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How long have you been a RN?
 
< 5 years
 
5-10 years
 
10-15 years
 
Over 15 years
 
 
 
What is your highest level of education?
 
AS/Diploma
 
BSN
 
MSN
 
Phd
 
 
 
Which unit do you work on?
 
Medical/Surgical
 
PCU
 
ER
 
Behavioral Health
 
ICU
 
 
 
Have you ever been verbally abused by a patient,family member or visitor?
 
Yes
 
No
 
 
 
Did you report this incident to your supervisor?
 
Yes
 
No
 
 
 
Have you been physically harmed by a patient or family member/visitor?
 
Yes
 
No
 
 
 
Did you report the incident to your supervisor?
 
Yes
 
No
 
 
 
Do you feel safe in your work environment?
 
Yes
 
No
 
 
 
Do you feel there is adequate security officers available to assist in a violent incident?
 
Yes
 
No
 
 
 
Do you feel enough protective measures are in place at your hospital? (IE adequate lighting in parking lots, screening of visitors)
 
Yes
 
No
 
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