Exit this survey AA&MDSIF <3s Nurses 2015 Tell Us About Your Special Nurse Question Title * 1. Who is your favorite nurse? Name: * Practice/Place of Employment: * Address: Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code: Country: Email Address: * Daytime Area Code and Phone Number: Question Title * 2. Please check the top qualities that best represent this nurse: Caring Coaching Collaborative Communicative Compassionate Considerate Decisive Dedicated Educational Empathetic Hopeful Influential Innovative Inspiring Intuitive Kind Knowledgeable Mentoring Patient Pleasant Powerful Responsive Scientific Supportive Understanding Other, please specify Question Title * 3. Please tell us, what makes this nurse special to you: Question Title * 4. What is their area of practice? (Please check all that apply) Oncology Radiology Gerontology Mental Health Pediatric Hematology Other (please specify): Question Title * 5. What is the name of the doctor your favorite nurse works with? First Name Last Name Next
