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Professional Information
Professional Status	Select... Registered nurse Licensed practical nurse Advanced practice nurse Nursing student Physician Other health care professional Consumer Other
Highest Degree Earned	Select... Nursing diploma Associate Bachelors Masters Doctorate Other
Settings	Select... Acute care-hospital Ambulatory/Primary care Extended care facility/Sub-acute care Home health care/Community health Hospice/Palliative Care Program Office-based practice Independent practice Academic Student health center Business or industry Military Other
Nurse Role	Select... Staff nurse Staff nurse - travel Nurse Manager Director/Asst. Director CNE/CNO/VP Advanced practice-nurse anesthetist Advanced practice-clinical nurse specialist Advanced practice-nurse midwife Advanced practice-nurse practitioner Educator-academic Educator-staff development or CE Case Manager/Discharge Planner Researcher Legal Consultant-Nurse Attorney Consultant Entrepreneur Student Other
Practice	None Ambulatory care Community health Critical care-burns Critical care-cardiac/cardiothoracic Critical care-emergency/trauma Critical care-general Critical care-neonatal/pediatrics Education Gerontology HIV or AIDS care Holistic practice Home health care Infection control Informatics Infusion therapy Management Medical/Surgical Gastroenterology Oncology Occupational health Ophthalmology Orthopedics Otorhinolaryngology Palliative care Pediatrics OR/PACU Primary care-adult Primary care-family Primary care-pediatric Psychiatry/Behavioral health Rehabilitation School nursing Surgical Urology Women's health/OB/Maternal/Child Wound care Other Diabetes Telemetry/Stepdown Dialysis/Nephrology Neonatal/Newborn/NICU Radiology Neurology Physical Therapy [Select any three, To select more than one press the [CRTL] key and click on the title.]
Specialty Certifications	None APRN, BC CCRN CEN CMSRN CNOR CNRI CPN CRNA OCN ONC [To select more than one press the [CRTL] key and click on the title.]
Years of Practice:	00-02 03-05 06-10 11-20 21+
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