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Nursing Concerns during COVID-19
1.
Are you a nurse (at any level of practice) working in Arkansas?
Yes
No
2.
Type of nursing license
CNA (certified Nurse's Aid)
MA-C (Medication Assistant-Certified)
LPN/LVN (Licensed Practical Nurse)
LPTN (Licensed Psychiatric Technician Nurse)
RN (Registered Nurse
RNP (Registered Nurse Practitioner) (BSN level- renewal license only)
CNP (Certified Nurse Practitioner) (all specialties- Master's level & above)
CRNA (Certified Registered Nurse Anesthetist)
CNS (Clinical Nurse Specialist)
CNM (Certified Nurse Midwive)
APRN (Advanced Practice Registered Nurse) - Other (please specify)
3.
Are you having trouble getting the proper PPE you need?
Yes
No
4.
Does your concern for adequate PPE impact where you are willing to work?
Yes
No
5.
If yes, what kind of practice do you work?
NP owned Primary care clinic
MD owned Primary care clinic
Hospital owned Primary care clinic
NP owned Specialty clinic- please answer type of specialty below
MD owned Specialty clinic- please answer type of specialty below
Hospital owned Specialty clinic- please answer type of specialty below
Hospital/Inpatient
Emergency Department
N/A- I am getting the PPE I need
Other/Type of specialty
6.
Are you currently working?
Yes
No, I'm furloughed from my job
No, I was unemployed prior to the COVID-19 pandemic
No, I am unemployed due to the COVID-19 pandemic
If furloughed or unemployed d/t COVID-19, have you sought other opportunities to work or volunteer in healthcare? What have you found?
7.
Are you willing to work or volunteer to help during this COVID-19 crisis?
Yes
No
I am willing to travel within Arkansas if needed.
How far are you willing to travel to help within Arkansas? Please note whether this includes work, volunteer, or both.
8.
Are you willing to work outside your typical practice setting to address current needs?
Yes
No
9.
Do barriers to your scope of practice within Arkansas impact where you plan to work?
Yes
No
I have considered working in another state.
10.
Tell your story about how COVID 19 has affected you, your practice, your family.
11.
Please give your City/Town.
Include your preferred email/contact, if you would like.
Name
City/Town
ZIP/Postal Code
Email Address
Phone Number
Current Progress,
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