Created: October 4, 2021 at 2:07 pm
Updated: October 4, 2021 at 3:53 pm
Draft Status: 0

Employee Information

Team Member: Olivia Moore

Employee ID: 12209
Email Address:
Department Name: Joint Center
Department Phone Number: 540-332-4160
Current Employment Status: FT
Current Level of Participation: Clinician II
Intended Level of Participation: Clinician III
Supervisor: Bonnie Sanner

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: 2 Orientees (6pts)
Preceptor Travel: 0
Secondary Preceptor: 0
Preceptor Capstone Student: 2 (2 pts)
Preceptor for Degree Completion:
Student Daily Shift Support: 0

Shared Decision Making

Unit Based Council/Committee/Taskforce: Member (2 pts)
System-Wide Committee: Members (2 pts)
Shared Governance Council: Members (4 pts)

Transformational Leadership Supporting/Validation Documents,,,,,

Structural Empowerment

Community Outreach/Events

Volunteer Event as RN or Medical Professional: 12 hours of event volunteering (2 pt)
Other Volunteer AH Event: 0
Coordinate Nursing Event:
Conferences: Other Instructor (3 pts)
Educational Leadership:
Journal Club:
Activities Through Nursing Education
Present Formal Education: [105]
AHA Instructor:
Skills Fair Instructor: 3 sessions (1 pt)
Other Instructor: Other Instructor (3 pts)
Nurse Residency Instructor: 0
Hold Active Certification not required by job description: 0

Structural Empowerment Supporting/Validation Documents,,,

Exemplary Professional Practices

Professional Development

BSN (4 pts)


Internal – Unit: 5 (5 pts)
Internal – System: 0
External – Health-Care Related: 0

Clinical Resource Roles

Shared Governance Council
Charge: Less than %50 (1 pt)
Patient Experience Rounding Nurse/Super-User Technology: Patient Experience Rounding Nurse (4 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

Performance Improvement

Other Improvement & EPB Projects

Hand Hygiene Coach (2 pts), Hand Hygiene Observer (1pt)

Knew Knowledge Supporting/Validation Documents,


Total TL: 18
Total SE: 6
Total EPP: 14
Total NKI: 3

Grand Total: 41