Measure Nurse Engagement and Spot Burnout Risk Early

An anonymous survey for hospital nurses that measures workload, staffing, workplace violence, engagement, and burnout risk to guide targeted support.

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Hospital Nursing Staff Engagement & Burnout Risk Survey

Primary Unit / Department

Current Role

Years of Nursing Experience

Submit

The Hospital Nursing Staff Engagement and Burnout Risk Survey is a ready-to-use, fully anonymous questionnaire that helps healthcare leaders understand how their nurses are really doing. It opens with role details such as unit, position, years of experience, employment status, and shift pattern. It then covers workload and work environment, including patient assignments, staffing pressures, and exposure to verbal abuse, threats, or physical violence. The final section measures engagement, emotional well-being, self-assessed burnout, and overall job satisfaction using clear agreement and frequency rating scales.

This template is built for chief nursing officers, nurse managers, HR teams, wellness committees, and quality improvement leaders in hospitals and health systems. No names or contact details are collected, and results are reported only in aggregate for groups of five or more, so nurses can share honest feedback without fear of being identified. Role and shift questions let you compare results across units and pinpoint exactly where staffing gaps, heavy workloads, or low morale are putting teams at risk.

Nurse burnout drives turnover, absenteeism, and patient safety concerns, so catching early warning signs matters. Use this survey as a baseline assessment or repeat it regularly to track progress over time. Customize the questions and design to fit your organization, share it with your nursing teams in minutes, and turn responses into actionable insights that help you retain experienced staff and build a healthier, more supportive workplace.

3 Pages

18 Questions

~6min To complete

Free No credit card needed

Field types Dropdown ×6 choicematrix ×4 Single Choice ×2 number Yes / No Star Rating NPS Score Multiple Choice Long Text

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 About Your Role 6 questions

About Your Role

Your participation is voluntary and completely anonymous. No names or contact details are collected, and results are reported only in aggregate for groups of 5 or more respondents. Unless otherwise noted, please answer based on your experiences over the past month.

1 Primary Unit / Department * Dropdown

2 Current Role * Dropdown

3 Years of Nursing Experience * Dropdown

4 Employment Status * Single Choice

5 Primary Shift * Dropdown

6 Typical Shift Length * Single Choice

Page 2 Workload & Work Environment 4 questions

Workload & Work Environment

This section asks about your recent workload, staffing, and the environment you work in every day. There are no right or wrong answers, so please respond based on your own experience. Your responses are anonymous and will help identify where support is needed most.

1 On a typical shift, how many patients are you assigned? (Enter 0 if not applicable) number

2 In the past month, how often have you experienced the following? * choicematrix

3 How much do you agree with the following statements about your work environment? * choicematrix

4 In the past 12 months, have you experienced verbal abuse, threats, or physical violence at work from patients, visitors, or colleagues? Yes / No

Page 3 Engagement, Burnout & Future Plans 8 questions

Engagement, Burnout & Future Plans

You're almost finished. Thank you for sharing your experiences so far. This final section asks about your engagement at work, your well-being, and your plans for the future. There are no right or wrong answers. Your responses are anonymous and will only be reported in aggregate.

1 How much do you agree with the following statements about your engagement at work? * choicematrix

2 In the past month, how often have you felt the following? * choicematrix

3 Using your own definition of burnout, which statement best describes you right now? * Dropdown

4 Overall, how satisfied are you with your current job? * Star Rating

5 How likely are you to recommend this hospital to a nursing colleague as a place to work? * NPS Score

6 How likely are you to leave your current position within the next 12 months? * Dropdown

7 Which of the following would most improve your well-being and make you more likely to stay? (Select up to 3) * Multiple Choice

8 What is one change that would make the biggest positive difference in your day-to-day work? Long Text

Thank you for taking the time to share your experiences. Your voice matters, and your feedback will help shape efforts to improve staffing, safety, and well-being for nursing teams across the hospital. If you're feeling overwhelmed or burned out, you don't have to face it alone. Confidential support is available through the Employee Assistance Program (EAP) and employee wellness resources.

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.