August 26th, 2011
By Jennifer Olin, BSN, RN
Nursing students are heading to school, and at hospitals across the country, new grads are starting jobs and attending hospital and nursing orientations. For many, that will include several hours spent in PBDS testing. PBDS stands for Performance Based Development System, and it is an assessment tool used by more than 500 hospitals to find out just how strong their nursing employees are in their critical thinking skills.
Since nursing decisions often profoundly affect the lives of patients and their families, professional nurses use critical thinking to make reliable observations, draw sound conclusions, create new information and ideas, and improve their knowledge base. Critical thinking is considered so important that it is one of the National League of Nursing's (NLN) required criterion for the accreditation of nursing schools.
PBDS was the brainchild of Dorothy del Bueno, EdD, RN, who described her program's goal as providing nursing interns with the foundation to perform advanced beginner competencies so they can continue to develop into proficient nurses. The PBDS tool assesses each nurse's critical thinking skills, ability, and learning needs, and assists educators and preceptors in tailoring an individualized internship plan.
The program focuses on three areas of competence:
Each nurse’s individual responses are compared to criteria and performance standards developed by the hospital. Educators, preceptors and coaches then use the results to develop an individualized training plan.
"PBDS allows for quick recognition of newly hired nurses' level of skill," says Debbie James, MSN, RN and senior nursing education instructor. "It prevents us from spending time on areas the nurse already knows well. It allows us to formulate training which is individualized to a nurse's skills and background."
How PBDS Works
Using a series of computer based scenarios that simulate clinical situations, the nurse is asked to describe the steps necessary to manage the incident played out. Each vignette is about two minutes long, and the test taker is only allowed to view it one time. Answers are written in narrative form, and the nurse is expected to include a notation of the primary problem or diagnosis and should include nursing actions that are appropriate to the situation, even actions that seem automatic or obvious.
How answers are spelled and phrased doesn't matter. In simple terms, PBDS asks the taker to determine:
Besides the video scenarios, other portions of the test include an audio selection, used in the interpersonal communication section. Using what are described as startling statements, the nurse is assessed on her response. In one example a physician says, "I don’t know why the administration of this hospital won’t hire any decent nurses when there are plenty of girls out there." The nurse then documents their "professional" response.
The test is timed overall by section but not by exercise. In the video section, the nurse is provided with some limited written information about each vignette, and if numbers are included in the video, like vital signs, those are documented for the test taker's support.
The tests are rated by outside judges from PMSI, the company that developed and administers the program. It usually takes about five business days for the results to be returned to the hospital, and the results are reviewed by the education and coaching staff for the test takers. There is no defined numeric "pass" or "fail” score; however, there is an acceptable level of achievement based on a scale score “rating”.
Who Else Takes the PBDS?
New nurse graduates are not the only people who take the PBDS examinations. New nursing employees from other hospitals and nurses changing departments will also be assessed when they work at a healthcare facility that has purchased the system. Nurses changing departments are assessed on the skills from their former specialty, not on the one they are about to learn.
Other uses for the PBDS include testing employees' competency maintenance and for assessing changes in performance. It is also a resource for validating the cost effectiveness of educational efforts provided by the organization.
PBDS Controversy and Concern
Many hospitals also use the PBDS for assessing potential contract or traveling nurses for employment. This raises a number of concerns among traveling nurses and many are unwilling to even consider employment at hospitals who utilize the system. This can cause staffing problems for the companies hired to supply contract nurses when their stable of nurses won't take a chance on the hospitals who are trying to hire.
For travelers who score less than satisfactory on the PBDS examination, participating facilities generally do not give a chance at remediation. Travel nursing contracts will then be canceled, which can be very costly financially and emotionally devastating for the agency nurse. After having moved across the country for a job with the possibility of losing it within days if your test is deemed unsatisfactory is not a risk most travelers are willing to take.
Another concern for many test takers is that in the vignettes, nurses are expected to make a medical diagnosis as part of their response. Many nurses feels this is out of their scope of practice and not what they are trained to do; therefore, they believe the test is already an unfair assessment tool.
I know as a traveler for many years I too avoided applying for assignments at hospitals which use the PBDS assessment. Stories circulate about experienced, qualified nurses who were left high and dry after reaching an assignment but then not passing the test. Were they true, or the travel nurse equivalent of an urban myth? I don't personally know. What I do know is that recently I had to take a PBDS assessment for another project. Did I pass? I don't know yet. The test seemed straightforward, I saw lots of things I would have done, or done differently. I responded to the best of my ability. It was an interesting experience and one I have definitely learned from. I suppose that is one way to judge the success of the PBDS…it was a learning experience.