduation

*
5. Please indicate the facility(ies) and type of unit(s) you've completed any clinical rotations.

*
6. Are you currently a Duke employee?

*
7. Can you work a 36-40 hour day/night rotation schedule for the entire 10 week program? (Program runs June 4th-August 12th)

*
8. Please indicate if you are currently certified Nursing Care Assistant I or II. (Note- this is not required to apply. However, you will need to obtain NC NA I or NA II registry by May 18, 2012 in order to participate in the program)

*
9. Please indicate preferred facility. Please know that we can not guarantee your preferred facility.

10. Please indicate up to 3 unit preferences. Please know that we can not guarantee preferred units.

*
11. Please respond to the following behavioral interview questions based on Duke values:

Excellence: We strive to achieve excellence in all that we do.

Give two examples of things you've done in previous jobs or in school that demonstrate excellence as an employee or student.

*
12. Safety: We hold each other accountable to constantly improve culture that ensures the
safety and welfare of all patients, visitors.

Tell of a time when you felt uncomfortable (or unsure) in completing an assignment or task. What did you do?

*
13. Integrity: Our decisions, actions, and behaviors are based on honesty, trust, fairness, and the highest ethical standards.

Describe a specific time when you had to handle a tough problem which challenged fairness or ethical issues.

*
14. Diversity: We embrace differences among people.

What measures have you taken to make someone feel comfortable in an environment that was obviously uncomfortable with his or her presence?

*
15. Teamwork: We have to depend on each other and work well together with mutual respect to achieve common goals.

Tell us about the most effective contribution you have made as part of a task group or special project team.

PNA 2012Exit this survey

1. Thank you for your interest the 2012 Summary PNA Program!

*1. Please complete the following demographic information.

*2. Please indicated which nursing program you are currently enrolled in.

*3. Please indicate the name of your school of nursing.

*4. Please indicate the anticipated year of your graduation

*5. Please indicate the facility(ies) and type of unit(s) you've completed any clinical rotations.

*6. Are you currently a Duke employee?

*7. Can you work a 36-40 hour day/night rotation schedule for the entire 10 week program? (Program runs June 4th-August 12th)

*8. Please indicate if you are currently certified Nursing Care Assistant I or II. (Note- this is not required to apply. However, you will need to obtain NC NA I or NA II registry by May 18, 2012 in order to participate in the program)

*9. Please indicate preferred facility. Please know that we can not guarantee your preferred facility.

10. Please indicate up to 3 unit preferences. Please know that we can not guarantee preferred units.

*11. Please respond to the following behavioral interview questions based on Duke values:Excellence: We strive to achieve excellence in all that we do.Give two examples of things you've done in previous jobs or in school that demonstrate excellence as an employee or student.

*12. Safety: We hold each other accountable to constantly improve culture that ensures thesafety and welfare of all patients, visitors.Tell of a time when you felt uncomfortable (or unsure) in completing an assignment or task. What did you do?

*13. Integrity: Our decisions, actions, and behaviors are based on honesty, trust, fairness, and the highest ethical standards.Describe a specific time when you had to handle a tough problem which challenged fairness or ethical issues.

*14. Diversity: We embrace differences among people.What measures have you taken to make someone feel comfortable in an environment that was obviously uncomfortable with his or her presence?

*15. Teamwork: We have to depend on each other and work well together with mutual respect to achieve common goals.Tell us about the most effective contribution you have made as part of a task group or special project team.

PNA 2012
Exit this survey

*
1. Please complete the following demographic information.

*
2. Please indicated which nursing program you are currently enrolled in.

*
3. Please indicate the name of your school of nursing.

*
4. Please indicate the anticipated year of your graduation

*
5. Please indicate the facility(ies) and type of unit(s) you've completed any clinical rotations.

*
6. Are you currently a Duke employee?

*
7. Can you work a 36-40 hour day/night rotation schedule for the entire 10 week program? (Program runs June 4th-August 12th)

*
8. Please indicate if you are currently certified Nursing Care Assistant I or II. (Note- this is not required to apply. However, you will need to obtain NC NA I or NA II registry by May 18, 2012 in order to participate in the program)

*
9. Please indicate preferred facility. Please know that we can not guarantee your preferred facility.

*
11. Please respond to the following behavioral interview questions based on Duke values:

Excellence: We strive to achieve excellence in all that we do.

Give two examples of things you've done in previous jobs or in school that demonstrate excellence as an employee or student.

*
12. Safety: We hold each other accountable to constantly improve culture that ensures the
safety and welfare of all patients, visitors.

Tell of a time when you felt uncomfortable (or unsure) in completing an assignment or task. What did you do?

*
13. Integrity: Our decisions, actions, and behaviors are based on honesty, trust, fairness, and the highest ethical standards.

Describe a specific time when you had to handle a tough problem which challenged fairness or ethical issues.

*
14. Diversity: We embrace differences among people.

What measures have you taken to make someone feel comfortable in an environment that was obviously uncomfortable with his or her presence?

*
15. Teamwork: We have to depend on each other and work well together with mutual respect to achieve common goals.

Tell us about the most effective contribution you have made as part of a task group or special project team.