Health Care Workers Staffing Experiences

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Are you a health care worker, or are you a union organizer or other representative filling this out on behalf of a health care worker?* This field is required.
I'm a health care worker
I'm filling this out on behalf of a health care worker
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As union staff, please fill out your name and email address (next two fields) and then fill out the rest of this form as if you were the health care worker (e.g., "Your name," "Job title," etc.).

If you just need to submit a video from a health care worker, you can skip the longer survey questions after the contact information and get to the video section.
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Union organizer/rep/staff name:
First Name
Last Name
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Email
example@example.com
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Union staff email address:
example@example.com
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Your name:* This field is required.
First Name
Last Name
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Job title:
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Hospital or facility where you work:
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City where you work:
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Phone Number:
Please enter a valid phone number.
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Personal (non-work) e-mail:
example@example.com
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Your union:* This field is required.
SEIU 1199NW
UFCW 21
WSNA
Other
Not a member of a union
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Why do you work in health care?
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How often do you feel you have enough staff on your unit to give all your patients enough time and attention, or if your job is not patient care, enough staff to do your job safely and correctly?
Never
Occasionally
About half the time
Most of the time
Always
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What was your experience with unsafe staffing before COVID-19? How did that impact patients?
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How have staffing problems gotten worse since the COVID-19 pandemic? Do you expect them to get better after the pandemic ends?
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What are you most worried about when staffing levels get low in your hospital?
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What’s the worst staffing level or caregiver-to-patient ratio you’ve seen in the past couple of years? How did that impact patient care?
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If you had to explain the staffing crisis to an elected official, Department of Health staffer, or community member with one story from your workplace, what story would you tell?
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Would you be willing to record a short video explaining your experience with short staffing in health care?
YESNO
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These videos will be very helpful in making this issue real to those outside the health care field, like lawmakers and other people in our community who can help support the call for safe staffing. Here's what you shared so far:

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When you click "next," you will have the option to record a video or submit one you've already recorded.
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Upload a video, record and submit a short video (60-90 seconds) on your phone, or even share photos or documents that tell your story here. Please remember your HIPAA training if sharing any patient stories.If you're on your phone, just click "browse files" and you can choose to share a video you've already recorded on your phone, or just take a video or photo right now.
Drag and drop files here
Select files to upload
Max. file size: 1.0GB
Cancelof
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Any information helpful to understanding or using this video, photo or document?
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By submitting video, photo, or written content through this form, you consent to its use by UFCW 3000, SEIU 1199NW, and/or WSNA to support a public campaign highlighting the importance of safe staffing in hospitals and advocating for better staffing including through social media, union websites, other media, and communications with elected officials. If a union representative is filling this form out on behalf of a health care worker, use the file upload section to submit a consent or permission form.
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