Exit Interview

Sample Exit Interview Program

Thank you for visiting our sample "Exit Interview Program". Included in the following is a sampling of questions that was designed to evaluate nurse turnover for both short and long term employees. The questions can be designed to specifically meet the needs of your organization. The Exit Interview Survey can be completed online before or after the employee leaves the company or in combination with a mailed response or even a personal telephone interview or focus group.

You can click on your choices as you page through the survey. All of our survey/assessment tools provide you with a comprehensive online assessment report that reflects real time results as they are entered into the survey. Please let us know if you have any questions. We would like to provide your survey/assessment needs.

Sample Exit Interview Program

Welcome to the XYZ Online Exit Interview Survey. The purpose of this survey is to get a better understanding of the reasons you have chosen to leave the organization and give you an opportunity to share your thoughts. The survey takes approximately 10 minutes or less to complete. Information from your survey, along with other participant surveys, will be shared with key employees in the organization. We appreciate your participation.

1. What is your name?

2. When did you leave the company?

3. What is your position?

4. Why did you leave your employment with XYZ?

Other Employment

Moved

Retired

Other (please specify)

Sample Exit Interview Program

In these questions please evaluate the person you identify as your immediate supervisor.

8. Who did you consider to be your immediate supervisor?

Charge Nurse

Assistant Manager

Manager

Department Head

Other

10. Would you work for this supervisor again?

Yes

No

11. Are there any supervisory issues you would like to share?

Sample Exit Interview Program

Here we address your perception of how the staff in your clinical area performed.

Sample Exit Interview Program

The following questions address your perception of how well the Organization met employee and patient needs.

14. Is there anything we might have done to retain you as our employee?

Sample Exit Interview Program

The following questions address your perception of how well the Organization met employee and patient needs.

15. Are there any ethical issues we should be aware of?

No

Yes (please specify below)

16. Would you like us to schedule a personal exit interview? If so, check the yes box below and provide a number where you can be reached.

No

Yes (please provide your number)

	Poor	Fair	Good	Excellent	N/A
Overall quality of the new employee orientation program
Amount of orientation time spent on learning general nursing
Content provided in general nursing orientation
Amount of time for unit-specific orientation
Content provided in unit specific orientation
Preceptor portion of orientation

	Poor	Fair	Good	Excellent	N/A
Ability to communicate with staff
Ability to explain new procedures
Fairness in scheduling
Fairness in giving work assignments
Fairness in completing performance evaluations
Timeliness in completing performance evaluations
Ability to admit mistakes if made
Give praise to people when appropriate
Follows organizations policies and procedures
Resolves complaints and grievances
Available to staff
Approachable
Ethical
Overall performance as a supervisor

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
When I began working, a preceptor spent adequate time orienting me to my responsibilities and members of my work group
People in my work group talked openly and made an honest effort to resolve problems among the group
My work group had the tools and resources necessary to do the job
I think the productivity of my work group could be improved
My work group had a mutual commitment to deliver high quality patient care
Decisions about quality of work life were reached by general agreement within my workgroup
People can raise concerns without fear of reprisal
People in my workgroup got feedback about the job performance of the group
The amount of job stress is what I would expect in my job
My work group worked well with other departments

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Continuing education opportunities are readily available on an equitable basis
Staff receive recognition and rewards regularly for doing a good job
Rules and procedures are emphasized over patient care
There are opportunities for advancement readily available in the patient care area
There are opportunities readily available for career advancement in the medical center
The medical center has a reputation for high quality care
People get feedback about their performance
The goals of the patient care area were well know to its employees
The work area leaders demonstrated an ongoing interest in my professional development
Overall, the patient care area was meeting its goals