Pre-Programme Impact Form - Florence Nightingale Foundation Academy

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– Step 1 of 3

Welcome

As part of your participation in this Florence Nightingale Leadership Programme, we invite you to complete this short survey. The purpose of this survey is to establish a baseline understanding of your current leadership confidence, perspectives and experiences before beginning the programme.

The survey takes less than five minutes to complete.

Your responses will be anonymised for analysis, ensuring your privacy is protected. Data collected may be used in aggregated form for academic publication, marketing and communications, as well as reporting to our commissioners.

You can view the full privacy policy here: https://florence-nightingale-foundation.org.uk/privacy-policy-2/

Thank you for taking the time to contribute – your input is an important part of evaluating and improving the programme.

Programme/Scholarship

Please tell us about the programme or scholarship you are about to take part on.

Programme/Scholarship *

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Section 1: Your Details

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Name *

First

Last

Email Address *

Confirm Email

Full Job Title *

Employing Organisation *

Please enter the full name of your organisation and try to avoid using any acronyms where possible.

NMC Professional Registration *

Select all that apply. If you are not registered with the UK Nursing Midwifery Council, please select “Not Currently an NMC Registered Nurse or Midwife”

Did you undertake your initial nursing or midwifery training or qualification in the UK? *

What is your professional registration or status? *

Select all that apply. If there is not a suitable option please select “Other”.

If "Other", please enter your Professional Registration or Status *

In what country did you obtain your initial nursing or midwifery qualification *

In what year did you qualify/complete your training as a nurse or midwife? *

In which sector do you work? *

If there is not a suitable option please select “Other”.

If "Other", please enter your Sector *

If "NHS", please specify the type of NHS body. *

If there is not a suitable option please select “Other”.

If "Other", please enter the type of NHS body *

NHS Pay Band/Grade or Equivalent *

Please select “Not Applicable” if your profession is not covered by Agenda for Change (AfC).

If "Other", please enter your Pay Band/Grade *

Demographic Information

Date of Birth *

Ethnicity *

If there is not a suitable option please select “Other”.

If "Other", please enter your Ethnicity *

Nationality *

Select all that apply. If there is not a suitable option please select “Other”.

If "Other", please enter your Nationality *

What best describes your gender? *

If there is not a suitable option please select “Prefer to Self-describe”.

If "Prefer to Self-describe" please enter your Gender *

Is your gender identity the same as the sex you were registered at birth? *

Yes
No
Prefer not to say

Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more? *

Yes
No
Prefer not to say

Do any of your conditions or illnesses reduce your ability to carry out day-to-day activities? *

Very frequently
Often
Sometimes
Rarely
Never
Prefer not to say

Do you identify as neurodivergent? *

Yes
No
Prefer not to say

Does your neurodivergence affect your ability to carry out day-to-day activities? *

Very frequently
Often
Sometimes
Rarely
Never
Prefer not to say

What is your Religion or Belief *

Which of the following best describes your sexual orientation? *

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Section 2: Intention to Stay

To what extent do you agree with the following:

I intend to remain in my current profession for the next 12 months *

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Strongly DisagreeI intend to remain in my current profession for the next 12 months Strongly Disagree	DisagreeI intend to remain in my current profession for the next 12 months Disagree	NeutralI intend to remain in my current profession for the next 12 months Neutral	AgreeI intend to remain in my current profession for the next 12 months Agree	Strongly AgreeI intend to remain in my current profession for the next 12 months Strongly Agree

I intend to remain in my current organisation for the next 12 months *

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Strongly DisagreeI intend to remain in my current profession for the next 12 months Strongly Disagree	DisagreeI intend to remain in my current profession for the next 12 months Disagree	NeutralI intend to remain in my current profession for the next 12 months Neutral	AgreeI intend to remain in my current profession for the next 12 months Agree	Strongly AgreeI intend to remain in my current profession for the next 12 months Strongly Agree

Section 3: Influencing and Advocating

For each of the following statements please indicate how much you agree

I feel confident advocating for the needs of my profession in my workplace. *

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Strongly DisagreeI intend to remain in my current profession for the next 12 months Strongly Disagree	DisagreeI intend to remain in my current profession for the next 12 months Disagree	NeutralI intend to remain in my current profession for the next 12 months Neutral	AgreeI intend to remain in my current profession for the next 12 months Agree	Strongly AgreeI intend to remain in my current profession for the next 12 months Strongly Agree

I understand how to effectively communicate the value of the nursing/midwifery professions to others.  *

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Strongly DisagreeI intend to remain in my current profession for the next 12 months Strongly Disagree	DisagreeI intend to remain in my current profession for the next 12 months Disagree	NeutralI intend to remain in my current profession for the next 12 months Neutral	AgreeI intend to remain in my current profession for the next 12 months Agree	Strongly AgreeI intend to remain in my current profession for the next 12 months Strongly Agree

I feel equipped to influence decisions that affect my profession. *

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Strongly DisagreeI intend to remain in my current profession for the next 12 months Strongly Disagree	DisagreeI intend to remain in my current profession for the next 12 months Disagree	NeutralI intend to remain in my current profession for the next 12 months Neutral	AgreeI intend to remain in my current profession for the next 12 months Agree	Strongly AgreeI intend to remain in my current profession for the next 12 months Strongly Agree

I have the skills to represent my profession in meetings or discussions with leadership. *

Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Strongly DisagreeI intend to remain in my current profession for the next 12 months Strongly Disagree	DisagreeI intend to remain in my current profession for the next 12 months Disagree	NeutralI intend to remain in my current profession for the next 12 months Neutral	AgreeI intend to remain in my current profession for the next 12 months Agree	Strongly AgreeI intend to remain in my current profession for the next 12 months Strongly Agree

Section 4: Self-Efficacy

I can always manage to solve difficult problems if I try hard enough *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

If someone opposes me, I can find the means and ways to get what I want *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

It is easy for me to stick to my aims and accomplish my goals *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

I am confident that I could deal efficiently with unexpected events *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

Thanks to my resourcefulness, I know how to handle unforeseen situations *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

I can solve most problems if I invest the necessary effort *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

I can remain calm when facing difficulties because I can rely on my coping abilities *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

When I am confronted with a problem, I can usually find several solutions *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

If I am in trouble, I can usually think of a solution *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

I can usually handle whatever comes my way *

Not at all true	Hardly true	Moderately true	Exactly true
Not at all trueItem #1 Not at all true	Hardly trueItem #1 Hardly true	Moderately trueItem #1 Moderately true	Exactly trueItem #1 Exactly true

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