1. Joswiak, M. Ellen DNP, RN, RN-BC


The tiered skills acquisition model (TSAM) is an effective method for structuring the clinical unit orientation. The orientee gradually assumes increased responsibilities based on advancing through tiers of skills from simple to complex. This article focuses on TSAM implemented at a teaching hospital with 188 newly licensed registered nurses. TSAM has increased nurses' confidence, role satisfaction, retention, reduced overall length of orientation by 18%, and increased the number of patient experiences by 45%.