PHN Residency: 12 month Preceptor Evaluation of PHN Residency

This survey should take approximately 10 minutes to complete. Your responses will be used to make improvements to the PHN Residency Program for New Graduates.

Thank you in advance for your feedback!

1. My overall satisfaction with the New Graduate PHN Residency is

	Not satisfied
	Somewhat satisfied
	Satisfied
	Very satisfied
	Extremely satisfied

2. Which portion(s) of the New Graduate PHN Residency were most helpful (may select more than one)

	Preceptor support
	Case studies
	Looping experiences
	Peer support contacts
	Professional development plan
	General orientation components
	The monthly calendar

3. Which portion(s) of the New Graduate PHN Residency were least helpful (may select more than one)

	Preceptor support
	Case studies
	Looping experiences
	Peer support contacts
	Professional development plan
	General orientation components
	The monthly calendar

4. Please list suggestions for improvement of the New Graduate PHN Residency or ares for further development

5. What is your age?

6. To which gender do you most closely identify?

7. What is your ethnicity?

8. What is your highest level of education completed?

9. How many years have you been a nurse?

10. How many years have you been employed as a public health nurse?

11. In what state are you employed as a public health nurse?

12. What is the size of the public health agency where you work?

	Small (1-24 employees)
	Medium (25-74 employees)
	Large (75 or more employees)

13. Which of the following best describes your area of practice?

	Governmental Public Health
	School Nursing
	Community-based Organization

14. Years as a preceptor (Please designate as whole and fractions of years; for example, if you have been a preceptor for 3 months, this is considered 0.25 years, if you have been a preceptor for 1 year and 3 months, this is considered 1.25 years)

Leave this blank, it's here to thwart SPAM bots.

Forms Manager

PHN Residency: 12 month Preceptor Evaluation of PHN Residency