1 I feel emotionally numb or disconnected from my work.
1 2 3 4 5
2 I experience waves of anger or irritation that seem out of proportion.
1 2 3 4 5
3 I find myself crying unexpectedly or feeling like I might cry at work.
1 2 3 4 5
4 I feel overwhelmed by emotions when dealing with patient or staff situations.
1 2 3 4 5
5 I struggle to feel empathy or compassion for others like I used to.
1 2 3 4 5
6 I feel like I am drowning in the emotional demands of my work.
1 2 3 4 5
7 Small setbacks feel like major disasters to me.
1 2 3 4 5
8 I find myself becoming emotionally reactive in ways that concern me.
1 2 3 4 5
9 I feel guilty or ashamed about my emotional responses to work situations.
1 2 3 4 5
10 I worry that my emotions might negatively impact my team or patients.
1 2 3 4 5
Section A Score: —
11 I have trouble falling asleep or staying asleep.
1 2 3 4 5
12 I experience physical symptoms like headaches, stomach issues, or tension.
1 2 3 4 5
13 I feel physically exhausted even after rest.
1 2 3 4 5
14 I notice my heart racing or feeling anxious in situations that should not be stressful.
1 2 3 4 5
15 I have been getting sick more often than usual.
1 2 3 4 5
16 I am using substances (alcohol, medication, etc.) to cope with stress.
1 2 3 4 5
17 My appetite has changed significantly (eating much more or less).
1 2 3 4 5
18 I feel like I am running on empty but cannot slow down.
1 2 3 4 5
19 I experience physical symptoms when thinking about work.
1 2 3 4 5
20 I feel like my body is constantly in fight or flight mode.
1 2 3 4 5
Section B Score: —
21 I have trouble concentrating or making decisions.
1 2 3 4 5
22 I find myself making more mistakes than usual.
1 2 3 4 5
23 I feel confused or scattered in my thinking.
1 2 3 4 5
24 I have difficulty prioritizing tasks or managing my time.
1 2 3 4 5
25 I forget important information or appointments.
1 2 3 4 5
26 I feel like my brain is in a fog.
1 2 3 4 5
27 I struggle to process information as quickly as I used to.
1 2 3 4 5
28 I have intrusive thoughts about difficult work situations.
1 2 3 4 5
29 I find myself replaying traumatic patient or workplace events.
1 2 3 4 5
30 I have difficulty thinking about the future or making plans.
1 2 3 4 5
Section C Score: —
31 I question whether I am good at what I do.
1 2 3 4 5
32 I feel like I am failing my coworkers or patients.
1 2 3 4 5
33 I wonder if I should leave nursing altogether.
1 2 3 4 5
34 I feel like I have lost my sense of purpose or meaning in my work.
1 2 3 4 5
35 I do not recognize the person I have become at work.
1 2 3 4 5
36 I feel like I am just going through the motions.
1 2 3 4 5
37 I have lost confidence in my clinical or professional abilities.
1 2 3 4 5
38 I feel disconnected from the values that brought me to nursing.
1 2 3 4 5
39 I feel like work is changing me in ways I do not like.
1 2 3 4 5
40 I worry that I am becoming someone I would not have recognized before.
1 2 3 4 5
Section D Score: —
41 I feel disconnected from my colleagues.
1 2 3 4 5
42 I withdraw from friends or family after work.
1 2 3 4 5
43 I feel like no one understands what I am going through.
1 2 3 4 5
44 My relationships outside of work are suffering.
1 2 3 4 5
45 I avoid talking about work with people who care about me.
1 2 3 4 5
46 I feel like a burden to others when I share my struggles.
1 2 3 4 5
47 I have lost interest in activities I used to enjoy.
1 2 3 4 5
48 I feel alone even when surrounded by people.
1 2 3 4 5
49 I struggle to be present with loved ones because work is always on my mind.
1 2 3 4 5
50 I feel like I am pushing people away.
1 2 3 4 5
Section E Score: —
51 I feel unsafe (physically or emotionally) at work.
1 2 3 4 5
52 I do not trust leadership to support me if something goes wrong.
1 2 3 4 5
53 I feel like I cannot speak up about problems without retaliation.
1 2 3 4 5
54 I have experienced or witnessed bullying, harassment, or incivility at work.
1 2 3 4 5
55 I feel unsupported by my manager or supervisor.
1 2 3 4 5
56 I do not have access to mental health resources through my workplace.
1 2 3 4 5
57 I feel like my concerns are dismissed or minimized.
1 2 3 4 5
58 I work in an environment where mistakes are punished rather than learned from.
1 2 3 4 5
59 I feel like I have to hide my struggles to protect my job.
1 2 3 4 5
60 I do not feel psychologically safe at work.
1 2 3 4 5
Section F Score: —