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Exit Survey
 
 
How many years have you been in nursing?
 
Less than 2 years
 
2-5 years
 
6-10 years
 
11-15 years
 
16-20 years
 
More than 20 years
 
 
 
How many years have you worked in the current organization?
 
Less than 2 years
 
2-5 years
 
6-10 years
 
11-15 years
 
16-20 years
 
More than 20 years
 
 
 
How many years have you worked on the current unit? 
 
Less than 2 years
 
2-5 years
 
6-10 years
 
11-15 years
 
16-20 years
 
More than 20 years
 
 
 
Gender
 
Male
 
Female
 
 
 
Age
 
Under 25
 
25- 35
 
36-45
 
46-55
 
56-65
 
Greater than 65
 
 
 
What is your highest level of education?
 
Associate Degree
 
Diploma
 
Bachelors Degree
 
Masters Degree in Nursing
 
Masters Degree in Other Field
 
Doctoral Degree in Nursing
 
Doctoral Degree in Other Field
 
 
 
What is your employment status
 
Full Time
 
Part Time
 
Supplemental
 
Exempt
 
 
 
Nationally Recognized Certification
   
 
 
 
Whta is your unit specialty
 
Medical-Surgical
 
Critical Care
 
Maternal Child
 
Mental Heath
 
Surgical Services
 
Emergency Department
 
Outpatient Clinics
 
Geriatrics
 
Other
 
 
 
 
Shift Time
 
Days
 
Nights
 
Evenings
 
Mixed
 
Other