Created: September 30, 2022 at 4:43 pm
Updated: September 30, 2022 at 4:43 pm
Draft Status: 0

Employee Information

Team Member: Carolynn Nesselrodt

Employee ID: 16024
Email Address:
Department Name: Center for Cancer & Blood Disorders
Department Phone Number: 540-332-5960
Current Employment Status: FT
Current Level of Participation: Not active
Intended Level of Participation: Clinician III
Supervisor: Mary-Kate DePriest

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: 2 (2 pts)
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: Vice Chair (10 pts)

Transformational Leadership Supporting/Validation Documents×150.png,,,,,,,

Structural Empowerment

Community Outreach/Events

Volunteer Event as RN or Medical Professional: 6 hours of event volunteering (1 pt)
Other Volunteer AH Event: 0
Coordinate Nursing Event: Coordinate Nursing Event (4 pts), Unit Peer Vaccinator (2 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: 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

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


Internal – Unit: 5 (5 pts)
Internal – System: 1 (4 pt)
External – Health-Care Related: 1 (6 pt)

Clinical Resource Roles

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


Article for Augusta Heartbeat Newsletter (2 pts), Abstract Submission 2 (pts), EBP Poster Presentation – External (4 pts)

Structural Empowerment Supporting/Validation Documents×150.png,,,,,,×150.png,,,,

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

Ongoing (3 pts)

Knew Knowledge Supporting/Validation Documents,


Total TL: 18
Total SE: 20
Total EPP: 30
Total NKI: 3

Grand Total: 71