MNA Ready and Willing Survey - COVID-19
Spring 2020
100%
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)
 
Management
 
Direct patient care community
 
Direct patient care LTC/SNF
 
Direct patient care home care
 
Direct patient care acute care
 
Emergency room
 
Urgent care
 
Ambulatory
 
Surgical
 
Critical care
 
Ventilator experience
 
Other
 

 
 
 
* 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
 
PPE
 
Isolation
 
Diabetes
 
HTN
 
Medication administration
 
Refresher course
 
None
 
Other
 

 
 
 
* 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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