Work and Health Employee Survey Work and Health Employee Survey
Dear Ma am/sir: In order to understand better the contribution of an individual s work attitudes to his well-being, job performance, and health, I am conducting a scientific research study. The ultimate benefit of this research is to learn more about what contributes to the health of healthcare employees, and how this in turn affects their ability to serve residents. The main idea is that healthy workers promote healthy residents. Enclosed you will find two separate sets of surveys and return envelopes one set for you to fill out and one set for your supervisor to fill out in order to have an assessment of your performance. If you decide to help me with this study, and I earnestly hope that you will, please fill out the survey Employee Survey, seal it in the attached envelope, and drop it in the box provided in your work area. Next, give the survey entitled Supervisor Survey to your immediate supervisor. The instructions attached to the supervisor survey will tell the supervisor to fill out the survey and return it to me in a separate attached envelope. Both you and your supervisor will find a statement of informed consent at the back of your survey for review. The code at the top of your questionnaire was randomly assigned and its primary purpose is to be able to match your responses with your supervisor s response while allowing you to remain anonymous. The other purpose of the code at the top of the questionnaire is to enter you into a random prize drawing. One week after everyone in your organization has had a chance to participate in the survey, I will conduct a random drawing for three cash prizes of $500, $300, and $200. Every submitted survey will be eligible. Tear off and keep the statement of informed consent page at the end of this booklet as your receipt. I will post the three winning numbers in public places in your organization, and if your number is posted, you can contact me for your prize! If you have any questions about the survey, I can be reached at (701) 231-5848 (work). You may also contact me by e-mail at Bret.Simmons@ndsu.nodak.edu. For any questions about the rights of human research participants, you may contact the NDSU Institutional Review Board at (701) 231-8908. The survey responses will be tabulated and provided to your organization in aggregate form. No individual responses will ever be identified to anyone in your organization and will remain completely confidential. Thank you very much for taking the time to complete this survey. Sincerely, Bret L. Simmons, Ph.D. Assistant Professor of Management, North Dakota State University STATEMENT OF INFORMED CONSENT You are under no obligation to participate in this research study. Your participation is voluntary, and there is no penalty for refusal to participate. If you decide to participate now, you are free to withdraw your consent and participation in this study at any time in the future without penalty. You are not obligated to contact anyone if you decide not to participate. To ensure absolute confidentiality, only averages and other descriptive statistics will be reported both to your employer and in any publication describing the findings of the research. Dr. Bret L. Simmons will securely store the completed surveys for a period of at least three years, after which surveys may be destroyed by shredding. Summaries of the data and descriptive statistics will be stored on his home computer indefinitely. Dr. Bret L. Simmons will consider requests for access to the data for research purposes only. This research is done as part of an ongoing scientific investigation entitled Eustress at Work: Accentuating the Positive. You may contact Dr. Bret L. Simmons at (701) 231-5848 if you have any questions or concerns. Please read and ensure that you understand and agree with the following aspects of this study: This is a research study conducted by Dr. Bret L. Simmons of North Dakota State University The purpose of this research is to understand better the affect of work related stress on an individual s well-being, performance, and health. If you decide to participate, you will spend approximately 20 minutes filling out a survey. There are no experimental procedures and no foreseeable risks involved in participating in this research. The primary benefit that you can expect to derive from participating in this research is the personal satisfaction of knowing that the results of this study will help organizations like yours understand how to improve work conditions for their employees. Confidentiality of records identifying you will be strictly maintained. Numbers listed on the top of the survey will only link your response with the responses provided by your supervisor- they cannot be used by the researcher to identify you in any way. As a final step to ensure your complete anonymity, you will not be asked to provide your signature certifying that you have read and understood the above statement of informed consent. KEEP THIS PAGE AS YOUR PRIZE DRAWING RECEIPT!
8. Employee Benefit questions: Approximately $.75 of every dollar Bethany spends on expenses related to providing resident care goes to employee salaries and benefits over $9 million in 2003! A. Please evaluate the value and importance of your benefit package by ranking the following list of employer-provided benefits (with 5 being most important, and 1 being least important): 401(k)/retirement Dental insurance Health insurance Life insurance Paid leave (PTO, EST) B. Bethany values your opinion on continued benefit offerings. What suggestions do you have on how Bethany can best make use of limited dollars available for salaries/benefits? What changes would you recommend in benefits, if funding becomes an issue? There are no correct or incorrect answers. Be sure to answer all the questions, but don t spend too much time on any one item. SECTION A. Please indicate your opinion on the following statements about your work and family. For each item, circle the number that most closely reflects the degree of your agreement or disagreement the larger the number, the more you agree, the smaller the number, the more you disagree. Disagree Agree 1. The demands of my work interfere with my home and family life. 2. Family-related strain interferes with my ability to perform my duties. 3. The amount of my time my job takes up makes it difficult to fulfill family responsibilities. 4. My home life interferes with my responsibilities at work such as getting to work on time, accomplishing daily tasks, and working overtime. 5. Things I want to do at home do not get done because of the demands my work puts on me. 6. Things I want to do at work don't get done because of the demands of my family. 7. My job produces strain that makes it difficult to fulfill family duties. 8. I have to put off doing things at work because of demands on my time at home. 9. Due to my work duties, I have to make changes to my plans for family activities. 10. The demands of my family interfere with work-related activities.
SECTION B. Below are a number of statements that describe different feelings that you may feel at work. Please indicate how often, in the past 30 workdays, you have felt each of the following feelings: Almost never Sometimes Almost always 1. I feel full of pep 2. I feel I can think flexibly 3. I feel I have physical strength 4. I feel able to show warmth to others 5. Feeling vigorous 6. I feel I can think rapidly 7. I feel able to be sensitive to the needs of coworkers and residents 8. I feel I am capable of investing emotionally in coworkers and residents 9. I feel energetic 10. I feel I am able to contribute new ideas 11. I feel capable of being sympathetic to co-workers and residents 12. Feeling of vitality 13. I feel able to be creative 14. A feeling of flow SECTION C. The following is a list of feelings that we all experience from time to time. Please indicate the frequency of appearance or each feeling during your working hours in the last month. Almost never Sometimes Almost always 1. I feel tired 2. I feel fed up 3. I am too tired to think clearly 4. I feel physically drained 5. I feel like my emotional batteries are dead 6. I have difficultly concentrating 7. I feel physically exhausted 8. I feel emotionally burned out in my job 9. My thinking process is slow 10. I have no energy for going to work in the morning 11. I have difficulty thinking about complex things 12. I feel emotionally fatigued SECTION J. Please answer the following questions by placing a check ( ) on the line in front of the answer chosen. 1. Gender: 3. Age: Female Male Less than 25 years 25 to 34 35 to 44 45 to 54 55 to 64 65 + 5. How long have you worked for this organization? Less than 1 year 1 to 2 years 3 to 5 years 6 to 10 years 11 to 15 years more than 15 years 2. Average number of hours worked per pay period: Less than 20 21 to 39 40 to 63 64 to 79 80 or more 4. What is the highest degree you have earned? Diploma Associate Degree BS/BA MS Ed.D, Ph.D. Other (please specify ) 6. How long have you been in your current position? Less than 1 year 1 to 2 years 3 to 5 years 6 to 10 years 11 to 15 years more than 15 years 7. Which of the following best describes your position/department? Administration Assisted Living/Personal Services Clerical/Reception Dietary Engineering Environmental Services Other Nursing-CNA Nursing-LPN Nursing-RN Nursing-Other Social Services Therapeutic Rec.
SECTION H. Please indicate your opinion on the following statements about your benefits. For each item, circle the number that most closely reflects the degree of your satisfaction or dissatisfaction the larger the number, the more you are satisfied, the smaller the number, the more you dissatisfied. Very Dissatisfied Very Satisfied 1. My benefit package 2. Amount the company pays toward my benefits 3. The value of my benefits 4. The number of benefits I receive 5. How the benefits program is administered 6. The effectiveness of the system that provides my benefits 7. The arrangements my organization has made for the delivery of my benefits 8. The efficiency with which the benefits are provided SECTION I. Please indicate your opinion on the following statements about how your benefits compare to others both within and outside of your organization. 1. Compared with others working for this organization, the level of benefits I currently receive is 2. Compared with others in my job category at this organization, the level of benefits I currently receive is 3. Compared with others in my job category outside of this organization, the level of benefits I currently receive is 4. Compared with others I know with similar abilities and training, the level of benefits I currently receive is 5. Compared with others my age, the level of benefits I currently receive is 6. Compared with others with my level of seniority, the level of benefits I currently receive is 7. Compared to my friends and family, the level of benefits I currently receive is 8. Compared with the benefits I need to meet my financial needs, the level of benefits I currently receive is Much Much less more SECTION D. Using the scale shown below, please select the number that best describes how you think about yourself right now. Please take a few moments to focus on yourself and what is going on in your life at this moment. Once you have this here and now mindset, go ahead and answer each item according to the following scale. Definitely False Definitely True 1. If I should find myself in a jam, I could think of many ways to get out of it. 2. I feel certain about how much authority I have. 3. According to the doctors I ve seen, my health is now excellent. 4. I feel better now than I ever have before. 5. At the present time, I am energetically pursuing my goals. 6. There are lots of ways around any problem that I am facing now. 7. I m as healthy as anybody I know. 8. I know I have allocated my work time properly. 9. I know what my responsibilities are. 10. My health is excellent. 11. Right now, I see myself as being pretty successful. 12. I know exactly what is expected of me at work. 13. I understand what needs to be done at work. 14. I can think of many ways to reach my current goals. 15. At this time, I am meeting the goals I have set for myself.
SECTION E. Using the following scale, please indicate the extent to which you agree with the following statements. Disagree Agree 1. I feel secure in my ability to meet life s challenges. 2. I can protect myself against being taken advantage of. 3. I can work alone and in a solitary fashion 4. I very carefully delegate work to those who I am sure can accomplish what I need done 5. On some tasks, I can work effectively without other people 6. I can perform high quality work with little support from others 7. I am successful at what I do 8. The actions I take are usually right 9. Independence is important to me 10. Most people can be counted on to do what they say they will do SECTION F. Think about your supervisor in your present job. For each statement, circle the number that best describes how much you agree or disagree with each statement. 1. If I had my way, I wouldn t let my supervisor have any influence over issues that are important to me. 2. I am comfortable discussing with my supervisor my ideas for improvement in the workplace. 3. I would be willing to let my supervisor have complete control over my future in this organization. 4. I really wish I had a good way to keep an eye on my supervisor. 5. I am comfortable discussing with my supervisor concerns I have about our working relationship. 6. I am comfortable discussing with my supervisor concerns I have about my ability to do my job. Disagree Agree SECTION G. Using the following scale, please indicate the extent to which you agree with the following statements. 1. I am willing to put in a great deal of effort beyond that normally expected in order to help this organization be successful. 2. I talk up this organization to my friends as a great organization to work for. 3. I would accept almost any type of job assignment in order to keep working for this organization. 4. I find that my values and the organization s values are very similar. 5. I am proud to tell others that I am part of this organization. 6. Employee input is used in determining the benefits that are included in the benefit program. 7. This organization really inspires the very best in me in the way of job performance. 8. My needs and desires concerning benefits are taken into account in planning the benefit program. 9. I am extremely glad that I chose this organization to work for, over others I was considering joining at the time. 10. This organization makes changes in the benefit package in response to environmental changes or employee desires. Disagree Agree 11. I really care about the fate of this organization. 12. The benefit program is planned without regard to employee needs and desires. 13. For me this is the best of all possible organizations for which to work.