Nursing Concerns during COVID-19

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* 1. Are you a nurse (at any level of practice) working in Arkansas?

Yes

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* 2. Type of nursing license

CNA (certified Nurse's Aid)

MA-C (Medication Assistant-Certified)

LPN/LVN (Licensed Practical Nurse)

LPTN (Licensed Psychiatric Technician Nurse)

RN (Registered Nurse

RNP (Registered Nurse Practitioner) (BSN level- renewal license only)

CNP (Certified Nurse Practitioner) (all specialties- Master's level & above)

CRNA (Certified Registered Nurse Anesthetist)

CNS (Clinical Nurse Specialist)

CNM (Certified Nurse Midwive)

APRN (Advanced Practice Registered Nurse) - Other (please specify)

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* 3. Are you having trouble getting the proper PPE you need?

Yes

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* 4. Does your concern for adequate PPE impact where you are willing to work?

Yes

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* 5. If yes, what kind of practice do you work?

NP owned Primary care clinic

MD owned Primary care clinic

Hospital owned Primary care clinic

NP owned Specialty clinic- please answer type of specialty below

MD owned Specialty clinic- please answer type of specialty below

Hospital owned Specialty clinic- please answer type of specialty below

Hospital/Inpatient

Emergency Department

N/A- I am getting the PPE I need

Other/Type of specialty

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* 6. Are you currently working?

Yes

No, I'm furloughed from my job

No, I was unemployed prior to the COVID-19 pandemic

No, I am unemployed due to the COVID-19 pandemic

If furloughed or unemployed d/t COVID-19, have you sought other opportunities to work or volunteer in healthcare? What have you found?

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* 7. Are you willing to work or volunteer to help during this COVID-19 crisis?

Yes

I am willing to travel within Arkansas if needed.

How far are you willing to travel to help within Arkansas? Please note whether this includes work, volunteer, or both.

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* 8. Are you willing to work outside your typical practice setting to address current needs?

Yes

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* 9. Do barriers to your scope of practice within Arkansas impact where you plan to work?

Yes

I have considered working in another state.

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* 10. Tell your story about how COVID 19 has affected you, your practice, your family.

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* 11. Please give your City/Town.
Include your preferred email/contact, if you would like.

Name

City/Town

ZIP/Postal Code

Email Address

Phone Number

Nursing Concerns during COVID-19

Question Title

* 1. Are you a nurse (at any level of practice) working in Arkansas?

Question Title

* 2. Type of nursing license

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* 3. Are you having trouble getting the proper PPE you need?

Question Title

* 4. Does your concern for adequate PPE impact where you are willing to work?

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* 5. If yes, what kind of practice do you work?

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* 6. Are you currently working?

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* 7. Are you willing to work or volunteer to help during this COVID-19 crisis?

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* 8. Are you willing to work outside your typical practice setting to address current needs?

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* 9. Do barriers to your scope of practice within Arkansas impact where you plan to work?

Question Title

* 10. Tell your story about how COVID 19 has affected you, your practice, your family.

Question Title

* 11. Please give your City/Town. Include your preferred email/contact, if you would like.

* 11. Please give your City/Town.
Include your preferred email/contact, if you would like.