2021 COVID-19 RN Screener

Question Title

* 1. Are you a licensed Registered Nurse?

Yes

No

Question Title

* 2. Which title best describes your current position in nursing?

Shift manager

Staff nurse

Charge nurse

Nurse practitioner

Nurse educator

Director of Nursing

Question Title

* 3. In what type of organization(s) are you currently employed at least part-time?

Hospital

Doctor’s office

Stand-alone clinic

None of the above

Question Title

* 4. How likely are you to consider working full- or part-time in a hospital setting in the future?

Very likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Very unlikely

Question Title

* 5. Thank you for your interest in the study about how you are feeling as an RN during the coronavirus (COVID-19) epidemic. Please let us know your contact information so we can send you a link to schedule your interview.

Name *

State/Province

Email Address *

Phone Number