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The Three Pillars of the Tiered Skills Acquisition Model

Oct. 7, 2026

The Three Pillars of the Tiered Skills Acquisition Model | Creative Health Care Insight

by: Dr. Ellen Josiwak, D.N.P., R.N., NPD-BC

The Tiered Skills Acquisition Model is an evidence-based framework designed to support individualized clinical orientation. It offers a structure that is both guided and flexible, allowing preceptors to tailor progression based on the preceptee’s demonstrated level of competence. 

Three foundational pillars shape that experience: simple-to-complex competency progression, continuous partnership, and dedicated resource and clinical debriefing time. Together, they give preceptors a roadmap for developing skills and interventions while making room for each preceptee’s learning needs.

This approach:

  • Helps preceptors adjust training as they observe performance in real time.
  • Creates a clear progression pathway from simpler to more complex responsibilities.
  • Makes expectations consistent while keeping learning personalized.

Pillar One: Simple to Complex Competency Progression 

The first pillar of the TSAM® framework focuses on organizing competencies in a simple-to-complex structure. This approach helps preceptees build confidence and comfort as they repeat essential skills in real clinical practices supported by a preceptor who is present at their side. 

How it works: 

  • The preceptee practices foundational skills repeatedly. 
  • The preceptor takes the lead on higher-level skills and interventions at first. 
  • The preceptee observes the preceptor managing those responsibilities within patient care assignments. 

This ongoing repetition—combined with role modeling of professional nursing practice—creates a strong foundation and sets the preceptee–preceptor pair up for success. For a closer look at how competencies are organized, read The Components of TSAM®.  

How Benner’s Novice to Expert Model Relates to TSAM® 

TSAM® also reflects Dr. Patricia Benner’s Novice to Expert Model, which describes how clinical expertise develops over time. Benner explains that moving from novice to expert is a progressive process, built through: 

  • Repeated exposure to real-world situations 
  • Reflective practice to deepen learning and improve decision-making 

Cognitive Load Theory (CLT), developed by Dr. John Sweller (1988), further supports the TSAM® approach. In clinical training, nurses can easily become overwhelmed by too much information at once. CLT emphasizes that learning improves when complex material is broken into smaller, manageable “chunks” that fit within working memory and can then be stored in long-term memory. 

How TSAM® uses CLT: 

  • Tier skills and interventions into smaller, progressive components 
  • Simplify complex concepts into parts that are easier to understand and remember 
  • Strengthening learning and recall by reducing cognitive overload 

Second Pillar: Continuous Partnership 

The second pillar of TSAM® emphasizes a continuous partnership between the preceptee and preceptor. During orientation shifts, the preceptee and preceptor are together at all times, creating an ongoing learning experience rather than a stop-and-start support model. This setup acts as a safety net for the preceptee while enabling continuous feedback and ongoing professional growth. Just as importantly, it gives the preceptee the chance to watch expert nursing practice unfold in real time. 

The benefits include:

  • Patient safety: The preceptor is immediately available to step in when needed and support safe care.
  • Immediate feedback: Assessment and guidance occur throughout the shift, helping the preceptee adjust and learn.
  • Professional modeling: The preceptee sees how the preceptor handles complex situations, manages time, and prioritizes skills and interventions.

For more on this relationship, explore The Role of the Preceptor in TSAM®.

Third Pillar: Resource Time + Clinical Debriefing Time 

The third pillar of TSAM® is resource time and debriefing time. This dedicated time allows preceptees to pause, reflect, and learn intentionally from what occurred during clinical practice. 

Resource time supports: 

  • Reflection on practice decisions and outcomes.
  • Development of critical thinking skills.
  • Practice with prioritization.
  • Hands-on experience with equipment or procedures that may not arise often during a shift.

Preceptees and preceptors both value this time because it creates focused, meaningful learning, not just “more exposure.” 

Preceptor and preceptee reviewing clinical orientation progress together during a nursing shift | Creative Health Care Insight

Why Reflection Matters During Clinical Orientation 

Benner’s work emphasizes that developing expertise takes more than time spent in a clinical setting. Reflection on interventions and outcomes helps learners make sense of their experiences and apply what they have learned.

For that reflection to be useful, preceptees need an environment where they can ask questions and discuss decisions honestly. Clinical debriefing gives preceptors and preceptees dedicated time to examine what happened, consider other approaches, and identify the next area for growth.

How the Three Pillars Work Together

The three pillars reinforce one another. A simple-to-complex progression clarifies what the preceptee is ready to practice. Continuous partnership gives the preceptor opportunities to observe, guide, and provide feedback. Resource and debriefing time turn clinical experiences into focused learning.

Together, they create an initial competency experience that is:

  • Individualized to demonstrate competence.
  • Structured and efficient.
  • Supportive of both preceptees and preceptors.
  • Focused on competence through practice, feedback, and reflection.

How CHCI Supports TSAM® Education and Implementation

Bring TSAM® to your organization with the only platform legally authorized to provide TSAM® implementation education and consulting. Creative Health Care Insight (CHCI) pairs the MyCHCI platform with TSAM® implementation education and consulting for CHCI platform clients. Led by Dr. Ellen Joswiak, TSAM® co-innovator and CHCI’s Chief Clinical Education Consultant, these services help organizations plan, implement, and sustain a tiered approach to clinical orientation. CHCI also offers preceptor development education and consulting to help prepare preceptors for their role in supporting learning and competency development. 

The MyCHCI Initial Competency Component can support traditional orientation or TSAM®, giving organizations tools to manage competencies and follow progression. To learn more about the work involved in bringing the model into practice, read How to Build a Sustainable TSAM® Implementation Plan.

Ready to explore TSAM® for your organization? Learn more about CHCI’s Competency Suite and connect with our team to discuss platform, education, and consulting options.

Frequently Asked Questions About the Three Pillars of TSAM®

The three pillars are simple-to-complex competency progression, continuous preceptor–preceptee partnership, and dedicated resource and clinical debriefing time. They work together to support individualized learning during clinical orientation.

Beginning with foundational responsibilities allows preceptees to practice essential skills repeatedly in real clinical situations. As they demonstrate competence, they can take on increasingly complex responsibilities with preceptor support.

The preceptor works alongside the preceptee during orientation shifts, models professional practice, observes performance, offers feedback, and steps in when needed to support safe patient care.

Preceptors and preceptees can reflect on clinical decisions and outcomes, discuss questions, practice prioritization, and address learning needs involving equipment or procedures that may not arise often during a shift.

Yes. CHCI offers TSAM® implementation education and consulting to CHCI platform clients, led by Dr. Ellen Joswiak, TSAM® co-innovator. These services connect expert guidance with the MyCHCI platform’s support for initial competency and orientation.

Sources:

Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (Commemorative ed.). Upper Saddle River, NJ: Prentice Hall.

Joswiak, M. E. (2018). Transforming orientation through a tiered skills acquisition model. Journal for Nurses in Professional Development, 34 (3) 118-122.

Joswiak, M. E., Wolfe, S., Nelson, D. (2024). Multisite implementation of the tiered skills acquisition model for orientation: Review and analysis. Journal of Continuing Education in Nursing, 55(3), 130-136.

Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science, 12 (2), 257-285.

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