New York State Nurse Practitioner Survey

Welcome!

Thank you for taking the time to complete this survey. After completion of the survey, you will be able to continue with your renewal of your NP registration on the New York State Education Department website.

BASIC INFORMATION

Question Title

* 1. Please provide your email address:

Question Title

* 2. Date completing survey:

Date

Question Title

* 3. New York State RN License Number:

Profession Code: 22 - RN

* RN License #:

Enter the 6-digit number

Question Title

* 4. New York State Nurse Practitioner License Number:

Profession Code:

Question Title

* NP License #:

Enter the 6-digit number

Question Title

* 5. National Provider Identifier: (If applicable.)

NPI #:
Enter the 10-digit number

Question Title

* 6. Year of Birth:
(XXXX)

Question Title

* 7. Gender:

Male

Female

Question Title

* 8. Ethnicity: Are you Hispanic / Latino?

Yes

Question Title

* 9. Race: (Mark all that apply.)

African American / Black

American Indian / Alaska Native

Asian / Pacific Islander

White

Other (specify):

EDUCATIONAL INFORMATION

Question Title

* 10. What educational program(s) did you complete for your NP preparation? (Mark all that apply.)

Certificate Program (no Master's Degree)

Master's Degree

Post Master's Certificate

Doctor or Nursing Practice Degree

Other (specify):

Question Title

* 11. Location of Education:

	Location of high school from which you graduated?	Location of first RN school from which you graduated?	Location of first NP education program from which you graduated?
Please select location for each	Please select location for each Location of high school from which you graduated? menu	Please select location for each Location of first RN school from which you graduated? menu	Please select location for each Location of first NP education program from which you graduated? menu

Question Title

* 12. What year did you graduate from your first NP education program?
(XXXX)

Question Title

* 13. For which NP specialties are you certified in New York? (Mark all that apply.)

01 - Acute Care

02 - Adult Health

03 - College Health

04 - Community Health

05 - Family Health

06 - Gerontology

07 - Holistic Medicine

08 - Neonatology

09 - Obstetrics/Gynecology

10 - Oncology

11 - Palliative Care

12 - Pediatrics

13 - Perinatology

14 - Psychiatry

15 - School Health

16 - Women's Health

Question Title

* Using the 2-digit numbers (01 to 16) above, please indicate your primary practice specialty:
(XX)

PRACTICE AND SERVICE INFORMATION

Question Title

* 14. What best describes your current work status? (Mark all that apply.)

Working in at least one position that requires NP certification

Volunteering in a position requiring NP certification

Working in a position that only requires RN licensure, but not NP certification

Working, but neither as a RN nor NP

Not currently working

Retired

Question Title

* 15. For all NP positions held, indicate the average number of hours currently spent per week on each major activity. (Exclude overtime.)

	None	1 - 9	10 - 19	20 - 29	30 - 39	40 - 49	50+
Primary care*	Primary care* None	Primary care* 1 - 9	Primary care* 10 - 19	Primary care* 20 - 29	Primary care* 30 - 39	Primary care* 40 - 49	Primary care* 50+
Other patient care	Other patient care None	Other patient care 1 - 9	Other patient care 10 - 19	Other patient care 20 - 29	Other patient care 30 - 39	Other patient care 40 - 49	Other patient care 50+
Research	Research None	Research 1 - 9	Research 10 - 19	Research 20 - 29	Research 30 - 39	Research 40 - 49	Research 50+
Teaching	Teaching None	Teaching 1 - 9	Teaching 10 - 19	Teaching 20 - 29	Teaching 30 - 39	Teaching 40 - 49	Teaching 50+
Administration	Administration None	Administration 1 - 9	Administration 10 - 19	Administration 20 - 29	Administration 30 - 39	Administration 40 - 49	Administration 50+
Other	Other None	Other 1 - 9	Other 10 - 19	Other 20 - 29	Other 30 - 39	Other 40 - 49	Other 50+

* Primary care is defined as first contact and continuing care, including basic or initial diagnosis and treatment, health supervision, management of chronic conditions, preventative health services and appropriate referral(s).

Question Title

* Do you spend any of your work time providing patient care services as a NP?

Yes

Question Title

* 1. Please provide your email address:

Question Title

* 2. Date completing survey:

Question Title

* 3. New York State RN License Number:

Question Title

* 4. New York State Nurse Practitioner License Number:Profession Code:

Question Title

* NP License #:

Question Title

* 5. National Provider Identifier: (If applicable.)

Question Title

* 6. Year of Birth:(XXXX)

Question Title

* 7. Gender:

Question Title

* 8. Ethnicity: Are you Hispanic / Latino?

Question Title

* 9. Race: (Mark all that apply.)

Question Title

* 10. What educational program(s) did you complete for your NP preparation? (Mark all that apply.)

Question Title

* 11. Location of Education:

Question Title

* 12. What year did you graduate from your first NP education program?(XXXX)

Question Title

* 13. For which NP specialties are you certified in New York? (Mark all that apply.)

Question Title

* Using the 2-digit numbers (01 to 16) above, please indicate your primary practice specialty: (XX)

Question Title

* 14. What best describes your current work status? (Mark all that apply.)

Question Title

* 15. For all NP positions held, indicate the average number of hours currently spent per week on each major activity. (Exclude overtime.)

Question Title

* Do you spend any of your work time providing patient care services as a NP?

* 4. New York State Nurse Practitioner License Number:

Profession Code:

* 6. Year of Birth:
(XXXX)

* 12. What year did you graduate from your first NP education program?
(XXXX)

* Using the 2-digit numbers (01 to 16) above, please indicate your primary practice specialty:
(XX)