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  • 1.  Orientation Model - Tiered Skills Acquisition Model

    Posted 06-06-2022 09:14
    Our health system has adopted the Tiered Skills Acquisition Model for our orientation and preceptor work and we are beginning work for our ambulatory clinics to implement it also.  I'm wondering if any ambulatory clinics have already implemented this model and could share any lessons learned and/or best practices.  I look forward to your feedback.

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    Phyllis Miller, MS, RN, NPD-BC, FHCE
    Nurse Manager
    Inova Physician Services
    Fairfax, VA
    703/407-5833
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  • 2.  RE: Orientation Model - Tiered Skills Acquisition Model

    Posted 06-23-2022 14:30
    Phyllis​, can you share how you are utilizing this model? I can not find any information specific to orientation.
    Thank you,
    Jessica

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    Jessica Skelton MSN, RN
    Nurse Clinician
    VCU Health
    Richmond VA
    (804)316-5812
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    Original Message


  • 3.  RE: Orientation Model - Tiered Skills Acquisition Model

    Posted 06-23-2022 14:56

    Hi, Jessica.  We are in the beginning stages of developing this for our ambulatory clinics.  Our health system has been using this in some of our acute units with good success and they are broadening that out, to more units and we are also working to incorporate it into ambulatory as well so I was seeking information as to anyone having experience using it in ambulatory.  The two articles that we are using as our primary information sources are the following:

     

    Joswiak, M.E.  (2018) Transforming Orientation Through a Tiered Skills Acquisition Model (TSAM).  Journal for Nurses in Professional Development. 34,3, 118-122.

     

    Cantrell, FL et al.  (2022).  Task-Layered Clinical Orientation for New Graduate Registered Nurses.  Journal for Nurses in Professional Development.  38,2, 13-18.

     

    Hope this helps.

     

    Phyllis

    Phyllis J. Miller, MS, RN, NPD-BC, FHCE

    Nurse Manager

    Inova Physician Services

    3130 Fairview Park Drive, Suite 300
    Falls Church, Virginia 22042

    Email:  phyllis.miller@inova.org
    M 703/407-5833

    INOVA_2C_PMS_NoTag_reg

     




    Original Message


  • 4.  RE: Orientation Model - Tiered Skills Acquisition Model

    Posted 02-21-2024 08:53

    we are also moving towards this model and are just beginning creating our tiers. I see this is from 2022, how has your progress been? i'm finding it challenging to create the tiers based on area (Primary care vs specialties); i'm wondering if we're going 'in too deep' and would be better to stay 'high level.' any thoughts on that or recommendations or 'ah-ha moments' you can share?



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    Carrie Lemke DNP RN NPD-S BC
    Advocate Aurora Health
    Denmark WI
    (920)655-7795
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    Original Message


  • 5.  RE: Orientation Model - Tiered Skills Acquisition Model

    Posted 02-22-2024 08:29

    We have been using the TSAM for years. It was initially developed for the inpatient setting and then was adapted for the ambulatory setting. The concepts are great however it is harder to implement in the ambulatory setting. We ended up adapting the model to fit our primary care setting. Essentially we start with the basics in the first tier and build, however some tiers are truly more task focused - for example telehealth, rooming, immunizations, etc. Within those more task focused tiers, they are built where the basics are first and build to the end of the tier with the most complex. 



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    Bridget Carter MS RN
    Nursing Education Specialist
    Mayo Clinic
    Rochester MN
    (507)293-3974
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    Original Message


  • 6.  RE: Orientation Model - Tiered Skills Acquisition Model

    Posted 02-22-2024 08:52
    We are currently in the process of developing the model for RNs only to begin. Where we are really getting stuck is, our current state has very granular checklists: "start iv, dc iv, hanging fluids, ear lavage, injections, etc." When we are thinking we should be moving towards a higher level of verbiage in our tiers-so essentially we'd have maybe 5-10 things max in our tiers vs 25 things in every tier and listing every task and resource.
     
    How did you navigate through this? We feel since sometimes people are thrown into precepting they don't always know what they don't know, so the granular task list helps to guide them; however, it's so tasky this way....when we reviewed other TSAM tiers, they're much more high level-so we want to move to that but not leaving our preceptors lost on concepts they should be covering or setting up the orientee to fail because things may be being missed.
     
    Thoughts or recommendations?
     
    Kind Regards,
     
    Carrie Lemke
     
    Carrie Lemke, DNP, RN, NPD-BC
    Nursing Professional Development-Specialist, Clinical Nursing Practice
    Midwest Region-Medical Group
     
     
     
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  • 7.  RE: Orientation Model - Tiered Skills Acquisition Model

    Posted 02-26-2024 08:58
      |   view attached

    We started using Tiered Skills Acquisition for onboarding for primary care clinics in October 2022.  Since then, all MAs, LPNs, and RNs that have started in primary care clinics have onboarded in this manner.  Our goal is to expand to all ambulatory clinics, but we have not been able to do so yet.  My recommendation, especially if you cover many clinics (primary & specialty) is to keep it high level.  You will have too have many documents to keep up with if you go too deep or try to get too specific.  I would also recommend starting in one area, monitor how your documents are working, and edit.  We had to make a couple of revisions to our original document during our pilot and now feel it works really well for all primary care clinics.

    As we expand, I do not see too much changing with the document itself since we did keep it high level; but there will certainly be adjustments to the length of orientations and more "NA" documentation as we move into some of the specialty clinics.  I am attaching here an example of our tiered orientation documents.  Please feel free to reach out if you have any further questions (brittney.sandlin@uky.edu).



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    Patricia Hughes DNP RN NE-BC
    Chief Nursing Officer, Ambulatory
    UK HealthCare
    Lexington KY
    (859)323-4413
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    Original Message


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