What is the Tiered Skills Acquisition Model (TSAM®)?

What is TSAM®?

The transition into a new clinical role represents one of the most challenging periods in a nurse’s career. Whether moving from school to practice, transferring to a new specialty, or stepping into an unfamiliar care setting, RN staff face the dual pressure of building competency while caring for real patients with real needs. The question health care organizations have long grappled with is: How do we structure this transition to maximize learning, build confidence, and ensure patient safety—all while supporting the orientee through what can be an overwhelming experience?

The Tiered Skills Acquisition Model®, or TSAM®, offers a research-informed answer to this challenge. This innovative orientation and competency development framework is transforming orientation in health care organizations, replacing outdated, inconsistent methods with a structured pathway that supports both the learner and the organization while addressing the gap that often exists between nursing education and independent practice.

Understanding the TSAM® Framework

TSAM® is a structured approach to clinical orientation that guides nurses and other clinical staff as they transition into new roles. Unlike traditional orientation models that may feel haphazard or overwhelming, TSAM® organizes skill development into progressive tiers, beginning with basic skills and foundational competencies, then systematically building toward mastery of more complex clinical tasks that require advanced critical thinking.

At its core, TSAM® recognizes a fundamental truth about how people learn: we develop expertise incrementally, not all at once. The acquisition model draws on educational theories of progressive skill development, acknowledging that competence is built layer by layer, with each tier providing the foundation for the next level of capability. This understanding of how nursing practice expertise develops is rooted in evidence-based practice and decades of research in nursing professional development (NPD).

What makes TSAM® distinctive is its integration of real-world patient care into the learning process. Rather than separating education from practice, orientees using TSAM® typically carry a full patient assignment from the start, learning through a combination of direct patient care, structured observation, guided preceptorship, and gradually increasing responsibilities as they demonstrate competence at each tier. This approach helps bridge the knowledge gap between academic preparation and the realities of clinical work.

How TSAM® Works in Practice

The beauty of TSAM® lies in its practical, learner-centered design. When new hires begin orientation using the TSAM® framework, they enter a structured progression through defined skill tiers. Each tier represents a specific set of competencies that build upon the previous level, creating a clear plan and roadmap for both the orientee and their preceptor to follow throughout the onboarding process.

During the orientation period, the preceptee works alongside an experienced preceptor who can evaluate progress, provide guidance, model expert practice, and gradually release responsibility as the orientee demonstrates readiness. This approach honors the reality that different individuals progress at different rates—some may advance quickly through certain tiers while needing more time and support in others.

The tiered structure allows preceptors to identify exactly where an orientee is in their development and what skills they need to focus on next. This precision eliminates the guesswork that often plagues traditional orientation, where both preceptors and orientees may be uncertain about expectations, progress, or readiness to advance. The number of days spent in each tier varies based on individual needs rather than a fixed timeline, ensuring genuine competency rather than simply completing a checklist. Additionally, using the tiered skills acquisition model can reduce the length of orientation for newly hired health care professionals, making the process more efficient while maintaining high standards of competency.

Importantly, TSAM® is designed to work within the real pressures of clinical practice. Orientees contribute to patient care from day one, learning in context rather than in artificial scenarios. This approach not only accelerates practical skill development but also helps new clinicians understand the pace, priorities, and realities of their unit or department.

Key Components of the TSAM® Approach

Structured Skill Progression

TSAM® organizes clinical competencies into hierarchical tiers, each building on the foundation of the previous level. This structure ensures that orientees master fundamental skills before progressing to more complex interventions, reducing the risk of gaps in essential knowledge or practice. The model helps staff advance from basic patient assignment responsibilities to full independent practice with confidence.

Real-Time Patient Care Integration

Unlike models that separate learning from practice, TSAM® embeds skill development directly into patient care activities. Orientees learn by doing, supported by their preceptor, which accelerates the transition from theory to confident clinical practice while maintaining patient safety as the top priority.

Guided Preceptorship

The preceptor plays a central role in TSAM®, serving not just as a supervisor but as an active coach and guide. The tiered structure gives preceptors clear tools to understand what to teach, when to teach it, and how to assess readiness for advancement. This support system helps preceptors provide consistent, high-quality training even during challenging times—lessons that became especially clear during the pandemic, when preparing new staff quickly became critical.

Individualized Pacing

TSAM® recognizes that competency development is not one-size-fits-all. The model allows for individualized progression, ensuring that each orientee receives the time and support they need to achieve genuine competence rather than simply completing a set number of orientation days. This flexibility helps create successful outcomes for individuals with varying levels of experience and educational backgrounds, from new graduates to experienced nurses transitioning to new specialties.

Competency Validation

At each tier, orientees must demonstrate competence before advancing. This validation process ensures that skill development is authentic and that patient safety is never compromised by premature progression. Preceptors evaluate and review performance systematically, providing objective assessment rather than subjective impressions.

The Benefits of Structured Skill Development

Health care organizations that implement TSAM® report meaningful improvement across multiple dimensions of clinical onboarding. By providing structure to what has traditionally been an unstructured process, TSAM® delivers benefits that extend far beyond the orientation period and create lasting value for the organization.

Enhanced Confidence: New clinicians often report feeling overwhelmed during orientation, uncertain about their abilities, and anxious about patient safety. TSAM®’s clear progression through defined tiers helps orientees see their own growth, building confidence as they systematically master each level of competency. This increased confidence translates to better performance and reduced stress as nurses start their careers or transition to new roles.

Improved Satisfaction: Both orientees and preceptors express higher satisfaction with the orientation process when using TSAM®. Orientees appreciate knowing exactly what’s expected of them and where they stand in their development. Preceptors value having a clear structure that makes their teaching more effective and their assessment more objective, leading to greater job satisfaction across the department.

Better Retention: The orientation experience significantly influences whether new clinicians stay in a role or leave. TSAM®’s structured, supportive approach to skill development creates a more positive onboarding experience, which translates into improved retention rates—a critical consideration given the ongoing challenges in health care workforce stability. Organizations see measurable results in retention metrics within months of implementation.

Consistent Competency Development: Traditional orientation methods often result in wide variation in what different orientees learn and how well they’re prepared. TSAM® standardizes the competency development process, ensuring that every clinician who completes orientation has genuinely achieved the necessary skills for safe, effective practice. This consistency supports compliance with regulatory standards and organizational policies.

Reduced Preceptor Burden: Precepting can be exhausting and unclear without a structured framework. TSAM® provides preceptors with a roadmap that makes their work more manageable and more rewarding, as they can clearly see the impact of their teaching. This reduced burden helps prevent preceptor burnout and creates opportunities for more staff to take on preceptor roles.

Cost Savings: While implementing TSAM® requires initial investment, organizations typically see significant cost savings over time. These savings result from improved retention (reducing recruitment and orientation costs for replacement hires), decreased orientation time through more efficient skill development, fewer patient safety incidents related to inadequately prepared staff, and reduced preceptor overtime. The return on investment often becomes apparent within the first year of implementation.

Why Progressive Skill Development Matters

The traditional approach to clinical orientation often follows a “sink or swim” mentality—throw new clinicians into the deep end and hope they figure it out. This approach is neither effective nor humane, and it certainly doesn’t serve patients well. The lack of structure creates unnecessary stress, increases the risk of errors, and contributes to early career turnover.

TSAM® is grounded in a more sophisticated understanding of how expertise develops. Educational research in nursing education and professional development consistently demonstrates that complex skills are best learned through progressive mastery, where learners build confidence and capability incrementally. Starting with foundational skills and gradually adding complexity allows the brain to consolidate learning at each stage before taking on additional challenges.

This progressive approach also aligns with how human beings naturally develop confidence and critical thinking abilities. When we experience small, manageable successes, we build the psychological resilience and self-efficacy necessary to tackle bigger challenges. TSAM®’s tiered structure creates these success experiences systematically, building not just skill but also the confidence to use those skills independently.

From a patient safety perspective, progressive skill development ensures that clinicians are never asked to perform tasks beyond their current competence. The validation checkpoints built into TSAM® create multiple safety nets, ensuring that gaps in knowledge or skill are identified and addressed before they can compromise patient care. This systematic approach to ensuring competence before independent action is a cornerstone of evidence-based practice in nursing professional development.

TSAM® and Technology-Enabled Implementation

Creative Health Care Insight (CHCI) plays a unique role in transforming how organizations implement and sustain TSAM®. CHCI is the only platform authorized to provide educational consulting services for TSAM® implementation. This also enables CHCI to integrate the TSAM® framework directly into its innovative digital platform, MyCHCI.

Through the MyCHCI platform, organizations can systematically manage the entire TSAM® process—from initial assessment through tier progression and final competency validation. Preceptors can easily document observations and evaluate progress, orientees can track their own advancement and review their accomplishments, and managers gain visibility into how orientation is progressing across their units. This comprehensive approach ensures nothing falls through the cracks and creates opportunities for continuous quality improvement.

This technology-enabled approach doesn’t replace the human elements of preceptorship and skill development; rather, it supports and enhances them by reducing administrative burden, improving documentation accuracy, and providing data that helps organizations continuously improve their orientation processes. The result is more effective use of preceptor time and better outcomes for new staff.

Implementing TSAM®: The Importance of Expertise

TSAM® is more than just a framework—it’s a comprehensive approach to competency development that requires thoughtful implementation and ongoing support.

Creative Health Care Insight’s exclusive authorization to provide educational consulting of TSAM® implementation means that organizations implementing the model receive expert guidance. From initial assessment and planning through full implementation and ongoing refinement, CHCI’s team brings both deep knowledge of the TSAM® framework and extensive experience in health care competency management.

This consulting approach ensures that TSAM® is not simply adopted in name but genuinely integrated into an organization’s culture and practices. The project requires careful planning and dedicated action, but the long-term benefits far outweigh the initial investment.

The Future of Clinical Orientation

Health care is evolving rapidly, and the way we prepare clinicians for practice must evolve as well. Traditional orientation methods—often inconsistent, poorly documented, and lacking clear structure—simply don’t meet the needs of today’s complex clinical environments or today’s learners who expect clear expectations and measurable progress.

TSAM® represents a new standard for clinical orientation: structured yet flexible, rigorous yet supportive, grounded in educational theory yet intensely practical. As more organizations discover the benefits of this approach, TSAM® is helping to establish what excellence in clinical onboarding actually looks like and creating a blueprint for transforming orientation across the profession.

For new clinicians starting their nursing careers or advancing to new roles, TSAM® offers a clearer, more supportive pathway into practice. For preceptors, it provides structure and clarity that makes their important work more effective and more rewarding. For organizations, it delivers improved confidence, satisfaction, retention, and ultimately, better patient care outcomes that create value across every level of the health system.

The challenges facing health care—workforce shortages, increasing complexity of patient needs, financial pressures—demand innovative solutions. TSAM® addresses these challenges head-on by ensuring that new hires are better prepared, more confident, and more likely to stay, while also providing the tools and structure that make the orientation process more efficient and effective.

Ready to Transform Your Clinical Orientation?

If your organization is ready to move beyond traditional orientation approaches and embrace a structured, evidence-based model for competency development, TSAM® may be the solution you’ve been looking for. The Tiered Skills Acquisition Model® offers a proven pathway to improving orientation outcomes, supporting staff development, and ultimately enhancing patient care through better-prepared nurses.

As the exclusive provider of educational consulting services for TSAM® implementation, Creative Health Care Insight can help you create an implementation plan tailored to your specific needs and provide ongoing support to ensure successful outcomes. Our team understands both the science of competency development and the practical realities of health care organizations, ensuring that implementation is both evidence-based and pragmatic.

To learn more about TSAM® and how it can transform clinical orientation in your organization, contact us today to schedule a demonstration. Discover how the Tiered Skills Acquisition Model® can enhance confidence, improve satisfaction, create cost savings, and build a stronger clinical workforce—one competent, confident clinician at a time. Take action today to provide your staff with the foundation they need for successful, fulfilling careers in nursing.