Confidential Provider Well-Being Survey (9 Question)

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* 1. Here are statements of job-related feelings. Please read each statement carefully and decide you have felt this way about your job. If you have never had this feeling, choose 0 (zero).

	Never	A few times a year or less	Once a month or less	A few times a month	Once a week	A few times a week	Every day
I feel emotionally drained from my work.	I feel emotionally drained from my work. Never	I feel emotionally drained from my work. A few times a year or less	I feel emotionally drained from my work. Once a month or less	I feel emotionally drained from my work. A few times a month	I feel emotionally drained from my work. Once a week	I feel emotionally drained from my work. A few times a week	I feel emotionally drained from my work. Every day
I feel used up at the end of the workday.	I feel used up at the end of the workday. Never	I feel used up at the end of the workday. A few times a year or less	I feel used up at the end of the workday. Once a month or less	I feel used up at the end of the workday. A few times a month	I feel used up at the end of the workday. Once a week	I feel used up at the end of the workday. A few times a week	I feel used up at the end of the workday. Every day
I feel fatigued when I get up in the morning and have to face another day on the job.	I feel fatigued when I get up in the morning and have to face another day on the job. Never	I feel fatigued when I get up in the morning and have to face another day on the job. A few times a year or less	I feel fatigued when I get up in the morning and have to face another day on the job. Once a month or less	I feel fatigued when I get up in the morning and have to face another day on the job. A few times a month	I feel fatigued when I get up in the morning and have to face another day on the job. Once a week	I feel fatigued when I get up in the morning and have to face another day on the job. A few times a week	I feel fatigued when I get up in the morning and have to face another day on the job. Every day
I can easily understand how my patients feel about things.	I can easily understand how my patients feel about things. Never	I can easily understand how my patients feel about things. A few times a year or less	I can easily understand how my patients feel about things. Once a month or less	I can easily understand how my patients feel about things. A few times a month	I can easily understand how my patients feel about things. Once a week	I can easily understand how my patients feel about things. A few times a week	I can easily understand how my patients feel about things. Every day
I feel I treat some patients as if they were impersonal objects.	I feel I treat some patients as if they were impersonal objects. Never	I feel I treat some patients as if they were impersonal objects. A few times a year or less	I feel I treat some patients as if they were impersonal objects. Once a month or less	I feel I treat some patients as if they were impersonal objects. A few times a month	I feel I treat some patients as if they were impersonal objects. Once a week	I feel I treat some patients as if they were impersonal objects. A few times a week	I feel I treat some patients as if they were impersonal objects. Every day
Working with people all day is really a strain for me.	Working with people all day is really a strain for me. Never	Working with people all day is really a strain for me. A few times a year or less	Working with people all day is really a strain for me. Once a month or less	Working with people all day is really a strain for me. A few times a month	Working with people all day is really a strain for me. Once a week	Working with people all day is really a strain for me. A few times a week	Working with people all day is really a strain for me. Every day
I deal very effectively with the problems of my patients.	I deal very effectively with the problems of my patients. Never	I deal very effectively with the problems of my patients. A few times a year or less	I deal very effectively with the problems of my patients. Once a month or less	I deal very effectively with the problems of my patients. A few times a month	I deal very effectively with the problems of my patients. Once a week	I deal very effectively with the problems of my patients. A few times a week	I deal very effectively with the problems of my patients. Every day
I feel burned out from my work.	I feel burned out from my work. Never	I feel burned out from my work. A few times a year or less	I feel burned out from my work. Once a month or less	I feel burned out from my work. A few times a month	I feel burned out from my work. Once a week	I feel burned out from my work. A few times a week	I feel burned out from my work. Every day
I feel I'm positively influencing other people's lives though my work.	I feel I'm positively influencing other people's lives though my work. Never	I feel I'm positively influencing other people's lives though my work. A few times a year or less	I feel I'm positively influencing other people's lives though my work. Once a month or less	I feel I'm positively influencing other people's lives though my work. A few times a month	I feel I'm positively influencing other people's lives though my work. Once a week	I feel I'm positively influencing other people's lives though my work. A few times a week	I feel I'm positively influencing other people's lives though my work. Every day
I've become more callous toward people since I took this job.	I've become more callous toward people since I took this job. Never	I've become more callous toward people since I took this job. A few times a year or less	I've become more callous toward people since I took this job. Once a month or less	I've become more callous toward people since I took this job. A few times a month	I've become more callous toward people since I took this job. Once a week	I've become more callous toward people since I took this job. A few times a week	I've become more callous toward people since I took this job. Every day
I worry that this job is hardening me emotionally.	I worry that this job is hardening me emotionally. Never	I worry that this job is hardening me emotionally. A few times a year or less	I worry that this job is hardening me emotionally. Once a month or less	I worry that this job is hardening me emotionally. A few times a month	I worry that this job is hardening me emotionally. Once a week	I worry that this job is hardening me emotionally. A few times a week	I worry that this job is hardening me emotionally. Every day
I feel very energetic.	I feel very energetic. Never	I feel very energetic. A few times a year or less	I feel very energetic. Once a month or less	I feel very energetic. A few times a month	I feel very energetic. Once a week	I feel very energetic. A few times a week	I feel very energetic. Every day
I feel frustrated by my job.	I feel frustrated by my job. Never	I feel frustrated by my job. A few times a year or less	I feel frustrated by my job. Once a month or less	I feel frustrated by my job. A few times a month	I feel frustrated by my job. Once a week	I feel frustrated by my job. A few times a week	I feel frustrated by my job. Every day
I feel I'm working too hard on my job.	I feel I'm working too hard on my job. Never	I feel I'm working too hard on my job. A few times a year or less	I feel I'm working too hard on my job. Once a month or less	I feel I'm working too hard on my job. A few times a month	I feel I'm working too hard on my job. Once a week	I feel I'm working too hard on my job. A few times a week	I feel I'm working too hard on my job. Every day
I don't really care what happens to some patients.	I don't really care what happens to some patients. Never	I don't really care what happens to some patients. A few times a year or less	I don't really care what happens to some patients. Once a month or less	I don't really care what happens to some patients. A few times a month	I don't really care what happens to some patients. Once a week	I don't really care what happens to some patients. A few times a week	I don't really care what happens to some patients. Every day
Working with people directly puts too much stress on me.	Working with people directly puts too much stress on me. Never	Working with people directly puts too much stress on me. A few times a year or less	Working with people directly puts too much stress on me. Once a month or less	Working with people directly puts too much stress on me. A few times a month	Working with people directly puts too much stress on me. Once a week	Working with people directly puts too much stress on me. A few times a week	Working with people directly puts too much stress on me. Every day
I can easily create a relaxed atmosphere with my patients.	I can easily create a relaxed atmosphere with my patients. Never	I can easily create a relaxed atmosphere with my patients. A few times a year or less	I can easily create a relaxed atmosphere with my patients. Once a month or less	I can easily create a relaxed atmosphere with my patients. A few times a month	I can easily create a relaxed atmosphere with my patients. Once a week	I can easily create a relaxed atmosphere with my patients. A few times a week	I can easily create a relaxed atmosphere with my patients. Every day
I feel exhilarated after working closely with my patients.	I feel exhilarated after working closely with my patients. Never	I feel exhilarated after working closely with my patients. A few times a year or less	I feel exhilarated after working closely with my patients. Once a month or less	I feel exhilarated after working closely with my patients. A few times a month	I feel exhilarated after working closely with my patients. Once a week	I feel exhilarated after working closely with my patients. A few times a week	I feel exhilarated after working closely with my patients. Every day
I have accomplished many worthwhile things in this job.	I have accomplished many worthwhile things in this job. Never	I have accomplished many worthwhile things in this job. A few times a year or less	I have accomplished many worthwhile things in this job. Once a month or less	I have accomplished many worthwhile things in this job. A few times a month	I have accomplished many worthwhile things in this job. Once a week	I have accomplished many worthwhile things in this job. A few times a week	I have accomplished many worthwhile things in this job. Every day
I feel like I'm at the end of my rope.	I feel like I'm at the end of my rope. Never	I feel like I'm at the end of my rope. A few times a year or less	I feel like I'm at the end of my rope. Once a month or less	I feel like I'm at the end of my rope. A few times a month	I feel like I'm at the end of my rope. Once a week	I feel like I'm at the end of my rope. A few times a week	I feel like I'm at the end of my rope. Every day
In my work, I deal with emotional problems very calmly.	In my work, I deal with emotional problems very calmly. Never	In my work, I deal with emotional problems very calmly. A few times a year or less	In my work, I deal with emotional problems very calmly. Once a month or less	In my work, I deal with emotional problems very calmly. A few times a month	In my work, I deal with emotional problems very calmly. Once a week	In my work, I deal with emotional problems very calmly. A few times a week	In my work, I deal with emotional problems very calmly. Every day
I feel patients blame me for some of their problems.	I feel patients blame me for some of their problems. Never	I feel patients blame me for some of their problems. A few times a year or less	I feel patients blame me for some of their problems. Once a month or less	I feel patients blame me for some of their problems. A few times a month	I feel patients blame me for some of their problems. Once a week	I feel patients blame me for some of their problems. A few times a week	I feel patients blame me for some of their problems. Every day

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* 2. How would you rate your overall quality of life on this 10 point scale?

0 = as bad as it can be

10 = as good as it can be

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. Please indicate how strongly you agree or disagree with the following statements:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I tend to bounce back quickly after hard times.	I tend to bounce back quickly after hard times. Strongly Disagree	I tend to bounce back quickly after hard times. Disagree	I tend to bounce back quickly after hard times. Neutral	I tend to bounce back quickly after hard times. Agree	I tend to bounce back quickly after hard times. Strongly Agree
It does not take me long to recover from a stressful event.	It does not take me long to recover from a stressful event. Strongly Disagree	It does not take me long to recover from a stressful event. Disagree	It does not take me long to recover from a stressful event. Neutral	It does not take me long to recover from a stressful event. Agree	It does not take me long to recover from a stressful event. Strongly Agree
I usually come through difficult times with little trouble.	I usually come through difficult times with little trouble. Strongly Disagree	I usually come through difficult times with little trouble. Disagree	I usually come through difficult times with little trouble. Neutral	I usually come through difficult times with little trouble. Agree	I usually come through difficult times with little trouble. Strongly Agree

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* 4. Please indicate how strongly you agree or disagree with the following statements:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I have a hard time making it through stressful events.	I have a hard time making it through stressful events. Strongly Disagree	I have a hard time making it through stressful events. Disagree	I have a hard time making it through stressful events. Neutral	I have a hard time making it through stressful events. Agree	I have a hard time making it through stressful events. Strongly Agree
It is hard for me to snap back when something bad happens.	It is hard for me to snap back when something bad happens. Strongly Disagree	It is hard for me to snap back when something bad happens. Disagree	It is hard for me to snap back when something bad happens. Neutral	It is hard for me to snap back when something bad happens. Agree	It is hard for me to snap back when something bad happens. Strongly Agree
I tend to take a long time to get over set-backs in my life.	I tend to take a long time to get over set-backs in my life. Strongly Disagree	I tend to take a long time to get over set-backs in my life. Disagree	I tend to take a long time to get over set-backs in my life. Neutral	I tend to take a long time to get over set-backs in my life. Agree	I tend to take a long time to get over set-backs in my life. Strongly Agree

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* 5. In the past 2 weeks how often did you experience the following:

When I made a mistake, I felt more self-condemnation than self-encouragement to learn from the experience.

Never

Rarely

Sometimes

Often

Always

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* 6. In the past 2 weeks how often did you experience the following:

I was less compassionate with myself than I was with others.

Never

Rarely

Sometimes

Often

Always

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* 7. In the past 2 weeks how often did you experience the following:

I put off taking care of my own health due to time pressure.

Never

Rarely

Sometimes

Often

Always

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* 8. In the past 2 weeks how often did you experience the following:

Taking care of my needs seemed incompatible with taking care of my patients' needs.

Never

Rarely

Sometimes

Often

Always

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* 9. Overall, based on your definition of burnout, how would you rate your level of burnout? (check only one)

I enjoy my work. I have no symptoms of burnout.

Occasionally under stress - but I don't feel burned out.

Definitely burning out.

Symptoms of burnout won't go away.

I feel completely burnout out and wonder if I can go on.

Confidential Provider Well-Being Survey (9 Question)

Question Title

* 1. Here are statements of job-related feelings. Please read each statement carefully and decide you have felt this way about your job. If you have never had this feeling, choose 0 (zero).

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* 2. How would you rate your overall quality of life on this 10 point scale?

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* 3. Please indicate how strongly you agree or disagree with the following statements:

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* 4. Please indicate how strongly you agree or disagree with the following statements:

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* 5. In the past 2 weeks how often did you experience the following: When I made a mistake, I felt more self-condemnation than self-encouragement to learn from the experience.

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* 6. In the past 2 weeks how often did you experience the following:I was less compassionate with myself than I was with others.

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* 7. In the past 2 weeks how often did you experience the following:I put off taking care of my own health due to time pressure.

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* 8. In the past 2 weeks how often did you experience the following:Taking care of my needs seemed incompatible with taking care of my patients' needs.

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* 9. Overall, based on your definition of burnout, how would you rate your level of burnout? (check only one)

* 5. In the past 2 weeks how often did you experience the following:

When I made a mistake, I felt more self-condemnation than self-encouragement to learn from the experience.

* 6. In the past 2 weeks how often did you experience the following:

I was less compassionate with myself than I was with others.

* 7. In the past 2 weeks how often did you experience the following:

I put off taking care of my own health due to time pressure.

* 8. In the past 2 weeks how often did you experience the following:

Taking care of my needs seemed incompatible with taking care of my patients' needs.