Date of Paper/Work


Type of Paper/Work

Scholarly project

Degree Name

Master of Arts in Nursing




Kathleen Kalb


The purpose of this project is to examine the effects of implementing a tiered skill acquisition model (TSAM) to new graduate nursing orientation within the orthopedic specialty. Historically, new graduates experience challenges in transitioning from their academic roles to practicing professionals. Correlatively the national turnover rate for new graduates is disproportionally high in their first year of employment. Conventional orientation models have proven to be outdated and do not utilize institutional resources adequately, leaving new nurses feeling ill-prepared to enter their roles. Over a 9-month period, a total of 14 new graduates entering the orthopedic specialty were tracked through their planned 10-week orientation timeline and assessed post-orientation completion for comfort level and job satisfaction via an emailed survey. Secondary outcome metrics for TSAM implementation over this timeframe include preceptor feedback regarding orientee performance, increases in the diversity and number of patient experiences, lower instances of staff turnover, and cost savings. Results show that TSAM has a positive effect on the comfort, competency, and positive socialization for all orientees under this redesign. Simultaneously, the model provides a significant increase in patient interactions due to the increased productivity throughout early tiers. Higher rates of staff retention, along with the secondary cost-avoidance benefits, offer evidence of TSAM’s success.