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* 1. Please enter the following:

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* 2. Which category below includes your age?

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* 3. What is your salary grade?

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* 4. Please indicate which choice applies to you. I work:

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* 5. What is your nursing title?

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* 6. What is the highest credential you currently hold?

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* 7. How many years have you been employed as a Nurse by New York State?

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* 8. How many years until your anticipated retirement from New York State?

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* 9. Are you the primary wage earner in your household?

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* 10. Do you have child and/or elder care responsibilities to consider when setting your work schedule?

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* 11. Does your current position involve direct patient care?

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* 12. In what type of setting do you work?

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* 13. What shift schedule do you work?

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* 14. Nurses work a variety of different schedules. Which of the following best describes the typical number of days you work per pay period?

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* 15. How many hours per day do you work?

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* 16. Ideally, if you were working full-time, how many days a week would you prefer to work?

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* 17. Ideally, if you were working full-time, how many hours a day would you prefer to work?

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* 18. Which is more important to you?

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* 19. Are you required to work weekends?

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* 20. Do all nurses in your facility have the opportunity to have some weekends off?

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* 21. In your opinion, weekends should be:

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* 22. Does your facility have an agreement or policy regarding bidding for shift and pass days?

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* 23. If you answered "no" to the previous question, do you believe an agreement is needed?

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* 24. If you do have a policy or agreement on bidding for shift and pass days, how satisfied are you with the local agreement or policy?

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* 25. Does your facility have an agreement or policy about vacation scheduling?

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* 26. If your facility does not have a policy or agreement about vacation scheduling, do you believe one is needed?

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* 27. If you do have a local agreement regarding vacation scheduling, how satisfied are you with it?

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* 28. In the past year, how many days of scheduled vacation were you allowed to use?

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* 29. In the past year, were you ever denied your request to use vacation based on operational need?

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* 30. Do you feel that you are given reasonable opportunity to use your vacation leave?

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* 31. In the past three years, have you had a previously approved vacation request rescinded for any reason?

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* 32. Does your facility have an agreement or policy on granting time off on major holidays?

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* 33. If you answered "no" to the previous question, do you feel an agreement or policy on granting time off on major holidays is needed?

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* 34. If your facility has a local agreement regarding time off on major holidays, how satisfied are you with it?

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* 35. Aside from overtime in your regular state position, do you work a second job?

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* 36. Is your second job in nursing?

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* 37. Is your second job "extra service" for the state or do you work for another employer?

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* 38. Is your second job a regularly scheduled obligation?

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* 39. Have you actively looked for other employment as an alternative to your state employment within the last 12 months?

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* 40. Based on your experience, would you say that there is a shortage of qualified nurses in your geographic area?

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* 41. Please answer the following:

  Very Easy Easy Difficult Very Difficult
How easy would it be to find a job that is as good as your present job?
How easy would it be to find a job that is better than your present job?
How easy would it be to find a job that is much better than your present job?

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* 42. Nurses are sometimes required to be available for recall to work (called standby or on-call). In the past 12 months, how many days have you been required to be on standby/on-call?

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* 43. In the past 12 months, how many times, if any, were you recalled to return to work when on standby/on-call?

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* 44. How many hours of voluntary overtime do you usually work per week?

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* 45. When mandated to work overtime, what is the average number of additional hours worked per week?

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* 46. In the past 12 months, how many times have you been mandated to work overtime?

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* 47. Does your facility pre-schedule mandatory overtime?

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* 48. In general, which of the following factors do you think most contributed to your being mandated?

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* 49. Have you ever been coerced or intimidated into volunteering for OT to avoid a mandate?

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* 50. When mandated to work a full or partial extra shift, when are you usually expected to return to work?

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* 51. We are interested in how much advance notice you receive when you are mandated for overtime. In general, when are you first notified of the mandate:

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* 52. Is there an established staff to patient ratio or minimum staffing levels in your facility/unit/work location?

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* 53. If your facility has a staff to patient ratio or minimum staffing levels and it has changed in the last 3 years, has it:

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* 54. In the last 3 years, have the number of nurses scheduled on your shift and unit/ward/work location changed?

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* 55. How has your caseload changed in the last 3 years?

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* 56. If working in the community, do you have significant travel time between patient locations?

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* 57. In the next three years, do you plan on pursuing additional academic degrees?

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* 58. Did you ever use the Tuition Reimbursement benefits provided by the PEF contract to pay for your education?

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* 59. How important is the availability of educational benefits (tuition reimbursement and/or tuition vouchers), to you?

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* 60. Have you ever used the Nurses Enhanced Workshop Seminar Reimbursement Program, CLEFR Program or any other educational benefits contained in Article 15 of the PEF Contract?

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* 61. In the past year, how many days of professional leave did you use?

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* 62. Was a request to use professional leave ever denied?

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* 63. Which of the following do you believe are the most significant problems facing direct care nurses. (Check top 3 choices)

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* 64. Which of the following changes do you believe would most improve your job? (Check top 3 choices)

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* 65. Which of the following benefits do you believe would most improve your job? (Check top 3 choices)

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* 66. In the past three years, would you say that your concern for your personal safety has:

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* 67. Which of the following Health and Safety hazards have you encountered at your workplace?

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* 68. Please check which factor(s) have affected the general safety of the workplace:

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* 69. In the past 12 months, how many times have you been required to float to another unit?

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* 70. In the past 12 months, have you been required to float to a unit for which you did not feel you were appropriately trained or otherwise qualified to work?

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* 71. In the past 12 months, in your opinion, have you been directed to perform out-of-title work?

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* 72. If you answered "yes" to being directed to perform out-of-title work, did you file a grievance challenging the out-of-title assignment?

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* 73. Have you filed a Protest of Assignment form or Mandatory Overtime Report form?

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* 74. Other suggestions/comments:

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