This is a study on hospital and other facility staffing methods. Additionally, it will assess for any moral distress experienced by nurses. You must have an active RN or LPN/LVN license and work in the US.  

Question Title

* 1. What is your age?

Question Title

* 2. What is your gender

Question Title

* 3. Are you of Hispanic or Latino or Spanish origin?

Question Title

* 4. Which best describes you? Select all that apply.

Question Title

* 6. What is your average annual salary?

Question Title

* 7. What clinical setting do you work?

Question Title

* 9. Does your state have legislation (commonly called a Registered Safe Nurse Staffing Act) that requires hospitals to establish nurse staffing guidelines committees?

Question Title

* 10. Do you work at a Magnet accredited hospital? (If your hospital is in process then mark no as they are not complete yet.)

Question Title

* 11. What type of hospital do you work at?

Question Title

* 12. Does your hospital have a staffing committee? (If you work in a hospital or facility that does not use staffing committees skip to question # 20)

Question Title

* 13. Is your staffing committee composed of 50% or more RNs, who work direct patient care at least 50% of the time? (Only answer if your hospital uses a staffing committee)

Question Title

* 14. Does the staffing committee encourage feedback from nurses related to staffing issues?

Question Title

* 15. Does a hospital member relieve you when you need to attend a staffing committee meeting on days that you are providing direct patient care?

Question Title

* 16. Does your staffing committee reevaluate at least semi annually the effectiveness of the staffing plan?

Question Title

* 17. Does your staffing committee reevaluate the variations between the staffing plan and the staffing actually occurring?

Question Title

* 18. Are the staffing recommendations determined by the staffing committees implemented in daily staffing census?  

Question Title

* 19. For hospitals with staffing committees: What percentage of the time is the recommended staffing used?

Question Title

* 20. Is your staffing based on the needs of the patients on your unit?

Question Title

* 21. Is the staffing reassessed and adjusted based off changes in patient condition, patient needs and on different shifts?

Question Title

* 22. Does your unit have a contingency plan for when the patient care needs unexpectedly exceed direct nurse resources?

Question Title

* 23. Is retaliation feared for nurses who provide input about staffing?

Question Title

* 24. Is there an acuity tool that your hospital uses?

Question Title

* 25. Do you feel that the nurse to patient ratio in your unit or facility is adequate/safe?

Question Title

* 26. If you answered NO to Question # 25, what percentage of the time is your unit not safe.

Question Title

* 28. Does your unit have a charge nurse?

Question Title

* 29. Does the charge nurse have a patient assignment?

Question Title

* 30. Does your unit use the following ancillary services. Mark all that apply.

Question Title

* 31. What is the normal CNA/PCT to patient ratio?

Question Title

* 32. Have you ever had to stay over your scheduled shift as "mandatory overtime" to cover scheduling gaps?

Question Title

* 33. Does your unit use team nursing with LPN/LVN assist?

Question Title

* 34. The next few questions are related to nurse staffing legislation and research. Are you aware there are two (2) federal legislative bills that if passed, would mandate Safe Patient Limits, or Nurse-Patient Ratios? HR 3165/S 1567 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 and HR 1976 Medicare For All Act. HR 3165 would include staffing by acuity, staffing committees, ratios, enforcement and whistleblower protections. California is still the only state that has ratio staffing mandated by state legislation passed in 1999, enacted in 2004. Massachusetts has mandated by state law ICU ratios since 2015. https://www.congress.gov/bill/117th-congress/house-bill/3165/text
https://www.congress.gov/bill/117th-congress/house-bill/1976/text

Question Title

* 35. Are you aware that only 8 states have legislation mandating hospitals to have staffing committees responsible for staffing plans and policy – CT, IL, NV, NY, OH, OR, TX, WA?

Question Title

* 36. Are you aware of Dr. Linda Aiken's recent nursing research in New York and Illinois which showed chronic staffing shortages Pre-Covid, published in 2019?  https://qualitysafety.bmj.com/content/qhc/30/8/639.full.pdf

Question Title

* 37. The next several questions are about moral distress. The American Association of Critical-Care Nurses (AACN) resource Moral Distress for Nurses: What You Need to Know defines moral distress as when someone knows the right thing to do, but constraints, conflicts, dilemmas or uncertainty makes it nearly impossible to pursue the right course of action. External factors can impede nurse actions contributing to moral distress such as bullying, incompetent colleagues, and an unhealthy work environment. Organizational factors can include inadequate staffing, lack of resources, pressures to decrease costs, hospital policies, violations in the standards of care, power hierarchy, ineffective communication and financial limitations. Moral distress manifests in both physical, emotional and psychological symptoms. Repeated unresolved episodes of moral distress may lead to moral residue – resulting in nurse burnout, leaving their jobs or the devastating decision to leave nursing altogether. https://www.aacn.org/clinical-resources/moral-distress

Do you believe you are experiencing moral distress in the work environment?

Question Title

* 38. Does your work environment provide you with any resources to support staff in determining the level of moral distress and improve staff well-being?

Question Title

* 39. If you answered YES to Question # 38, please select all responses that apply:

Question Title

* 40. Do you have a routine at the end of the day to transition away from work?

Question Title

* 41. Are you able to schedule personal time off from work?

Question Title

* 42. Are you able to “detach” from work when you have personal time off?

Question Title

* 43. Do you think you're depressed due to moral distress?

Question Title

* 44. Have you seen a therapist for your moral distress?

Question Title

* 45. Have you left a Nursing position to take another Nursing position in the last six (6) months?

Question Title

* 46. If you answered YES to Question # 45, please choose one or more of the following reasons for leaving that position:

Question Title

* 49. If you answered YES to Question # 45, did you LEAVE to take a contract position, e.g. a travel nurse?

Question Title

* 50. Are you considering leaving the nursing profession within the next twelve (12) months?

Question Title

* 51. If you answered YES to Question # 50, please select one or more of the following reasons why you may be leaving the nursing profession:

Question Title

* 52. In today’s healthcare industry unlicensed assistive personnel (UAP e.g. MA, CNA, PCT) are now expected to perform similar tasks that RNs do. It is typically not a state-licensed/certified profession. This means that UAPs do not typically need specific credentials to practice or accomplish state agency approved standard education/licensure or are accountable to state agency oversight like RNs. All work of the UAP is delegated by a licensed person (i.e. MD, APRN, RN) if allowed in medical/nursing state acts.                                     

The 2019 National Guidelines for Nursing Delegation joint statement by National Council State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) state clinical reasoning, nursing judgment and critical decision making cannot be delegated. Included in their 5 Rights of Delegation are: delegation of the right task, to the right person, in the right circumstance, with the right directions, and the right supervision. The facility is responsible for competency training. The delegatee must possesses the appropriate skills and knowledge to perform the activity. The RN should be onsite and available to intervene if necessary. https://www.ncsbn.org/NGND-PosPaper_06.pdf

A nursing intervention is defined as: “any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes” (Butcher, Bulechek, Docterman, & Wagner, 2018, p.xii).

Do you delegate nursing interventions to unlicensed assistive personnel (MA, CNA, PCT) in your workplace?  Including medication administration or IV insertion. It does not include typical UAP patient care activities.

Question Title

* 53. Please choose interventions that you have delegated to UAPs. You may choose more than one.

Question Title

* 54. When delegating nursing interventions to UAPs (MA, CNA, PCT), are you on site and readily available to directly supervise the UAP?  

Question Title

* 55. Lastly, at your place of employment are you a member of a union?

Question Title

* 56. If you answered YES to Question #55, and therefore you are in a union, please name the Union:

Question Title

* 57. If you answered NO to Question # 55, are you interested in joining a union?

Question Title

* 58. If you wish to add a comment about your experiences working through the Covid pandemic then please do so. Thank you for taking the time to complete the survey and recording your comments. 

T