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1. Function
in an advanced nursing role |
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| 2. Perform comprehensive
assessments |
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| 3. Care for
individuals with complex health/illness processes |
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| 4. Identify
needed areas of nursing intervention and evaluation |
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| 5. Perform advanced
nursing skills and skills procedures |
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| 6. Use effective
communication and interviewing skills |
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| 7. Facilitate
health care across the continuum to individuals & families |
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| 8. Provide health
promotion & illness prevention with clients |
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9. Organize and
prioritize delivery of care in your practice.
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| 10. Integrate
research findings in your professional nursing role |
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| 11. Use effective
problem solving strategies in your nursing role |
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| 12. Work in interdisciplinary
teams |
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| 13. Collaborate
with interdisciplinary colleagues |
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| 14. Influence
health care trends or practice in your setting |
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| 15. Assume responsibility
for continuing professional development |
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16. On a scale of 1 to 5,
1 indicating "not satisfied at all" and 5 indicating "very
satisfied" how satisfied were you with the following
in your program:
1. Academic advising
2. Mentoring for your research or scholarship
3. Course scheduling
4. Overall Curriculum
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17. In the text box below,
please provide any comments you may have
about the topics listed above.
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18. What do you think are the strengths
in the College of Nursing NP Program.
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19. What suggestions
for change or improvements do you have?
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20. Are there any other
comments you would like to share with us?
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21. On a scale of 1 to 5, 1 indicating "not satisfied at all"2, indicating "somewhat satisfied", 3 indicating "satisfied", 4 indicating "mostly satisfied" and 5 "indicating very satisfied", how satisfied were you with
the quality of the College of Nursing Program?
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22. Indicate the program
in which you were enrolled.
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23. I was enrolled in the
ADN-MS Pathway
Yes
No
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24. Indicate semester and
year of graduation
graduation Year:
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| 25. Current Certification
- Enter the appropriate information in the areas below:
Area:
Date of Certification:
Certifying Agency:
Area:
Date of Certification:
Certifying Agency:
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26. Current Employment
Name of Employer:
Employer Address:
Address
(cont):
City:
State:
Zip:
Title of your position:
Salary (optional):
Type of Position
Employed:
# of years in current position:
If not employed:
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27. What percent of your
work time in clinical practice involves people from medically
undeserved populations?
%
Please state name or description of setting:
28. Location of current
practice:
Is your current practice located in an underserved area?
Yes
No
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Professional / Scholarly Activities
30. Publications
Have you published since graduation?
Yes
No
if yes, please indicate the number of publications
31. Presentations
Have you presented since graduation?
Yes
No
If yes, please check all that apply and indicate number of presentations below.
local presentations:
(number)
Invited, regional presentations:
(number)
Invited, national presentations:
(number)
Invited, international presentations:
(number)
Invited Keynote addresses:
(number)
32. Research / Scholarship
Have you been involved in any research or scholarly projects since graduation?
Yes
No
If yes, please check all that apply and indicate number below.
External funding:
(number)
Internal funding/support:
(number)
Independent without support:
(number)
Systematic literature review:
(number)
Evaluation/outcomes research projects:
(number)
Theory analysis/development:
(number)
How many, if any, were funded?:
(number)
Funding Supported through the employer?:
(number)
33. Healthcare Media Production
Have you been involved in the production of any healthcare media such as online resources, videos, DVDs, podcasting, since graduation?
Yes
No
If yes, please indicate the type and how many.
Online resources:
(number)
Videos:
(number)
DVDs:
(number)
Podcasting:
(number)
34. Organizational Membership/ Service
Do you serve in a leadership capacity for any organization?
Yes
No
If yes, please check all that apply below and indicate the name of the organization below.
Board Member:
Name of Organization (s)
Committee Chair:
Name of Organization (s)
Committee Member:
Name of Organization (s)
35. Involvement in Policy Development
Are you involved in policy development?
Yes
No
If yes, please check all that apply below.
Local involvement with policy development
State involvement with policy development
Regional involvement with policy development
National involvement with policy development
International involvement with policy development
Have you had any involvement in influencing public health policy at the local, state, or national levels?
Yes
No
If yes, please indicate how so.
Please email a copy of your CV to Dr. Alice Pasvogel at pasvogel@nursing.arizona.edu
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QUESTIONS? Please contact:
The University of Arizona College of Nursing, at 520-626-6656.
We appreciate your time
in completing this form. Your feedback is vital in our
efforts to evaluate our nursing programs.
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