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NNU's Workplace Violence Survey
How Safe is Your Workplace From Violence?
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1.
What types of workplace violence have you experienced
in the previous year
? (Select all that apply)
(Required.)
Objects thrown at you
Pinched or scratched
Slapped, punched, or kicked
Spat on or exposed to other bodily fluids
Verbally threatened
Physically threatened
Groped or touched inappropriately
Verbally harassed based on your sex, appearance, and/or race or ethnicity (including sexual harassment)
I have not experienced workplace violence
Other (Please specify)
2.
Share your experience of workplace violence here. Use as little or as much detail as you would like.
Sharing your experience will help shape policy and legislation/regulation to prevent workplace violence in the healthcare setting.
Your experience will only be shared as you specify below.
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3.
After a workplace violence incident, my employer generally ___________.
(Required.)
Yes
No
I don't know
Investigates what happened
Yes
No
I don't know
Provides access to counseling for employees
Yes
No
I don't know
Trains or retrains employees on preventing workplace violence
Yes
No
I don't know
Changes practices to reduce the risk of workplace violence (e.g., adds cameras, adds staff, increases security, adds alarm systems, etc.)
Yes
No
I don't know
Discourages employees from reporting incidents
Yes
No
I don't know
Reprimands or blames employees
Yes
No
I don't know
Ignores it
Yes
No
I don't know
Other (Please specify)
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4.
How has workplace violence impacted you and your work? (Select all that apply)
(Required.)
Physical injury or other physical symptoms (e.g., headaches, stomach aches, etc.)
Took time off or reduced work
Anxiety, fear, or increased vigilance
Difficulty working in environment that reminds me of past incident
Applied for workers' compensation
Changed or left job
Considered leaving profession
Left profession
Physical injury prevents me from working
Psychological effects prevent me from working
No injury or no effect
Other (Please specify)
*
5.
What does your employer currently do to prevent workplace violence?
(Required.)
Provides training on workplace violence prevention
Places additional staff to reduce the risk of violence (e.g., sitters, additional nurses, additional techs, security staff)
Uses a charting or room flagging system to indicate increased risk for violence
Provides a clear way of reporting incidents to management
Has staff available at all times to respond to violent incidents (e.g., security guards, BERT teams)
Uses metal detectors
Uses security cameras
Limits visiting hours
Includes nurses and other direct care employees in violence risk assessments
I'm not sure
None of these
Other (Please specify)
*
6.
Has workplace violence increased on your unit
in the previous year
?
(Required.)
Increased a lot
Increased a little
Stayed the same
Decreased a little
Decreased a lot
Not sure
In your experience, what has contributed to the increase or decrease in workplace violence on your unit?
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7.
What kind of healthcare facility do you work in?
(Required.)
Hospital
Home care/hospice
Skilled nursing facility/long-term care
Outpatient clinic
Medical offices
Retired
Currently not employed as a nurse
Other (Please specify)
8.
If you work in a hospital, what type of unit do you work on?
Emergency department
Medical/surgical unit
Intensive care unit
Operating room/post-anesthesia care unit (PACU)/pre-op
Pediatric unit
Labor and delivery unit
Oncology/Hematology unit
Interventional Radiology
Psychiatric/behavioral health unit
Step-down unit
Telemetry unit
Other (please specify)
*
9.
What state do you work in?
(Required.)
*
10.
Are you an RN?
(Required.)
Yes
No
I am a(n) _______________ (please specify)
*
11.
Your personal information will be kept confidential and will only be shared as you specify below.
(Required.)
First name
Last name
Email
City
State
Zip/postal code
Phone (for follow up questions)
Where do you work (will not be shared without your permission)
*
12.
Can we share your story anonymously?
(Required.)
Yes
No
*
13.
Can we share your story with just your state (no name)?
(Required.)
Yes
No
*
14.
Can we share your story publicly with your name and city, state?
(Required.)
Yes
No
*
15.
Can we contact you about your story?
(Required.)
Yes
No
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