TSAM® Nursing Orientation Framework, Now Digital in Xapify
An Overview of TSAM®
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:
- 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. - 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 - 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.
How Xapify delivers TSAM®
Xapify brings the TSAM® framework to life in a fully digital workflow:
Role-based assignments – TSAM® competencies are automatically added to nursing job roles in Xapify.
Seamless onboarding – When a nurse is assigned a role, their full set of TSAM® competencies (core, specialty, and individual) are instantly assigned.
Digital precepting – Nurses work with their preceptors to demonstrate skills and progress through tiers, with every sign-off captured directly in the system.
Audit-ready records – All competency sign-offs are tracked in real time, creating a clear digital record of orientation progress.
With Xapify, TSAM® becomes a practical, scalable orientation solution, ensuring every nurse can advance through the framework consistently, confidently, and with full visibility for educators.
Digitize your nursing orientation.
Discover how TSAM® in Xapify helps preceptors save time while building nurse confidence.
