MNA Ready and Willing Survey - COVID-19
Spring 2020
Questions marked with an * are required Exit Survey
Additional qualified nurses are needed to supplement hospital/clinic capacity during the COVID-19 crisis. MNA is asking retired nurses, those who have experienced reduced hours or loss of employment, and those working part-time who are willing to re-enter the workforce and/or transition to full-time, to complete the MNA Ready and Willing Survey. Hospitals are already requesting names of interested nurses!

By submission of the survey, you authorize the Mississippi Nurses’ Association to provide your information to healthcare related facilities/clinics during the COVID-19 pandemic.

Mississippi needs you now more than ever - your education, experience and expertise - to assist in this crisis.
Section 1: Personal Information
* Last Name
* First Name
* Phone
* Email
* Address
* City
* State
* Zip/Postal Code
* County
* Age
* License Number
* State License Issued By
Section 2: Professional Experience
* License Choices
* Certifications
* Are you currently working?
* If you are currently working
* Last date of practice
* Role in last practice (select all that apply)
Direct patient care community
Direct patient care LTC/SNF
Direct patient care home care
Direct patient care acute care
Emergency room
Urgent care
Critical care
Ventilator experience

* I am ready to return to acute care practice
strongly agree agree neither disagree strongly disagree
* To increase my confidence and safety in returning to the clinical setting I would like training on (select all that apply)
Respiratory assessment
Oxygen delivery devices
Medication administration
Refresher course

* Would you be willing to work in any region in Mississippi?
In which regions are you not interested in working?
* Would you have your own transportation to and from the assigned site?
* If assigned, how long would you be available?
0-3 Months
3-6 Months
6-9 Months
9 Months - 1 Year
1 Year or More
Describe your interest and ability to be able to provide your services to treat patients, if needed:
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