Atlanta VA Medical Center
Shared Governance Practice Council
MD/RN Communication and Collaboration Survey - (copy)

Directions: The purpose of this tool is to determine the extent of collaborative behaviors which generally exist between you and the nurses with whom you work. Following a few demographic questions, for each statement, please check the one answer that indicates how often you believe that each behavioral statement occurs.

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Name (optional): 


  1. Identify your level of practice: 


  1. Identify your primary area of practice: 


  1. I have functioned as a provider at the Atlanta VA in the last 3 months.
    Yes
    No


  1. Do nurses and physicians share in decision-making?
    Always
    Sometimes
    Rarely
    Never


  1. Do nurses and physicians cooperate in decisions?
    Always
    Sometimes
    Rarely
    Never


  1. Do nurses and physicians plan together before making decisions?
    Always
    Sometimes
    Rarely
    Never


  1. Is there open communication between physicians and nurses in making decisions?
    Always
    Sometimes
    Rarely
    Never


  1. I get relevant information on the status of patients from nurses.
    All of the time
    Most of the time
    Some of the time
    Rarely
    Never


  1. There are no delays in relaying information regarding patient care.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. Nurses call in a timely manner.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. I receive complete information from nurses.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. I have good communication with nurses.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. I feel certain about the accuracy of information from nurses.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. I enjoy collaborating with nurses.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. I have easy access to knowledgeable nurses.
    Strongly agree
    Moderately agree
    Agree
    Moderately disagree
    Strongly disagree


  1. Please offer comments and suggestions to enhance communication and collaboration.




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