Purpose: Our organization is committed to providing an exceptional environment for our staff so that you can provide exceptional care to our patients. Please take a few moments to complete this anonymous survey. Your honest feedback is invaluable and will directly influence organizational changes.
Rating Scale: Unless otherwise specified, please rate the following statements using this 5-point scale:
To maintain anonymity while allowing for data segmentation, please select the most appropriate options.
Department/Unit: [e.g., ER, ICU, Pediatrics, Outpatient, Admin, Radiology]
Role Category:
Physician / Advanced Practice Provider (NP/PA)
Nursing (RN/LPN/CNA)
Allied Health (Therapists, Techs, Pharmacists)
Administrative / Support Staff
Shift Usually Worked:
Day
Night
Rotating
Tenure at Organization:
Less than 1 year
1–3 years
4–7 years
8+ years
This section measures psychological safety, collaboration, and mutual respect within your immediate team.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | There is a strong sense of teamwork and cooperation in my department. | ||||||
2 | I feel respected by my colleagues and peers. | ||||||
3 | Different departments collaborate effectively to provide seamless patient care. | ||||||
4 | Conflict within my team is handled constructively and professionally. | ||||||
5 | My team values diverse perspectives and backgrounds. |
This section evaluates communication, trust, and support from both immediate supervisors and executive leadership.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | My direct supervisor is approachable and easy to talk to. | ||||||
2 | My supervisor provides constructive feedback that helps me improve. | ||||||
3 | I trust the decisions made by my direct supervisor. | ||||||
4 | My supervisor actively works to resolve issues raised by staff. |
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Senior leadership communicates a clear vision for the organization. | ||||||
2 | Senior leadership is transparent about major organizational changes. | ||||||
3 | I feel that executive leadership genuinely cares about staff well-being. |
This section addresses operational challenges, staffing ratios, and the physical/emotional toll of the job.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Staffing levels in my department are sufficient to provide safe patient care. | ||||||
2 | My current workload is manageable during my standard shift. | ||||||
3 | I am able to take my designated breaks (meals, rest periods) consistently. | ||||||
4 | The organization offers adequate resources to help cope with stress and burnout. | ||||||
5 | I frequently feel emotionally exhausted or burned out by my work. |
This section examines the clinical environment and the organization's commitment to high-quality care.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Patient safety is treated as a top priority by this organization. | ||||||
2 | I feel comfortable reporting medical errors or "near-misses" without fear of retribution. | ||||||
3 | We have the necessary supplies, PPE, and equipment to do our jobs safely. | ||||||
4 | I am proud of the quality of clinical care we provide to our patients. |
This section looks at the physical workspace and the software/hardware systems used daily.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Our Electronic Health Record (EHR) system is user-friendly and efficient. | ||||||
2 | The physical work environment (lighting, cleanliness, temperature) is comfortable. | ||||||
3 | IT and facility support requests are resolved in a timely manner. |
This section evaluates continuing education, advancement pathways, and training.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | I am provided with adequate orientation and training for my specific role. | ||||||
2 | There are clear opportunities for career advancement within this organization. | ||||||
3 | The organization supports my continuing education (CEUs, certifications, tuition aid). |
This section assesses financial satisfaction and how valued employees feel.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | My base salary/hourly wage is competitive with similar roles in the market. | ||||||
2 | The benefits package (medical, dental, retirement) meets my and my family’s needs. | ||||||
3 | I feel fairly compensated for the amount of effort I put into my job. | ||||||
4 | I receive regular recognition or praise for doing good work. |
This section measures the Employee Net Promoter Score (eNPS) and long-term commitment.
Statement | 1 | 2 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | I would recommend this healthcare organization to friends and family as a great place to work. | ||||||
2 | I would recommend this organization to loved ones as a premier place to receive medical care. | ||||||
3 | I see myself still working at this organization two years from now. |
Please provide text responses to help us better understand your answers above.
What are the top 2 or 3 things this organization does well to support its healthcare staff?
What are the 2 or 3 biggest challenges you face in your daily work that administration needs to address immediately?
If you could change one thing about the workflows, technology, or staffing in your unit to improve patient care, what would it be?
Please share any additional comments, concerns, or ideas you have regarding your satisfaction at work.
Thank you for your dedication to our patients and for taking the time to complete this survey!
Survey Template Insight
Please remove this survey template insights section before publishing.
To create a highly effective, premium template for your form builder, it helps to understand why these specific questions are asked and how healthcare organizations use the data.
When marketing this template, sharing these insights or embedding them as "tooltips" within your form creator will provide massive value to your users (HR managers, hospital administrators, and clinic directors).
Here is a detailed breakdown of the structural logic, key dimensions, and best practices for this survey template.
The demographic section at the beginning is intentionally high-level. Healthcare workers are often hesitant to share honest feedback due to fear of workplace friction. By asking for "Department" or "Tenure" rather than specific names, the form allows administrators to filter results (e.g., Are night-shift nurses experiencing more burnout than day-shift nurses?) while protecting the individual’s identity.
Using a 5-point Likert scale (Strongly Disagree to Strongly Agree) is the industry standard for employee feedback. It provides a neutral midpoint, which reduces "survey fatigue" and allows for clean, quantifiable data visualization (like bar charts or net agreement scores) in your form tool's analytics dashboard.
In healthcare, teamwork directly correlates with patient outcomes. Poor communication between doctors, nurses, and allied health staff can lead to clinical errors. This section measures interprofessional collaboration and mutual respect, helping management identify if there is a toxic sub-culture in specific departments.
There is a well-known maxim in workforce management: "Employees don't leave jobs; they leave managers." * Direct Supervisors: Have the most immediate impact on daily morale.
This is currently the most critical metric for healthcare employers. Staff shortages lead to a vicious cycle: heavy workloads cause stress, which leads to turnover, which worsens the shortages.
Design Note: Question 17 ("I frequently feel emotionally exhausted...") is reverse-scored. This is a deliberate technique used in survey design to ensure respondents are reading the questions carefully rather than just clicking "5" all the way down.
Healthcare staff need to feel safe to report errors. A "Just Culture" environment means that if a nurse catches a medication error, they can report it as a system flaw rather than being unfairly blamed. High scores in this section indicate a healthy, transparent clinical environment.
If you want this template to perform exceptionally well on your platform, consider incorporating these technical design tips into your form builder:
When promoting this template, you can remind your users that this form helps them calculate two vital high-level metrics:
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation section before publishing.
When setting up this template in an online form creator, making every single question mandatory can lead to survey fatigue and high abandonment rates. Healthcare workers are notoriously pressed for time, so a strategic approach is best: make only the most critical, foundational questions mandatory, and leave the highly specific or open-ended questions optional.
Here are the specific questions from the survey that should be hard-coded as mandatory, along with the data-driven reasons why.
When building the settings for this template, configure it so that:
To configure an element, select it on the form.