Created: October 5, 2021 at 5:22 pm
Updated: October 5, 2021 at 5:22 pm
Draft Status: 0

Employee Information

Team Member: Shannon Burke

Employee ID: 06988
Email Address:
Department Name: OB/PEDS
Department Phone Number: 540-332-4360
Current Employment Status: FT
Current Level of Participation: Clinician III
Intended Level of Participation: Clinician IV
Supervisor: Roxanne Harris

Clinician Requirements Roadmap

Clinician II Requirements Completed:
Clinician III Requirements Completed: 30 Total Points (from at least 3 categories- 1 must be TL), 3 Years of RN Experience*, National Certification OR BSN, Leadership contact hours (8 hours), Behavioral Exemplar: Clinician III
Clinician IV Requirements Completed:

Transformational Leadership

Professional Nursing Organizations: Members (2 pts)

Educational Roles

Precept AH Team Member: 0
Preceptor Travel: 0
Secondary Preceptor: 0
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: Members (4 pts)

Transformational Leadership Supporting/Validation Documents

Structural Empowerment

Community Outreach/Events

Volunteer Event as RN or Medical Professional: 0
Other Volunteer AH Event: 1 (1 pt)
Coordinate Nursing Event: Coordinate Nursing Event (4 pts)
Educational Leadership: Competency Validator (3 pts), Unit Inservice Education (2 Inservices/Yr) (2 pts)
Journal Club:
Activities Through Nursing Education
Present Formal Education: [105]
AHA Instructor:
Skills Fair Instructor: 0
Other Instructor:
Nurse Residency Instructor: 0
Hold Active Certification not required by job description: 1 addtional certification (1 pt)

Structural Empowerment Supporting/Validation Documents

Exemplary Professional Practices

Professional Development

BSN (4 pts), Cross-training to another department (3pts)


Internal – Unit: 1 (1 pt)
Internal – System: 1 (4 pt)
External – Health-Care Related: 0

Clinical Resource Roles

Shared Governance Council
Charge: 0
Patient Experience Rounding Nurse/Super-User Technology:


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

Performance Improvement
PI Unit based education (4 pts), Key Participant in PI/RCI/Kaizen project (3 pts)
Other Improvement & EPB Projects
PI Unit based education (4 pts), Key Participant in PI/RCI/Kaizen project (3 pts)
Short Term (1 pt), Ongoing (3 pts), Hand Hygiene Coach (2 pts)

Knew Knowledge Supporting/Validation Documents


Total TL: 10
Total SE: 11
Total EPP: 12
Total NKI: 15

Grand Total: 48