Nurses, Politics and Policy Podcast Pilot Program Pre-survey

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* 1. What is your name?

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* 2. Please enter your current email address:

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* 3. In what state or U.S. territory do you currently work?

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* 4. In what state do you reside?

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* 5. Years as a nurse

Haven't graduated from nursing school yet

1-2 years

3-6 years

7-9 years

10-15 years

16-20 years

More than 20 years

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* 6. Gender: How do you identify?

Woman

Non-binary

Man

Prefer to self-describe, below

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* 7. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 8. What is your ethnicity? (Please select all that apply.)

American Indian or Alaskan Native

Asian or Pacific Islander

Black or African American

Hispanic or Latino

White / Caucasian

Prefer not to answer

Other (please specify)

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* 9. What is the highest level of education you have completed?

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* 10. Nursing Licensure

Student Nurse

Licensed Vocational Nurse

Registered Nurse

Advanced Practice Registered Nurse

Other (please specify)

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* 11. Current Practice Setting

Inpatient hospital setting

Outpatient clinical setting

not applicable- I do not interact with patients in my position

Other (please specify)

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* 12. Are you a registered voter?

Yes

Unsure / Don’t know

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* 13. What city do you currently live in?

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* 14. Nursing Specialty

Clinician

Administration

Education

Other

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* 15. Have you ever participated in other programs to prepare you for political involvement?

Yes

If yes, please specify:

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* 16. Previous Level of Political Involvement

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* 17. Please list any previous policy/political activity you been involved in:

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* 18. What are your goals for policy/political involvement?

Run for Congress

Run for State office

Run for local office (school board, mayor, etc)

I don't want to run for office, but would like to support state nursing advocacy groups, such as Texas Nurses Association

I would like to become more involved in my local nursing advocacy groups

I would like to support potential candidates through campaigns and grassroots

I want to learn how to advocate for my profession as a nurse through policy change

Other (please specify)

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* 19. How do you perceive your level of understanding about politics? e.g. branches of government and policy; how they interact, how policy gets made by regulators, what does Congress do, what do executive agencies do?

Extremely familiar

Very familiar

Somewhat familiar

Not so familiar

Not at all familiar

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* 20. What do you identify as barriers to becoming more politically involved?

Lack of education about politics and policy in nursing school

Feel intimidated that, as a nurse, am not prepared to be involved in politics

Feel that society in general has a bias toward the nursing profession and they do not see the potential of what I have to offer

Fear society would not take me seriously because I am not a doctor or lawyer

Financial constraints

Time constraints

I do not know how to fundraise for a campaign

Other (please specify)

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* 21. What do you hope to gain from this podcast series?

A better understanding of the governmental process

How I can become more involved in politics and policy as a nurse

Develop confidence that as a nurse, I can be valuable in the political arena

To learn about other nurses and political leaders in Texas and make connections

Other (please specify)