survey

Please feel free to print this page and complete the survey. I am yet not gifted enough to do it online. :)

1. Unit Name: (optional)
2. Affiliation: (check one)
q Fresenius
q Gambro
q DaVita
q Dialysis Clinic Inc.
q Independent
q Other (please specify)
3. Total patient population as of 10/31/02:
4. Total number of dialysis stations at your facility:
5. Total number of shifts per week:
6. Services offered: (check all that apply)
q In center hemodialysis
q Peritoneal dialysis
q Home hemodialysis
q Nocturnal in center hemodialysis
q Nocturnal home hemodialysis
q Pediatric services
q Transplant
q Hospital based
q Other (please specify)
7. Total number of Social Workers at your facility
8. Highest degree among social workers at your facility: (check one)
q BSW	q MSW	q PhD	q Other
9. Ratio of patients to social worker
10. Are you a member of NC-CNSW?
q Yes		q No

11. Do you regularly attend chapter meeting?
q Yes		q No
12. If no, why?
q Not interested
q Not informed
q Too far to travel
q Can’t get time off
q Other (please specify)
13. What topics would interest you at the CNSW meetings? (Please list)


14. What concerns you most in your dialysis unit? (Check all that apply)
q Role of social workers
q The size of caseloads
q Physical safety
q Licensure
q Job security
q Burnout
q CEU’s
q Other (please specify)
15. What is your greatest contribution to your unit? (Check all that apply)
q Counseling
q Advocacy
q Resources
q Referrals
q Insurance
q Transportation
q Education
q Other (please specify)

16. What is the greatest challenge in your unit? (Check all that apply)
q Noncompliance (diet and treatments)
q Aggressive physical behavior
q Disruptive verbal behavior
q Transpiration
q Scheduling
q Depression
q Anxiety
q Mental Illnesses
q Addiction
q Lack of insurance
q Lack of resources
q Other (please specify)
17. What can CNSW do to help you address these challenges? (Please list)