Are you on the Verge of Burnout? - COPIED [CMMWUDI | Sample Survey, Examples, Questions & Questionnaires

Do you have difficulty getting up in the morning-and that is out of bed to go to work =}

Are you always tired?

Do you forget things?

Do you have unexplained aches and pains?

Are you irritable at work and at home?

Are you finding you are losing your temper easily more often?

Have you lashed out at any co-workers-family, or patients, whether they deserved it or not?

Do you feel overwhelmed most the time?

Do you feel like you have less control over things at work or home?

Do you feel stressed most of the time?

Have you begun wondering why you are doing what you are doing career wise?

When at work are you a clock watcher wondering how long you have been there or how long you have left?

Are you finding yourself going through the motions just to get through your shift?

Have you been experiencing more headaches, stomachaches, rashes, chest pains or any illness?

Have you lost interest in things you used to find exciting?

Are you bored?

Do you feel like you're in a rut?

Have you answered enough damn questions? =}Thanks!

Are you on the Verge of Burnout? - COPIED [CMMWUDI

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1.Gender: Male Female What is your age group? 18-30 31-40 41-50 >50 What is your marital status? Married Single Divorced Widowed Significant other What is your job title? Doctor/PA/NPT Resident (specify year) RN/LPN Pre-hopsital (EMT,CEP,FF, etc.) Student (any type of medicine) Other What shift do you work? Days Nights Graveyard Other: please specify________________________ Do you have another job besides your primary health care job? Yes No Are you: Full time Part time Per diem volunteer other How long have you been working in the medical field? <6 months 6-12 months 1-3 years 3-6 years 6-10 years 10-20 years >20 How long have you been employed with your current employer? <6 months 6-12 months 1-3 years 3-6 years 6-10 years 10-20 years >20 years What kind of shift schedule do you work? Please specify your schedule i.e. Kelly shift, threee 12 hour shift etc.._________________________ Select any of the following that apply? Some of the questions may be redundant. Do you have difficulty getting up in the morning-and that is out of bed to go to work =} Are you always tired? Do you forget things? Do you have unexplained aches and pains? Are you irritable at work and at home? Are you finding you are losing your temper easily more often? Have you lashed out at any co-workers-family, or patients, whether they deserved it or not? Do you feel overwhelmed most the time? Do you feel like you have less control over things at work or home? Do you feel stressed most of the time? Have you begun wondering why you are doing what you are doing career wise? When at work are you a clock watcher wondering how long you have been there or how long you have left? Are you finding yourself going through the motions just to get through your shift? Have you been experiencing more headaches, stomachaches, rashes, chest pains or any illness? Have you lost interest in things you used to find exciting? Are you bored? Do you feel like you're in a rut? Have you answered enough damn questions? =}Thanks! How many hours do you put in a pay-period (specify pay period time, i.e. weekly, bi-weekly, etc) Does your employer offer overtime? Yes No Only when deemed necessary Sometimes Never Does your job require you to work over your normal scheduled time if the situation calls for it? Yes No Sometimes Only if I feel like it =} Only if your boss feels it's necessary Do you work over your scheduled hours if the situation deems necessary (i.e. late call,staffing issue,etc., whether mandatory or not? Always Only when necessary occassionally very rarely never Do you feel you have the proper and most updated equiptment to do your job professionally and safely? Agree Somewhat agree Neutral Somewhat Disagree Totally disagree! In thinking about the variety of tasks and duties you perform in your line of work, would you say you have: Too many Just enough Neutral Not enough Very few at all I feel satisfied with what I am required to do Do you feel you have autonomy in line of work? Yes No Do you feel your job gives you adequate amount of time for breaks to eat, to have a relaxed meal? Yes No Does your job allow you to have enough opportunity to interact with other employees on a formal level regardless of the title they possess? Always Sometimes Very rarely They never listen anyway Not at all Do you feel you have a clear path for career advancement in your field? Yes No Please select what areas are important in respect to how you choose your employer: Mark all that apply Competancy of the medical staff Reputation of the organization Benefits Pay Past experiences of patients Teamwork amongst the employees Job duties Career opportunities Proper working environment (equiptment updated and working) Retirement Opportunity for advancement Education support (CE's, Recerts,etc.) Number of patient contact Work schedule Other please specify_____________________ Do you feel like there is a sense of teamwork advocated in your workplace? Yes No Do you feel work assignments are distributed equally amongst the staff? Yes No Mark all that apply in respect to your job: I have the support and authority to make decisions on my own when needed. I feel my job gives me a sense of accomplishment. The work I do makes a difference in my job. I feel valued as a team member. I receive encouragement to come up with new ideas and better ways that can improve my work place. I feel satisfied with the recognition I receive for doing a good job. My job uses good use of my skills and thinking abilities. I have the tools and resources to do my job well. I feel the employees are recognized as individuals. In regards to patients, how do you treat them? Be honest and if more than one applies, mark it On an individual basis depending on their condition I treat all my patients the same no matter what their condition I admit I tend to treat some different depending on the circumstances, like if they are drunk and killed someone, child abuse, etc. Half of them don't need emergency treatment and it makes me tend to treat them differently They're all a bunch of whiners Do you find yourself feeling tired and run down after work? Almost always Some of the time Dont' really notice Occasionally Never Do you ever find yourself dreading going to work? Everyday Most of the time Occasionally Never I'd rather be on the beach drinking margaritas It's just a paycheck to me Check all that may apply: Even if it is occasionally mark next to the question always,sometimes, or never. I feel too much is expected of me at work. I feel isolated at work. I feel emotionally or physically drained. I am easily bored with my job. Non-working realtionships are affected by work feelings. I find myself envious of those who are happy with their jobs. I care less about doing a good job than I used to. I don't feel I am able to use my full potential at work. I don't feel like have enough leisurely time because of my working hours. I don't feel as if I am appreciated by my superiors. My work is redundant. I dislike some of the people I work with I don't get paid enough for what they have me doing. I feel burnt-out with my job I have often thought about quitting my job to do something else I have a hard time dealing with dying patients A good day is multiple traumas and a lot of autonomy and analytical thinking A good day is no patients at all The best day is my day off The best day is when I retire and don't have to do this shit anymore Anything you want to add_______________ What do you like most about your job? What do you like least about your job? If you were to chose a different profession, what would it be? Any input with regards to your profession, whether positive or negative would be greatly appreciated. Thanks!