Fragmented, inconsistent competency programs quietly cost health systems in two ways that matter most: wasted time and compromised patient safety. When every unit defines competent differently, onboarding drags, gaps go unnoticed, and clinical risk climbs. The Tiered Skills Acquisition Model (TSAM) was built to solve exactly this problem, giving health systems one structured, evidence-based framework for developing and verifying competency.
In this guide, you’ll learn what each TSAM component does and how they work together, from foundational skill tiers through advanced competency validation.
TSAM® identifies three levels of competencies:
1. Core: Core competencies serve as the foundation for all specialty content. Every orientation record will include a Core assigned with tiered competencies. For example, all inpatient nurses regardless of where they work in the inpatient setting are assigned the same core competencies. These are based on the ANA Scope and Standards of Practice.
2. Specialty: Additionally, Specialty competencies can be assigned based on the patients served in that unit. The majority of orientation records will include a specialty with tiered competencies. This is where skills required to care for a Specialty patient population will be incorporated (e.g. nurses working in oncology units – these are based on the nursing specialty organization standards of practice).
3. Individual: Lastly, Individual competencies can be chosen. These competencies may be needed across identified specialties but not all. They are selected and added to the orientation as required competencies but are not tiered. An example would be blood administration. Some units require the nurse to hang blood but others don’t.
In totality, the three levels of competencies are designed to prepare the Preceptee to competently and comprehensively care for the patient.