UTMB SCHOOL OF NURSING
Staff Professionalism Survey

All employees of the University of Texas Medical Branch are held to the highest standards of professional behavior. Students are evaluated on professional behavior in all classroom, laboratory, and patient care interactions. This evaluation form asks for your OVERALL perceptions of the professional behavior of students, faculty, and staff.

Please complete this evaluation on students, faculty, or staff with whom you have had meaningful contact during your time at the School of Nursing . Please DO NOT identify yourself or the persons you are evaluating on this form.

Thank you for your participation.

OVERALL perception of Students

	Consistently	Frequently	Occasionally	Never	Not Applicable
1. Students' input is valued in the SON.
2. Students are treated with respect and courtesy.
3. I observed a student making derogatory statements about others in professional settings.
4. I observed a student using derogatory terminology / inappropriate language in professional settings.
5. I observed a student discussing confidential information in an inappropriate setting.
6. I observed a student treating a person differently because of socioeconomic background, race, ethnicity, religion or sexual preference.
7. I observed a student treating others in a disrespectful or demeaning manner.
8. I observed a student being unwilling to take responsibility for a personal error.
9. I observed a student acting as a role model for professionalism.

1. Please describe any exemplary professional behaviors that you have observed being demonstrated by students (please use additional pages if necessary).

2. Please describe any behaviors that you considered unprofessional by students (please use additional pages if necessary).

OVERALL perception of Faculty

	Consistently	Frequently	Occasionally	Never	Not Applicable
1. Faculty's input is valued in the SON.
2. Faculty are treated with respect and courtesy.
3. I observed a faculty member making derogatory statements about others in professional settings.
4. I observed a faculty member using derogatory terminology / inappropriate language in professional settings.
5. I observed a faculty member discussing confidential information in an inappropriate setting.
6. I observed a faculty member treating a person differently because of socioeconomic background, race, ethnicity, religion or sexual preference.
7. I observed a faculty member treating others in a disrespectful or demeaning manner.
8. I observed a faculty member being unwilling to take responsibility for a personal error.
9. I observed a faculty member acting as a role model for professionalism.

1. Please describe any exemplary professional behaviors that you have observed being demonstrated by faculty (please use additional pages if necessary).

2. Please describe any behaviors by faculty that you considered unprofessional (please use additional pages if necessary).

OVERALL perception of Staff

	Consistently	Frequently	Occasionally	Never	Not Applicable
1. Staff members' input is valued in the SON.
2. Staff members are treated with respect and courtesy.
3. I observed a staff member making derogatory statements about others in professional settings.
4. I observed a staff member using derogatory terminology / inappropriate language in professional settings.
5. I observed a staff member discussing confidential information in an inappropriate setting.
6. I observed a staff member treating a person differently because of socioeconomic background, race, ethnicity, religion or sexual preference.
7. I observed a staff member treating others in a disrespectful or demeaning manner.
8. I observed a staff member being unwilling to take responsibility for a personal error.
9. I observed a staff member acting as a role model for professionalism.

1. Please describe any exemplary professional behaviors that you have observed being demonstrated by staff:

2. Please describe any behaviors that you considered unprofessional by staff:

PLEASE CHECK 5 (FIVE) WORDS WHICH, IN YOUR PERCEPTION, BEST EXEMPLIFY PROFESSIONALISM:

Respect
Honesty
Courtesy
Fairness
Optimism

Accountability
Compassion
Integrity
Empathy
Competence

UTMB SCHOOL OF NURSING Staff Professionalism Survey

OVERALL perception of Students

OVERALL perception of Faculty

OVERALL perception of Staff

PLEASE CHECK 5 (FIVE) WORDS WHICH, IN YOUR PERCEPTION, BEST EXEMPLIFY PROFESSIONALISM:

UTMB SCHOOL OF NURSING
Staff Professionalism Survey