QUESTIONNAIRE FOR HOSPITALS
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1 370 QUESTIONNAIRE FOR HOSPITALS Identification: 1. Name of Hospital.. 2. Address.. 3. Name of the head of hospital. 4. Kind of Hospital : Public Private 5. Nature of Hospital : General Special 6. Teaching Hospital : Yes No 7- Facilities: 7. 1-Number of beds: Beds Number and kind of wards: Years No.& Kind of wards Medical Surgical Pediatric Heart Orthopedic Gynecology Emergency Nephrology Neurology Neurosurgery ENT Eye CCU ICU Maternity/ (New Born) Delivery room Operating room Skin Others Male Female M F M F M F M F
2 Medical and Paramedical services facilities: Med & Para. Yes No Y N Y N Y N Y N S : Outpatient. S Emergency S. Clinical Lab. Blood bank Diagnostic X Ray Radio therapy Nuclear Medicine Drug Store Physiotherap y Others Ambulance and duty driver: Numbers of Ambulance & driver 7. 5 Educational and Research Facilities: Education & Yes No Y N Y N Y N Y N Research Facilities Library Conference hall Research center Educational development Center(EDC) Internet Medical records center Hospital Information System (HIS) Others..
3 Other Public Facilities: Facilities: Yes No Y N Y N Y N Y N Gift shop Book shop Florist s shop. Cafeteria /snack Bar Drinking water fountains Waiting room Pay telephone Others.. 8-Human Resources: 8. 1 Technical; Medical Staff Doctors: No. of Doctors: Male Female M F M F M F M F G. Surgeon Gynecologist G. Physician Pediatrician Orthopedist Anesthetist Ophthalmologist Nephrologist Neurologist Neurosurgeon ENT-Surgeon Nephro. Surg. Radiologist Cardiologist Dermatologist Pathologist Internist Pharmacologist Infection Dr. Psychiatrist Dentist Physiotherapist Others..
4 Nurses: Years Number Matron Supervisor Head nurse Staff nurse Midwife Number and kind of Employment of Nurses: Number Full time Part time Per diam Permanent Temporary Paramedical Staff: Number Lab. Tech. Radiology Technician Operation room Tech. Anesthelog-ist. Tech. Dietician Others Non Technical (Non-medical staff): Number Clerical staff Manual and other staff
5 Management ( Experience and Educational status): Exp. Edu. Exp. Edu. Exp. Edu. Exp. Edu. Exp Edu. Exp.&. Edu. Status Director /Chief Executive officer.(ce O) Administrat -ive manager Director of Nursing/ Matron Director (C.E.O) educational Status: M.D. M.D. + Ph.D. +Post graduate diploma/courses in Management - Post graduate diploma/courses in Management M.Sc. Others 9. Organizational chart: (please draw in given space
6 Customers (number and kind of admitted patient): Years Number In-patient Outpatient 11- Number of Expired Patient: Number Expired Patient 12- Nursing Recruitment Position: Number Nurses 13- Which method have you adopted for appointment of nurses : Interview Exam Only showing documents Exam and interview Others 14. Do you need recruitment of new nurses for next year? Yes No If yes: number 15. Do you have performance appraisal system? Yes No 15.1 If Yes, Please tick ( ) the appropriate boxes. Annually Every 6 months Monthly 15.2 Who is responsible for performance appraisal system? Please tick ( ) the appropriate boxes. Head Nurse Supervisors Matron/Nursing Superintendent CEO (Chief Executive Officer)
7 Educational Activities: (Number & No. of participate) Years Education. Activities: Lectures -Nursing -General Medical Conferences -Nursing -General Medical Seminars -Nursing -General Medical Workshops -Nursing -General Medical Others 17-Number of staff (nursing) representing for seminars/ workshops: Years No. of Staff Rep. -Seminar -Workshop No. Participate No. Par. No. Par. No. Par. No. Par Locally Outstation Loc. Out. Loc. Out. Loc. Out. Loc. Out.
8 377 QUESTIONNAIRE FOR NURSE Kind of Hospital: Public Private DEMOGRAPHIC DATA 1. Gender: Male Female 2. Age: Year 3. Martial Status: Single Married Divorced Widowed Live separately 4. Staying with parents: Yes No 5. Number of dependents: 6. Number of Children: 7. Number of Children below 7 years : 8. Educational Status: B.Sc. M Sc. Ph.D. 9. Year of graduation: 10. Work experience Years 11. Years of employment, Years 12. Kind of employment Temporary Permanent 13. Working Years in This Hospital Years 14. Position Staff (general duty) Head Nurse Assistant Head nurse Supervisor Others
9 What type of setting do you working in? /ward Medical/Internal Surgical Emergency Critical care unit Operating room Pediatrics Other specify type Number of beds 15.2 Number of Nurses 15.3 Staffing of this ward : Under staffing standard staffing Over staffing 16. Time on present unit months. 17. Employment Status: Full Time Part time Per diem 18. Are you currently employed in more than one nursing position? Yes No 19. Are you currently doing overtime in this hospital? Yes hours per month No 20. Shift worked : Long Shift Day shift Afternoon shift Night shift Monthly rotation/rotating Any other information Number of night duty shifts per month. ( 0 ), (1-3), (4-6), (7-9), (10-12) (13+)
10 Daily Shift length Day hours. Afternoon hours. Night hours. 23. Spouse s Educational level, Diploma B.Sc. M Sc. Ph.D. M.D. 24. Spouse s Job: Medical Doctor 25. Type of Residences Engineer Faculty member Teacher/Lecturer Others Ownership Rental With parents 26. Distance of your Residence from hospital? Near (less than 30 minutes by walk) Moderate (31-60 minutes by walk) Far (60 +minutes by walk) 27. What kind of transport do you use for hospital? By walking Bus Taxi Own Car Hospital Service facility others. 28. Did you represent for seminars/workshops etc.? Yes No 28.1 Number of times Workshops Seminars Conferences
11 380 Ask yourself: How satisfied am I with this aspect of my job? 1=Very dissatisfied 2= Dissatisfied 3= Neutral 4= Satisfied 5=Very satisfied NA= Not Applicable S. Particulars NA No. 1 Nature of work 2 Work load 3 Hours of work 4. Working long shift 5 Overtime 6 Working of weekend 7 Number of weekends 8 Working at night 9 Working on holidays 10 Working scheduling 11 Variety of hours required to work 12 Flexibility at work 13 Job stability 14 Equipments (Instruments) 15 Staffing adequacy 16 Non-nurse staffing adequacy 17 Rotation to other wards 18 Working at this ward ( only one ward) 19 Working environment 20 Safety measures 21 Feeling of accomplishment of nursing care 22 Contribution in quality care to patients. 23 Non-nursing duties 24 Visiting hours 25 Uniform Autonomy 1 Areas of recognizing their achievements 2 Independent thinking 3 Decision making opportunities for independent work 4 Control in the work setting 5 Control over work condition
12 381 S. Particulars NA No Co-worker 1 Team working 2 Relationship with coworker 3 Relationship with physician 4 Relationship with supervisors 5 Relationship with head nurse 6 Relationship with manager 7 Relationship with patients 8 Relationship with Director 9 Relationship with others ( Visitors) 10 Coworker Support Recognition 1 The recognition I receive from my peers by doing my job. 2 The recognition I receive from other professional groups by doing my job 3 The recognition I receive from the general public by doing my job 4 The recognition I receive from the status of my position within my profession 5 The recognition I receive from my supervisors by doing my job 6 The recognition I receive from my family by doing my job. Promotion 1 Opportunities for on-the-job training 2 Access to training program for learning new things. 3 Interaction with Nursing faculty. 4 Committee Membership 5 Participation in Nursing Research 6 Writing and Publishing papers, documents, journals. 7 Clinical ladder (opportunities for improvement) 8 Opportunities of continuing education
13 382 S. Particulars NA No. Supervision 1. Managers Leadership Styles 2 Participation and involvement in the policies of hospitals and decision making. 3 Awareness of the hospitals mission, strategy,goals and milestones 4 How the Hospital handles staff complaints. 5 Fairness to the performance appraisal system 6 Caring from supervisors. 7 The amount of job security 8 The reward system and package 9 Welfare issues 10 The work unit s atmosphere 11 The quality of work condition 12 Coordination in administration 13 Supporting nurses by the administration in conflict situation 14 Response of administration to nurses needs, demands 15 Incentives of administration for nurses Pay 1 Salary 2 Bonuses 3 Paid for overtime 4 Fringe benefits 5 Vacations 6 Leisure activities. * Overall job satisfaction
14 383 Identification of HRM Practices affected on Job satisfaction 1- Factors: Salaries and Fringe benefits Negligible Very high (1) Pay is satisfactory (2) Education and experience are recognized and used (3) Opportunities exist for career advancement (4) The pay system rewards my years of experience (5) The pay is adequate for shifts, weekends, and holidays (6) Fringe benefits are known (7) Employees are satisfied with fringe benefits (8) Child care services and satisfactory (9) The retirement program is a strong one.. 2- Factor: Staffing philosophy, clerical work: floating and rotating shifts (1) The staffing philosophy is fair (2) A float pool covers absences and supplemental staffing (3) Clinical nurses have input into staffing policies and procedures. (4) Opportunities exist for flexible work schedules (5) Clerical duties are performed by clerical personnel.
15 384 (6) Appropriate activities are performed by other departments, such as pharmacy, medical laboratory and dietary. 3- Factor: Professionalism; interdisciplinary relationships; public relations (1) Clinical nurses serve on all organizational committees. (2) Administrators promote cooperative interdisciplinary relationships. (3) Clinical nurses spend their time taking care of patients. (4) Clinical nurses make decisions about patient care. (5) Clinical nurses participate in nursing management (6) Clinical nurses are recognized and rewarded for nursing excellence. (7) Clinical nurses participate in quality assurance. (8) Clinical nurses receive awards for merit. (9) The communication system is informative, provides for clinical nursing input, and gives feedback. (10) Job vacancies are posted (11) Clinical nurses participate in public relations functions.
16 Factor: Staff development (1) A career development program exists (2) Good opportunities for continuing education are available (3) A good orientation program is in force (4) Personnel are reimbursed for staff development activities. (5) Refresher courses are available (6) Staff development programs are marketed (7) Incompetent nurses are identified and handled appropriately. (8) Good leadership training courses are available. (9) Clinical nurses participate in staff development planning. 5- Factor : Administration Support (1) Clinical nurses can follow through on beliefs and values. (2) Clinical nurses are not subjected to punitive action by supervisors. (3) Productivity standards are known (4) Employees have access to senior management. (5) Nursing service and nursing education are in harmony. (6) Patient safety is emphasized (7) An up-to-date nursing management information system is available (8) Managers are visible to nursing staff and patients.
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