1. What is your gender?

Male
Female

2. What is your age?

3. What is the highest degree you hold?

Diploma
AD
BSN
MSN
DNP
PhD

4. How did you receive your nurse practitioner education?
Certificate Program
MSN Program

5. In what specialty area(s) were you educated?

6. How long have you been employed as a nurse practitioner?

7. How long have you been employed as a nurse practitioner in West Virginia?

9. Are you currently working in West Virginia?
Yes
No


10. In what county are you employed?

11. In what area is your collaborating physician(s) specialized, if applicable? Check all that apply.
OB/GYN
Surgery
Internal Medicine
Family Practice
Pediatrics
Other
N/A


12. If you are faculty, please estimate the percentage of your time spent as faculty and the percentage spent in non-faculty clinical practice.
Faculty %
Non-faculty practice %
N/A


13. If you hold a faculty position, in what type program do you teach? Check all that apply.
AD
BSN
MSN
Doctorate
NP Program
Other
N/A


14. Which of the following best describes your direct care practice environment?

15. Please check all the types of clients to whom you provide care most of the time.
Rural/small town residents
Inner-city residents
Migrant workers
Homeless clients
Individuals who cannot pay
Other (Specify)


16. In what type practice are you employed?
Joint practice
Private practice
Contract services
Salaried
Hospital setting
Other (specify)


17. To whom do you report for clinical practice?
Physician
Non-physician, non-nurse administrator
Nurse manage/director/supervisor
No one
Other


18. Which of the following health care providers are available in your setting to support your practice? Check all that apply.

19. How often are you on call?
Never
1 night per week
Every other night
1 week on/1 week off
Other

20. How are you reimbursed for call?
flat rate per call period
only if called
comp time
no reimbursement

21. Please check each resource that is not available in your community, but is needed.

22. Please estimate the percentage of your time given to each of the following types of patients. (The total should equal 100%)

23. Patients receiving my services are: (check all that apply)
My own caseload
Randomly assigned to available provider
Selected complaints
Scheduled in a specific appointment book for me
Walk ins/call ins
Other:

24. Please estimate the percentage of your time given to each of the following age groups. (The total should equal 100%).

25. Please check each employment benefit available to you. Check all that apply.

27. What is your annual income from your work as a nurse practitioner if employed part-time?

28. What is your hourly wage if employed by the hour?

29. Fees for your nurse practitioner services are usually:
Equal to MD
Less than MD
More than MD


30. What is the source of your annual income as a nurse practitioner?

31. How many hours a week do you work as a nurse practitioner?
hours

32. How many miles is it (round trip) from your residence to the place where you practice?
miles

33. Is travel included in your typical workday? (If yes, answer #34 and #35).
Yes
No


34. How many miles do you travel each week as a part of your NP practice?
miles

35. Are you reimbursed for any required travel?
Yes
No


36. What type of physician backup do you have? (Check all that apply)
Phone PRN
Physician usually present
Physician on phone with weekly visit to clinic
Physician reviews records
Other

37. What type of practice protocol do you have? (Check all that apply)
Individually developed protocol
Standardized protocol
Board guidelines, no protocol
Verbal protocol
Other

38. By whom was your protocol developed?
By physician alone
By NP and physician jointly
By NP with physician approval
Other

39. How is your Quality Assurance accomplished?

40. What is the average amount of time you spend on an initial new patient visit?
minutes


41. What is the average amount of time you spend on each follow up visit?

minutes

42. What is the average number of hospital visits for seeing patients that you make each week, if applicable?

visits

43. What is the average number of outpatients you see daily?
patients


44. Do you feel you are given adequate opportunity to present problems, complaints, or suggestions to your colleagues?
Never
Seldom
Occasionally
Almost daily
Daily

45. Do physicians frequently delegate inappropriate tasks to you?
Never
Seldom
Occasionally
Almost daily
Daily

46. Within the next six months to one year, do you intend to quit your job?
Very unlikely
Unlikely
Likely
Most likely
Certain

47. How much does your job allow you to make decisions on your own regarding patient care?
Too much
As much as I want
Not as much as I would
Too little
None at all


48. How much does your job allow you to take part in making decisions that affect you?
Too much
As much as I want
Not as much as I would
Too little
None at all


49. Do you have a lot to say over what happens on your job?
Too much
As much as I want
Not as much as I would
Too little
None at all


Please indicate how frequently the following situations cause you to experience stress.

50. Cristicism by a physician:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


51. Performing procedures that patients experience as painful:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


52. Dealing with government rules and regulations related to practice:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


53. Conflict with a physician:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


54. Fear of making a mistake in treating a patient:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress

55. Disagreement concerning the treatment of a patient:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


56. Being asked a question by a patient for which I do not have a satisfactory answer:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


57. Making a decision concerning a patient when the physician is unavailable?
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress

58. Feeling inadequately prepared to help with the emotional needs of a patient:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


59. Not enough time to provide emotional support to a patient:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


60. A physician not being present in an emergency situation:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


61. Uncertainty regarding the operation and functioning of
specialized equipment:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


62. Being required to work outside your speciality area:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


63. General dissatisfaction with being a nurse practitioner:
Never causes stress
Occasionally causes stress
Frequently causes stress
Very frequently causes stress


64. Please list any other areas that cause you to experience stress that we have not addressed.
1.
2.
3.


65. Please identify all professional organizations of which you
are a member. Check all that apply.

66. Please identify all of the political activities with which
you have been involved during the last six months.

Information on malpractice related to nurse practitioners is difficult to access. This information is needed to promote legislation for third party reimbursement. Please answer the following questions on malpractice.

67.   Have you ever been named in a malpractice suit?
Yes
No


68. What was the nature of the case, if answered yes to above question?

69. What was the outcome of the case?



70. Do you currently have hospital privileges?
Yes
No (If no, please skip to question #73)


71. Which activities are included in your hospital privileges? (Please check all applicable responses)

72. If you do not currently have hospital privileges, have you
ever applied for hospital privileges in West Virginia?
Yes
No


73. If you have ever applied for hospital privileges and were denied privileges, what was the primary reason given?
No staff category for nurse practitioners in
Qualifications were inadequate
No collaborating physician
Other (Please specify)
Not applicable


74. Medications are prescribed by:
Me, with my own prescriptive privileges
Phoned in by me
Prescription pads signed by physician
Office staff phones in
Other (Please specify)


75. How long did it take to receive your hospital privileges from the time you first applied for them?
1-3 months
4-6 months
7-12 months
More than 12 months


76. What effects would the extension of limited prescriptive authority to nurse practitioner have on your ability to care for patients?
Greatly enhance
Moderately enhance
Slightly enhance
No effect
No opinion


77. To what extent has West Virginia's current limitation of prescriptive authority for nurse practitioners resulted in delays in treatment for your patients?
No delays due to lack of prescriptive authority
Brief delays
Moderate delays
Long delays, but no significant impacts on patient health
Long delays, with significant impacts on patient health
Not applicable.

78. How important would the ability to directly bill third party payers for nurse practitioner services be to your practice?
Very important
Important
Ambivalent about the issue (or no opinion)
Unimportant


79. How important would the ability to directly bill third party payers for nurse practitioner services be for other nurse practitioners?
Very important
Important
Ambivalent about the issue (or no opinion)
Unimportant


80. Do you have a DEA number?
Yes
No (if no, please explain)



81. Do you participate in a managed care plan or plans?
Yes
No


82. If you answered yes to question #81, please name which plan or plans.



83. Have you been denied participation in a managed care plan?
Yes
No


84. Please comment on any aspect of practice that you want to make known but were not asked about in this survey.