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:
Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Beds

7. 2- Number and kind of wards:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
No.& Male Female M F M F M F M F
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---
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7. 3 - Medical and Paramedical services facilities:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
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..

7. 4- Ambulance and duty driver:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Numbers of
Ambulance & driver

7. 5 Educational and Research Facilities:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
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..
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7. 6 Other Public Facilities:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Facilities: Yes No Y N Y N Y N Y N
Gift shop
Book shop
Florists shop.
Cafeteria /snack Bar
Drinking water
fountains
Waiting room
Pay telephone
Others..

8-Human Resources:

8. 1 Technical; Medical Staff

8. 1. 1- Doctors:
Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
No. of Doctors: Male Female M F M F M F M F
G. Surgeon
Gynecologist
G. Physician
Pediatrician
Orthopedist
Anesthetist
Ophthalmol-
ogist
Nephrologist
Neurologist
Neurosurgeon
ENT-Surgeon
Nephro. Surg.
Radiologist
Cardiologist
Dermatologist
Pathologist
Internist
Pharmacologist
Infection Dr.
Psychiatrist
Dentist
Physiotherapist
Others..
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8. 1. 2- Nurses:
Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
Matron
Supervisor
Head nurse
Staff nurse
Midwife

8. 1. 3- Number and kind of Employment of Nurses:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
Full time
Part time
Per diam
Permanent
Temporary

8. 1. 4- Paramedical Staff:
Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
Lab. Tech.
Radiology
Technician
Operation room
Tech.
Anesthelog-ist.
Tech.
Dietician
Others

8. 2- Non Technical (Non-medical staff):

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
Clerical staff
Manual and
other staff
 374

8. 3- Management ( Experience and Educational status):

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
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

8.3.1 Director (C.E.O) educational Status:

M.D. +Post graduate diploma/courses in Management

- Post graduate diploma/courses in Management

M.D. + Ph.D.

M.Sc.

Others

9. Organizational chart: (please draw in given space

 375

10- Customers (number and kind of admitted patient):

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
In-patient
Outpatient

11- Number of Expired Patient:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
Expired
Patient

12- Nursing Recruitment Position:

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005
Number
Nurses

13- Which method have you adopted for appointment of nurses :

Interview Only showing documents

Exam 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 Matron/Nursing Superintendent

Supervisors CEO (Chief Executive Officer)

 376

16- Educational Activities: (Number & No. of participate)

Years 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005

Education. No. Parti- No. Par. No. Par. No. Par. No. Par.
Activities: cipate
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 2000-2001 2001-2002 2002-2003 2003-2004 2004-2005

No. of Locally Out- Loc. Out. Loc. Out. Loc. Out. Loc Out.
Staff Rep. station .
-Seminar
-Workshop
 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
 378

15. What type of setting do you working in? /ward

Medical/Internal Critical care unit

Surgical Operating room

Emergency Pediatrics

Other specify type.

15.1 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..

21. Number of night duty shifts per month.

( 0 ), (1-3), (4-6), (7-9),

(10-12) (13+)
 379

22. Daily Shift length

Day --------------- hours.

Afternoon -------- hours.
Night ------------- hours.

23. Spouses Educational level,

Diploma B.Sc. M Sc. Ph.D. M.D.

24. Spouses Job: Medical Doctor

Engineer

Faculty member

Teacher/Lecturer

Others

25. Type of Residences

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

 380

Ask yourself:
How satisfied am I with this aspect of my job?
1=Very 2= 3= 4= 5=Very NA= Not
dissatisfied Dissatisfied Neutral Satisfied satisfied Applicable

S. Particulars 1 2 3 4 5 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
 381

S. Particulars 1 2 3 4 5 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
 382

S. Particulars 1 2 3 4 5 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 units 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
 383

Identification of HRM Practices affected on Job satisfaction

Negligible Very high

1- Factors: Salaries and Fringe benefits

(1) Pay is satisfactory 1 2 3 4 5

(2) Education and experience are

recognized and used 1 2 3 4 5

(3) Opportunities exist for career 1 2 3 4 5

advancement

(4) The pay system rewards 1 2 3 4 5

my years of experience

(5) The pay is adequate for shifts, 1 2 3 4 5

weekends , and holidays

(6) Fringe benefits are known 1 2 3 4 5

(7) Employees are satisfied 1 2 3 4 5

with fringe benefits

(8) Child care services and 1 2 3 4 5

satisfactory

(9) The retirement program is 1 2 3 4 5

a strong one.

. 2- Factor: Staffing philosophy, clerical work: floating and rotating

shifts
(1) The staffing philosophy is fair. 1 2 3 4 5

(2) A float pool covers absences and 1 2 3 4 5

supplemental staffing

(3) Clinical nurses have input into staffing 1 2 3 4 5

policies and procedures.

(4) Opportunities exist for flexible work 1 2 3 4 5

schedules

(5) Clerical duties are performed by 1 2 3 4 5

clerical personnel.
 384

(6) Appropriate activities are performed 1 2 3 4 5

by other departments,
such as pharmacy, medical laboratory
and dietary.

3- Factor: Professionalism; interdisciplinary

relationships; public relations
(1) Clinical nurses serve on all 1 2 3 4 5
organizational committees.

(2) Administrators promote cooperative 1 2 3 4 5

interdisciplinary relationships.

(3) Clinical nurses spend their time 1 2 3 4 5

taking care of patients.

(4) Clinical nurses make decisions 1 2 3 4 5

about patient care.

(5) Clinical nurses participate in 1 2 3 4 5

nursing management

(6) Clinical nurses are recognized and 1 2 3 4 5

rewarded for nursing excellence.

(7) Clinical nurses participate in quality 1 2 3 4 5

assurance.

(8) Clinical nurses receive awards 1 2 3 4 5

for merit.

(9) The communication system is 1 2 3 4 5

informative, provides for clinical
nursing input, and gives feedback.

(10) Job vacancies are posted. 1 2 3 4 5

(11) Clinical nurses participate in public 1 2 3 4 5

relations functions.
 385

4- Factor: Staff development

(1) A career development program exists. 1 2 3 4 5

(2) Good opportunities for continuing 1 2 3 4 5

education are available

(3) A good orientation program is in force 1 2 3 4 5

(4) Personnel are reimbursed for staff 1 2 3 4 5

development activities.

(5) Refresher courses are available 1 2 3 4 5

(6) Staff development programs 1 2 3 4 5

are marketed

(7) Incompetent nurses are identified 1 2 3 4 5

and handled appropriately.

(8) Good leadership training courses 1 2 3 4 5

are available.

(9) Clinical nurses participate in 1 2 3 4 5

staff development planning.

5- Factor : Administration Support

(1) Clinical nurses can follow 1 2 3 4 5
through on beliefs and values.

(2) Clinical nurses are not subjected 1 2 3 4 5

to punitive action by supervisors.

(3) Productivity standards are known. 1 2 3 4 5

(4) Employees have access to senior 1 2 3 4 5

management.

(5) Nursing service and nursing 1 2 3 4 5

education are in harmony.

(6) Patient safety is emphasized 1 2 3 4 5

(7) An up-to-date nursing management 1 2 3 4 5
information system is available
(8) Managers are visible to 1 2 3 4 5
nursing staff and patients.