TSAM® is an evidence-based framework developed by Mayo Clinic to guide nurses through a tiered progression of skills, helping ensure they build the competence and confidence required to deliver safe, consistent, and high-quality care.
In TSAM®, the Preceptee progresses through tiers of competencies which outline skills that are built from simple to complex. The Preceptee must master the skills outlined in each tier prior to moving onto the next. For example, in Tier 1, if vital signs, intake and output and documentation of these findings are required, the Preceptee only performs these skills (with Preceptor oversight) for a full patient assignment. The Preceptor performs all other skills and interventions for these same patients thus meeting all the needs for the patient assignment. Once Tier 1 is mastered, the Preceptee moves onto Tier 2. The Preceptee continues performing all the skills learned in Tier 1 and then begins to master the skills in Tier 2. The Preceptor is always present observing and assuring the skills/interventions are performed competently. This progression continues throughout the orientation until skills/interventions in all outlined tiers have been mastered.
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.