Created: October 25, 2021 at 2:42 pm
Updated: October 25, 2021 at 2:42 pm
Draft Status: 0

Employee Information

Team Member: Matthew Mullin

Employee ID: 15809
Email Address:
Department Name: Medical
Department Phone Number: 540-332-4220
Current Employment Status: FT
Current Level of Participation: Clinician III
Intended Level of Participation: Clinician IV
Supervisor: Brannelly Batman

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, Behavioral Exemplar: Clinician III
Clinician IV Requirements Completed:

Transformational Leadership

Professional Nursing Organizations:

Educational Roles

Precept AH Team Member: 1 Orientee (3pts)
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: 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:
Educational Leadership: Competency Validator (3 pts), Content Contributor (1 pt), 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)


Internal – Unit: 10 (10 pts)
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: 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
Lead PDCA/PI/Rapid Cycle Improvement unit project (8 pts), Key Participant in PI/RCI/Kaizen project (3 pts)
Other Improvement & EPB Projects
Lead PDCA/PI/Rapid Cycle Improvement unit project (8 pts), Key Participant in PI/RCI/Kaizen project (3 pts)

Knew Knowledge Supporting/Validation Documents


Total TL: 13
Total SE: 8
Total EPP: 20
Total NKI: 11

Grand Total: 52