Nurse Practitioner Needs Assessment Survey

Question Title

* 1. Which state(s) do you work in? (check all that apply)

Maine

New Hampshire

Vermont

Other (please specify)

Question Title

* 2. What is your subspecialty?

Family FNP

Adult-Gerontology AGNP

Neonatal NNP

Pediatrics PNP

Women's Health WHNP

Psychiatric-Mental Health PMHNP

Other (please specify)

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* 3. How long have you been a nurse practitioner?

5 years or less

5-10 years

10 years or more

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* 4. What type of setting do you primarily work in?

Office-based

Hospital acute care

Hospital rehabilitation

Other (please specify)

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* 5. What age groups represent the patients in your practice? (check all that apply)

Infants

Pediatrics

Adolescents

Adults 18-60 years of age

Adults 60+ years of age

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* 6. Have you ever called the poison center for patient management/treatment advice or other questions?

Yes

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* 7. Do any of the following prevent you from calling the poison center? (check all that apply)

Lack of time, busy with patient care

Don't have the poison center number

Other policy or procedure in place

Poor cell phone reception

Not sure if the poison center can help

Other (please specify)

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* 8. How can the poison center help your practice? (check all that apply)

Provide patient education

Provide data and trends

Provide advice for managing your patient

Provide staff training

Other (please specify)

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* 9. What poison-related information are you interested in? (check all that apply)

Pharmacology/toxicity

Expected clinical findings

Management of poisoned patients

Trends/statistics

Other (please specify)

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* 10. Which of the following medications would you be interested in learning more about? (please select up to 5)

Vaccines

Over-the-counter medications (ibuprofen, acetaminophen, cough and cold preparations, etc.)

Cardiac medications

Psychiatric and behavioral medications (antidepressants, antipsychotics, anxiolytics, etc.)

Antibiotics/anti-infectives/antivirals

Anti-rheumatic agents (methotrexate, etc.)

Anticoagulants/antiplatelets

Alzheimer medications

Prescription drugs involved in substance use

Supplements, vitamins and naturopathic products (hormones, dietary supplements, etc.)

Diabetic medications

Cannabis/marijuana and CBD products (flower, edibles, topicals, etc.)

Question Title

* 11. Which of these poisoning topics would you be interested in learning more about? (please select up to 5)

Street drugs and illicit substances (cocaine, methamphetamine, ecstasy, etc.)

Prevention for young children

Environmental and occupational poisonings (pesticides, herbicides, etc.)

Plants and mushrooms

E-cigarettes

Household products (cleaners, hydrocarbons building products, etc.)

Current trends and emerging issues

Heavy metals (lead, cadmium, mercury, arsenic, etc.)

Adverse events from medications

Fumes, gases and vapors (carbon monoxide, cyanide, chlorine gas, etc.)

Prevention for teens and adults

Drug interactions

Prevention for older adults

Self-harm attempts

Question Title

* 12. What education platforms do you prefer for your practice? (check all that apply)

In-person presentations

Phone conversations with poison center staff

Podcasts

Recorded, on-demand presentations

Zoom, GoToMeeting, or other live, remote platforms

Question Title

* 13. If you are interested in professional education or materials from the poison center, please provide your contact information.

Name

Practice Name

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Nurse Practitioner Needs Assessment

Question Title

* 1. Which state(s) do you work in? (check all that apply)

Question Title

* 2. What is your subspecialty?

Question Title

* 3. How long have you been a nurse practitioner?

Question Title

* 4. What type of setting do you primarily work in?

Question Title

* 5. What age groups represent the patients in your practice? (check all that apply)

Question Title

* 6. Have you ever called the poison center for patient management/treatment advice or other questions?

Question Title

* 7. Do any of the following prevent you from calling the poison center? (check all that apply)

Question Title

* 8. How can the poison center help your practice? (check all that apply)

Question Title

* 9. What poison-related information are you interested in? (check all that apply)

Question Title

* 10. Which of the following medications would you be interested in learning more about? (please select up to 5)

Question Title

* 11. Which of these poisoning topics would you be interested in learning more about? (please select up to 5)

Question Title

* 12. What education platforms do you prefer for your practice? (check all that apply)

Question Title

* 13. If you are interested in professional education or materials from the poison center, please provide your contact information.

Question Title

* 14. Please provide any additional comments here.