42 - Standardizing OR Nurse Onboarding Using the Tiered Skills Acquisition Model

Description: Standardizing OR Nurse Onboarding Using the Tiered Skilled Acquisition Model (TSAM): A System Wide Innovation for Perioperative Practice
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Description of Team
The project team was composed of Perioperative Professional Development Specialists across the MedStar Health system. These educators collaborated with clinical leaders, preceptors, and orientees to design a model that was educationally sound, practical, and adaptable across various perioperative settings.
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Preparation and Planning
The team conducted a review of onboarding practices across perioperative units and identified wide variability in orientation length, content, and delivery. Using Benner's Novice to Expert theory and adult learning principles, the team developed the Tiered Skilled Acquisition Model (TSAM), a structured orientation framework specifically designed for OR nurses. Preparation included the development of weekly milestone guides, skill checklists, and support tools for preceptors and new hires.
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Assessment
Initial assessments highlighted several challenges including inconsistent skill development, lack of standardization, and preceptor burnout. A needs analysis revealed gaps in role clarity and onboarding structure. These findings drove the design of TSAM and informed key outcome metrics such as orientee confidence, milestone achievement, and quality of feedback.
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Implementation
TSAM was implemented across multiple perioperative units at MedStar. The model features:
- Tiered skill progression
- Shared accountability between preceptor and orientee
- Structured weekly check ins
- Flexible orientation timelines with standardized expectations
Support tools including educator coaching sessions and orientation toolkits helped ensure consistent application across sites.
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Outcomes
Early outcomes include:
- Increased orientation consistency
- Improved preceptor satisfaction and reduced role strain
- Enhanced orientee engagement and confidence
- More predictable skill progression
- Improved retention and readiness at several MedStar hospitals
Feedback from stakeholders indicated that TSAM provided a clear and supportive structure that benefited both learners and preceptors.
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Implications for Perioperative Nursing
TSAM aligns with the AORN Guidelines for Perioperative Practice: Orientation (2024 Edition) and offers a scalable and evidence based solution to enhance perioperative nurse onboarding. By promoting structured learning, preceptor support, and skills based progression, TSAM strengthens team relationships, builds professional confidence, and supports long term workforce development in perioperative settings.