Created: October 2, 2022 at 11:11 am
Updated: October 7, 2022 at 10:44 am
Draft Status: 0

Employee Information

Team Member: Charlotte Maiden

Employee ID: 04801
Email Address:
Department Name: Surgical Services
Department Phone Number: 540-245-7873
Current Employment Status: FT
Current Level of Participation: Clinician IV
Intended Level of Participation: Clinician IV
Supervisor: Dana Shomo

Clinician Requirements Roadmap

Clinician II Requirements Completed:
Clinician III Requirements Completed:
Clinician IV Requirements Completed: 40 Total Points (from all 4 categories), BSN OR MSN, 4+ Years of RN Experience*, National Certification, Teach In-House or Community, Leadership contact hours (12 hours), Behavioral Exemplar: Clinician IV

Transformational Leadership

Professional Nursing Organizations: Members (2 pts), Leaders (6 pts)

Educational Roles

Precept AH Team Member: 0
Preceptor Travel: 0
Secondary Preceptor: 4 shifts+/ team member (2 pt)
Preceptor Capstone Student: 0
Preceptor for Degree Completion:
Student Daily Shift Support: 0

Shared Decision Making

Unit Based Council/Committee/Taskforce: Chair (4 pts)
System-Wide Committee:
Shared Governance Council:

Transformational Leadership Supporting/Validation Documents

Structural Empowerment

Community Outreach/Events

Volunteer Event as RN or Medical Professional: 48 hours of event volunteering (6 pt)
Other Volunteer AH Event: 3 (3 pt)
Coordinate Nursing Event: Unit Peer Vaccinator (2 pts)
Educational Leadership: Unit Inservice Education (2 Inservices/Yr) (2 pts)
Journal Club:
Activities Through Nursing Education
Present Formal Education: [105]
AHA Instructor:
Skills Fair Instructor: 6 sessions (2 pts)
Other Instructor:
Nurse Residency Instructor: 0
Hold Active Certification not required by job description: 0

Structural Empowerment Supporting/Validation Documents

Exemplary Professional Practices

Professional Development

Healthcare-related Masters (6pts), National Nursing Certification (3 pts) *Non-nationally recognized certification, see SE Activities through Nursing Education section


Internal – Unit: 0
Internal – System: 0
External – Health-Care Related: 0

Clinical Resource Roles

Shared Governance Council
Charge: Greater than %50 (2 pts)
Patient Experience Rounding Nurse/Super-User Technology:


Article for Augusta Heartbeat Newsletter (2 pts)

Structural Empowerment Supporting/Validation Documents,

New Knowledge, Innovation, Improvements

New Knowledge & Innovations

Complete 1 CEU & Present topic to unit: 0
Continuing college credits: 0
Clinical Resource Roles
Nursing Division (6 pts)
Performance Improvement

Other Improvement & EPB Projects

Ongoing (3 pts)

Knew Knowledge Supporting/Validation Documents


Total TL: 14
Total SE: 21
Total EPP: 13
Total NKI: 11

Grand Total: 59