Medical Staff Wellness

Survey regarding wellness and burnout

The first 6 questions are demographic. The next 3 questions relate to your experience of stress and burnout. The last 2 questions are the Maslach Burnout Inventory, a validated tool to assess burnout.

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* 1. Please indicate your age group:

Up to age 35 years

36-40 years

41-45 years

46-50 years

51-55 years

56-60 years

61-65 years

Greater than 65 years

I prefer not to answer

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* 2. Please indicate your gender:

Female

Male

I prefer not to answer

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* 3. Please indicate your CURRENT status:

Single, sharing a home with my significant other

Single, not sharing a home with my significant other

Single, without significant other

Married, sharing a home with my husband or wife

Married, not sharing a home with my husband or wife

I prefer not to answer

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* 4. If you have ever been divorced, please indicate how long it has been since your divorce:

Divorce was within the last 1 year

Divorce was more than a year ago

I have never been divorced

I prefer not to answer

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* 5. Please indicate your professional degree:

MD/DO

Nurse Practitioner

Physician Assistant

Other Advanced Practice Provider (please specify)

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* 6. How many years have you worked in your current role? If you have more than one role, answer with regard to your main clinical role.

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* 7. If your main role is at least 20% clinical, please indicate in what setting you spend the majority of your work time. If your role is primarily administrative, please indicate that.

Primarily inpatient

Primarily outpatient

Significant time in both inpatient and outpatient

Primarily ED or Urgent Care

Primarily Critical Care (pediatric or neonatal)

My role is primarily administrative

Other (please specify)

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* 8. What factors in your work life contribute to your stress or burnout?

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* 9. What do you do to help you manage stress or prevent burnout?

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* 10. What changes at work might help you manage stress better or lead to better prevention of burnout?

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* 11. Please indicate how often each statement below feels true:

	Never	A few times a year or less	Once a month or less	A few times a month	Once a week	A few times a week	Every day
I feel emotionally drained from my work.	I feel emotionally drained from my work. Never	I feel emotionally drained from my work. A few times a year or less	I feel emotionally drained from my work. Once a month or less	I feel emotionally drained from my work. A few times a month	I feel emotionally drained from my work. Once a week	I feel emotionally drained from my work. A few times a week	I feel emotionally drained from my work. Every day
I feel used up at the end of my work day.	I feel used up at the end of my work day. Never	I feel used up at the end of my work day. A few times a year or less	I feel used up at the end of my work day. Once a month or less	I feel used up at the end of my work day. A few times a month	I feel used up at the end of my work day. Once a week	I feel used up at the end of my work day. A few times a week	I feel used up at the end of my work day. Every day
I feel tired when I get up in the morning and have to face another day on the job.	I feel tired when I get up in the morning and have to face another day on the job. Never	I feel tired when I get up in the morning and have to face another day on the job. A few times a year or less	I feel tired when I get up in the morning and have to face another day on the job. Once a month or less	I feel tired when I get up in the morning and have to face another day on the job. A few times a month	I feel tired when I get up in the morning and have to face another day on the job. Once a week	I feel tired when I get up in the morning and have to face another day on the job. A few times a week	I feel tired when I get up in the morning and have to face another day on the job. Every day
Working all day is really a strain for me.	Working all day is really a strain for me. Never	Working all day is really a strain for me. A few times a year or less	Working all day is really a strain for me. Once a month or less	Working all day is really a strain for me. A few times a month	Working all day is really a strain for me. Once a week	Working all day is really a strain for me. A few times a week	Working all day is really a strain for me. Every day
I can effectively solve the problems that arise in my work.	I can effectively solve the problems that arise in my work. Never	I can effectively solve the problems that arise in my work. A few times a year or less	I can effectively solve the problems that arise in my work. Once a month or less	I can effectively solve the problems that arise in my work. A few times a month	I can effectively solve the problems that arise in my work. Once a week	I can effectively solve the problems that arise in my work. A few times a week	I can effectively solve the problems that arise in my work. Every day
I feel burned out in my work.	I feel burned out in my work. Never	I feel burned out in my work. A few times a year or less	I feel burned out in my work. Once a month or less	I feel burned out in my work. A few times a month	I feel burned out in my work. Once a week	I feel burned out in my work. A few times a week	I feel burned out in my work. Every day
I feel I am making an effective contribution to what this organization does.	I feel I am making an effective contribution to what this organization does. Never	I feel I am making an effective contribution to what this organization does. A few times a year or less	I feel I am making an effective contribution to what this organization does. Once a month or less	I feel I am making an effective contribution to what this organization does. A few times a month	I feel I am making an effective contribution to what this organization does. Once a week	I feel I am making an effective contribution to what this organization does. A few times a week	I feel I am making an effective contribution to what this organization does. Every day
I have been become less enthusiastic about my work.	I have been become less enthusiastic about my work. Never	I have been become less enthusiastic about my work. A few times a year or less	I have been become less enthusiastic about my work. Once a month or less	I have been become less enthusiastic about my work. A few times a month	I have been become less enthusiastic about my work. Once a week	I have been become less enthusiastic about my work. A few times a week	I have been become less enthusiastic about my work. Every day

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* 12. Please indicate how often each statement below feels true:

	Never	A few times a year or less	Once a month or less	A few times a month	Once a week	A few times a week	Every day
I have become less interested in my work since I started this job.	I have become less interested in my work since I started this job. Never	I have become less interested in my work since I started this job. A few times a year or less	I have become less interested in my work since I started this job. Once a month or less	I have become less interested in my work since I started this job. A few times a month	I have become less interested in my work since I started this job. Once a week	I have become less interested in my work since I started this job. A few times a week	I have become less interested in my work since I started this job. Every day
In my opinion, I am good at my job.	In my opinion, I am good at my job. Never	In my opinion, I am good at my job. A few times a year or less	In my opinion, I am good at my job. Once a month or less	In my opinion, I am good at my job. A few times a month	In my opinion, I am good at my job. Once a week	In my opinion, I am good at my job. A few times a week	In my opinion, I am good at my job. Every day
I feel exhilarated when I accomplish something at work.	I feel exhilarated when I accomplish something at work. Never	I feel exhilarated when I accomplish something at work. A few times a year or less	I feel exhilarated when I accomplish something at work. Once a month or less	I feel exhilarated when I accomplish something at work. A few times a month	I feel exhilarated when I accomplish something at work. Once a week	I feel exhilarated when I accomplish something at work. A few times a week	I feel exhilarated when I accomplish something at work. Every day
I have accomplished many worthwhile things in this job.	I have accomplished many worthwhile things in this job. Never	I have accomplished many worthwhile things in this job. A few times a year or less	I have accomplished many worthwhile things in this job. Once a month or less	I have accomplished many worthwhile things in this job. A few times a month	I have accomplished many worthwhile things in this job. Once a week	I have accomplished many worthwhile things in this job. A few times a week	I have accomplished many worthwhile things in this job. Every day
I just want to do my job and not be bothered.	I just want to do my job and not be bothered. Never	I just want to do my job and not be bothered. A few times a year or less	I just want to do my job and not be bothered. Once a month or less	I just want to do my job and not be bothered. A few times a month	I just want to do my job and not be bothered. Once a week	I just want to do my job and not be bothered. A few times a week	I just want to do my job and not be bothered. Every day
I have become more cynical about whether my work contributes anything.	I have become more cynical about whether my work contributes anything. Never	I have become more cynical about whether my work contributes anything. A few times a year or less	I have become more cynical about whether my work contributes anything. Once a month or less	I have become more cynical about whether my work contributes anything. A few times a month	I have become more cynical about whether my work contributes anything. Once a week	I have become more cynical about whether my work contributes anything. A few times a week	I have become more cynical about whether my work contributes anything. Every day
I doubt the significance of my work.	I doubt the significance of my work. Never	I doubt the significance of my work. A few times a year or less	I doubt the significance of my work. Once a month or less	I doubt the significance of my work. A few times a month	I doubt the significance of my work. Once a week	I doubt the significance of my work. A few times a week	I doubt the significance of my work. Every day
At my work, I feel confident that I am effective at getting things done.	At my work, I feel confident that I am effective at getting things done. Never	At my work, I feel confident that I am effective at getting things done. A few times a year or less	At my work, I feel confident that I am effective at getting things done. Once a month or less	At my work, I feel confident that I am effective at getting things done. A few times a month	At my work, I feel confident that I am effective at getting things done. Once a week	At my work, I feel confident that I am effective at getting things done. A few times a week	At my work, I feel confident that I am effective at getting things done. Every day