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  5. Nursing
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What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What is your marital status?
 
Never Married
 
Living with significant other
 
Separated
 
Divorced
 
Widowed
 
 
 
Do you smoke?
 
Yes
 
No
 
 
 
What is your current work status?
 
Full-Time
 
Part-Time
 
PRN/Flex Status
 
 
 
What is your ethnicity?
 
Black
 
Caucasian
 
Asian
 
Hispanic
 
Indian
 
Other
 
 
 
 
What is your highes level of education?
 
Associates in Nursing
 
Bachelors
 
Masters
 
Doctoral
 
 
 
What Department of Nursing are you in?
 
ICU
 
ER
 
OR
 
Med-Surgical/Floor
 
Other
 
 
 
 
How satisfied are you with your overall health?
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied