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Report unsafe staffing
1.
Are you a RN, LPN, or CNA
RN
LPN
CNA
*
2.
What area do you work in?
(Required.)
ED
ICU any
Step down, PCU, IMCU
Med Surg
Telemetry
Pediatrics
L&D
Mother & Baby
Postpartum
Psych
Acute Rehab
LTACH
LTC
PACU
Pre op
Ambulatory
Procedural area
Operating room
Other
*
3.
What state do you work in?
(Required.)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
4.
What is your zip code
*
5.
Is your assignment safe?
(Required.)
Yes
No
*
6.
How many patients do you have at one time?
(Required.)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
>50
*
7.
Did you get your break?
(Required.)
Yes
No
*
8.
Do you have support staff? (select all that apply) If you are a CNA skip the question.
(Required.)
I do not have support staff
CNA/PCT
Respiratory Therapist
Unit Clerk
Monitor Tech
EKG tech
Phlebotomist
*
9.
Do you support having a safe patent limit?
(Required.)
Yes
No
I am not sure.
10.
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