The Components of TSAM®: How a Tiered Competency Framework Is Actually Built

Most people who search for “TSAM® components” want a parts list, a quick rundown of what goes into the Tiered Skills Acquisition Model so they can judge whether it fits their orientation program. That’s a fair place to start. But after years of helping health care organizations stand this model up, we’ve learned something a parts list can’t show you: the components of TSAM® only make sense once you see how they fit together.

If you’ve ever built an orientation program, you already know the problem the model is trying to solve. There’s a gap between the day a nurse is hired and the day they can safely practice on their own, and traditional orientation tries to close that gap with a calendar. So many weeks on days, so many on nights, a checklist signed off somewhere along the way. Everyone involved can feel how arbitrary that is. The new grad who’s ready early waits anyway. The one who needs more time runs out of it. And the preceptor in the middle is documenting all of it on a clipboard or a spreadsheet at the end of a twelve-hour shift, hoping the boxes they checked actually mean what they’re supposed to mean.

The Tiered Skills Acquisition Model was built to replace the calendar with a structure. It’s an evidence-based clinical orientation framework co-innovated by Dr. Ellen Joswiak. And that structure, not a list of features, is the real subject of this article.

So instead of a flat list, we’ll walk through the model the way it is actually engineered: along two axes. Picture a grid. One axis runs vertically, the tiers that carry a new clinician from simple skills to complex ones. The other runs horizontally, the types of competencies that decide which skills belong in that progression in the first place. Understand both axes, and you understand TSAM®. (For a broader primer on the model itself, our overview of what the Tiered Skills Acquisition Model is is the place to start.)

The Vertical Axis: Tiers That Build From Simple to Complex

The “tiered” in Tiered Skills Acquisition Model is the vertical dimension, the staircase a new clinician climbs during orientation. Each tier holds a defined cluster of competencies, sequenced so foundational skills come first and the more cognitively demanding work comes later, once the groundwork is solid.

What makes the staircase work is one rule: mastery before advancement. An orientee doesn’t graduate from one tier to the next because a set number of days have passed. They advance because they’ve demonstrated competence in everything that tier requires. That single shift, from time to proven ability, changes the entire experience for the person learning.

Here’s how it looks on a unit. Picture a newly hired RN starting orientation on a medical-surgical floor. In the earliest tier, that nurse takes full ownership of a defined set of foundational responsibilities for their patient assignment, say, baseline assessment, routine monitoring, and documenting those findings, while the preceptor handles the higher-acuity interventions for those same patients. The orientee isn’t sidelined or running drills in a lab. They’re caring for real patients from day one, but only for the part of that care they’re genuinely ready to own. As they prove competence, the preceptor hands over more. The patient assignment stays whole the whole time; what changes is how much of it the orientee carries.

That design does two things at once. It protects patients, because no one is ever asked to work beyond their demonstrated ability. And it protects the new nurse’s confidence, because growth becomes something they can see, one tier at a time, instead of a daily test of whether they’re going to sink. The preceptor’s job changes too, less supervisor checking boxes, more coach who can see exactly where their orientee stands and what comes next.

The Horizontal Axis: Three Types of Competencies

The tiers tell you how skills are sequenced. They don’t tell you which skills belong in an orientation, or why one nurse’s orientation looks different from the nurse’s down the hall. That’s the horizontal axis, and it’s where the design of TSAM® is at its most useful. The model sorts every competency into one of three types, and the mix of those types is what makes each orientation fit the role it’s actually preparing someone for.

Core Competencies

Core competencies are the foundation, and they’re non-negotiable. These are the skills and judgments every clinician in a given practice environment must hold, no matter which unit they land on. For inpatient nurses, the core is the same whether they end up on a surgical floor, a telemetry unit, or general medicine, because it’s anchored to professional standards of practice rather than the quirks of one department. Every orientation record in TSAM® includes a core set, and those competencies are tiered, progressing from simple to complex along the vertical axis. If an orientation is a building, the core competencies are the load-bearing structure.

Specialty Competencies

Specialty competencies layer on top of the core to reflect the patients a clinician will actually serve. A nurse heading into oncology, one heading into labor and delivery, and one heading into critical care share the same core, but their specialty competencies diverge sharply, because the patients in front of them have profoundly different needs. These competencies come from the practice standards of the relevant nursing specialty, and like the core, they’re tiered. Most orientation records include a specialty layer; it’s what turns a competent generalist into someone ready for a particular kind of care.

Individual Competencies

Individual competencies are the most situational of the three, and they behave differently from the other two. These are skills required in some settings but not others, and they aren’t tiered. They’re selected and added to an orientation record as needed, standing on their own rather than climbing a staircase. Blood product administration is a clear example: some units expect every nurse to manage transfusions, while others rarely or never do. When a role calls for that skill, it’s added as an individual competency; when it doesn’t, it simply isn’t there. This is the type that keeps TSAM® from becoming one-size-fits-all. It lets an orientation account for the real demands of a specific job without padding everyone’s orientation with skills they’ll never use.

Where the Components Meet: The Orientation Record

Here’s the payoff, and it’s the part that flat “components” explanations tend to skip. The two axes aren’t separate systems running side by side, they intersect inside one artifact: the orientation record.

When an organization builds a TSAM® orientation record, it’s making deliberate choices on both axes at once. Horizontally, it decides which core, specialty, and individual competencies a role demands. Vertically, it sequences the tiered competencies so the orientee climbs from foundational to complex. The result is a complete, role-specific map of everything a new clinician must demonstrate before practicing independently, and a shared, honest picture of where they stand at any given moment.

That intersection is what makes the model work in the real world. A preceptor can look at the record and know precisely what to teach next. A nurse manager can see how orientation is progressing across a whole unit without chasing people down for updates. And the orientee can see their own path laid out in front of them, which, in our experience, does more for new-graduate confidence than almost anything else. The components stop being abstract categories and become a working tool.

What the Architecture Makes Possible

Because TSAM® is built on this grid rather than on a timeline, it makes possible a few things calendar-based orientation never could.

Competency validation that means something. Advancement is tied to demonstrated ability at each tier, so “finished orientation” actually means “validated as competent,” not “showed up for the required shifts.” The validation checkpoints act as safety nets, surfacing gaps before they ever reach the bedside.

Documentation that holds together. When every competency lives in a defined type and tier, the record of an orientee’s progress is consistent and auditable instead of a scattered pile of checklists. That coherence is exactly what supports alignment with recognition frameworks like Magnet® and Pathway to Excellence®, which reward structured, evidence-based professional development.

A model that grows with you. A clear structure is a repeatable one. Once a team understands how core, specialty, and individual competencies combine across tiers, it can build orientation records for new roles and units without reinventing the approach each time.

This is also where technology earns its keep. Running a multi-axis competency framework on paper is possible, but it’s punishing, and it usually lands on the preceptor at the end of an already long shift. CHCI’s MyCHCI platform was designed to hold the whole structure, tiers, competency types, validation, and real-time progress, so preceptors can spend their energy developing people instead of wrangling paperwork. The components stay human; the administration gets automated.

Why the Source of the Components Matters

A growing number of platforms reference tiered or TSAM®-inspired content, and it’s easy to assume the components are interchangeable wherever you find them. They aren’t. The integrity of this model lives in the relationships between its parts, how the tiers are sequenced, how the three competency types interlock, and how validation gates advancement. Reproduce the labels without that underlying logic and you get the vocabulary of TSAM® without its results.

That’s why Creative Health Care Insight (CHCI) is the only platform authorized to provide educational consulting for TSAM® implementation, working directly with the model’s co-innovator, Dr. Ellen Joswiak. The role isn’t to store a copy of the framework, it’s to help organizations implement the authentic model with fidelity, so the structure you put in place is the one that’s actually been shown to work. (We’ve written more on why that fidelity changes outcomes, and the hands-on implementation workshop led by Dr. Joswiak walks teams through it directly.)

If your team is weighing TSAM® and wants to see how these components would map onto your own roles, units, and orientation goals, schedule a personalized demonstration. We’ll walk you through how the pieces come together for your organization specifically, not in theory, but in the system your preceptors and new nurses will use every day.

Frequently Asked Questions

Sources

1. Joswiak, M. E. (2018). Transforming Orientation Through a Tiered Skills Acquisition Model. Journal for Nurses in Professional Development, 34(3), 118–122. https://doi.org/10.1097/NND.0000000000000439

Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Addison-Wesley.

MAGNET®, Magnet Recognition Program®, Pathway to Excellence® Program, Demographic Data Collection Tool®, and DDCT® are registered trademarks of the American Nurses Credentialing Center (ANCC). The products and services of Creative Health Care Insight are neither sponsored nor endorsed by ANCC. The content presented here is the expressed opinion of the author and not that of the American Nurses Credentialing Center (ANCC).