Created: October 15, 2021 at 12:49 pm
Updated: October 15, 2021 at 12:49 pm
Draft Status: 0
Employee Information
Team Member: Carolyn Balkey
Employee ID: 18576
Email Address: CB5760820@augustahealth.com
Department Name: Crossroads
Department Phone Number: 540-332-4060
Current Employment Status: FT
Current Level of Participation: Not active
Intended Level of Participation: Clinician II
Supervisor: April Simmons
Clinician Requirements Roadmap
Clinician II Requirements Completed: 25 Total Points (from at least 2 categories), 2 years of RN experience OR completion of the AH Nurse Residency Program*, Leadership contact hours (4 hours), Behavioral Exemplar: Clinician II
Clinician III Requirements Completed:
Clinician IV Requirements Completed:
Transformational Leadership
Professional Nursing Organizations: Members (2 pts)
Educational Roles
Precepting
Precept AH Team Member: 0
Preceptor Travel: 0
Secondary Preceptor: 0
Preceptor Capstone Student: 0
Preceptor for Degree Completion:
Mentorship
LANTERN MENTOR:
AH NPDP: 0
Student Daily Shift Support: 0
Shared Decision Making
Unit Based Council/Committee/Taskforce: Member (2 pts)
System-Wide Committee:
Shared Governance Council:
Transformational Leadership Supporting/Validation Documents
https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/ANA.pdf, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/unit-council-3.pdf, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Untitled-3.pdf
Structural Empowerment
Community Outreach/Events
Volunteer Event as RN or Medical Professional: 0
Other Volunteer AH Event: 0
Coordinate Nursing Event:
Conferences:
Educational Leadership:
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: 0
Structural Empowerment Supporting/Validation Documents
https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/VNA-certificate-for-hours-1-150×150.png, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Hand-hygiene-and-education-1.doc, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Untitled-2.pdf
Exemplary Professional Practices
Professional Development
Recognition
Internal – Unit: 8 (8 pts)
Internal – System: 0
External – Health-Care Related: 0
Clinical Resource Roles
Shared Governance Council
Charge: 0
Patient Experience Rounding Nurse/Super-User Technology:
Presentations/Publications
EBP Poster Presentation – Internal (2 pts), EBP Oral Presentation – Internal (2 pts)
Structural Empowerment Supporting/Validation Documents
https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Internal-Recognition.doc, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/CIWA-residency.pptx, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Carolyn-Balkey-Letter-1.doc, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/MM-right.pdf, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Untitled-1.pdf
New Knowledge, Innovation, Improvements
New Knowledge & Innovations
Complete 1 CEU & Present topic to unit: 0
Continuing college credits: 4 Courses (8 pts)
Clinical Resource Roles
Performance Improvement
Other Improvement & EPB Projects
Audits
Hand Hygiene Coach (2 pts)
Knew Knowledge Supporting/Validation Documents
https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/ODU-150×150.png, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/ODU2-150×150.png, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Hand-hygiene-and-education.doc, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/ODU-unofficial-transcript.doc, https://futureproviders.augustahealth.com/wp-content/uploads/formidable/3/Untitled.pdf
Totals
Total TL: 4
Total SE: 2
Total EPP: 12
Total NKI: 10