PBDS Update

  1. Yes, our facility is still using the Performance-Based Data Systems to "screen" all the new nurses. I found out that this system was developed by a nurse with a PhD. Our unit educator states that this testing system is "research based with high veracity and reliability." She says it is useful to screen out the nurses who may be a threat to patient safety. I, for one, have big doubts. It troubles me that nurses are being judged by this "standard," when the scenarios themselves are so ambiguous and open to interpretation. I know of a wonderful LPN with excellent clinical skills and broad-based nursing knowledge and experience who was rejected by our hospital because she didn't "make the score" with PBDS. Now she is happily employed at a smaller hospital, and it is our hospital's big loss. The testers are looking for very specific answers in each of these hundred or so video tapes; however, who is to say that their "answers" are any better than something else you or I might come up with. The whole concept of nurses being tested in such an arbitrary way really bothers me. We still lack so much control over our practice environment. To make matters worse, we desperately need nurses in our unit--we just had five quit "out of the blue" and our nurse manager is resorting to travelers. Well, guess what, half of the travelers she was counting on to fill the "holes" flunked the test. Some of the new grads couldn't cut it either and so quit the unit after three months of orientation. I am scratching my head over this one. The worse nursing shortage since WWII, and turning desperately needed nurses away.
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  2. 37 Comments

  3. by   P_RN
    You know what...that stinks.

    I remember many years back we had a marvelous Nursing Assistant. She worked like a Trojan, she was loved by patients, nurses and doctors alike. You never had to tell her anything twice. Her work was letter perfect.

    BUT, she did not have the reading skills to pass the arbitrary Nurse Tech test.....so we lost her. She finally got a job as a transporter. What a shame.

    They couldn't HAVE someone who didn't play by their rules. Since then we must have had 50-75 well read techs who unfortunately couldn't or wouldn't do the job.

    Throwing the baby out with the bathwater has always been a bad idea....only it seems that it took a PhD to come up with it this time. But what can we do?
  4. by   JWRN
    I know of many facilities that use the PBDS system to assess the new hires (RNs and LVNs and GNs), the facility I work uses the PBDS system on new hires. Though it is up to the director/manager as to whether or not to terminate the employee who is not acceptable. If an employee is unacceptble then they are reassessed within 2-4 weeks, most often attending a course during that time (Critical care course or Tele curriculum course or Med-surg course, etc) then they are reassessed on videos specific to their area and facility. If the employee is unacceptable the second time around then a performance development plan is implemented, and the employee is reassessed within a time frame that is decided upon by educator and employee usually 3-4 weeks, depending on when classes are offered, etc....I have only seen employees quit or resign prior to being reassessed and have never seen or heard of one being terminated because of PBDS at the health system I work for.

    PBDS was developed by a lady named Dorothy del Bueno, and yes she does have a PhD, but that does not mean she doesn't know what she is talking about the pathophysioolgy and treatment of the diseases has not changed drastically in the last 30 years (though it has probably been many years since she has had direct patient contact), she has been doing this type of research since the 1970's, she was instrumental in coining the term Competency based orientation. I do see both sides of this system and yes I think the videos need some work. The employee only watches 9 or 10 videos based on their past experience (so ICU nurse with many years of exp would watch the ICU assessment videos, and a GN would watch the med-surg videos), the system also uses other information to base its assessment upon not just the videos alone, there is a 'what if' section where the employee is given a written scenario then is asked to label it either must do, should do or could do, it is looking at the employees prioritizing skills, etc...The videos present problems that nurses should be able to recognize, and label it and treat it appropriately...Now those that score this assessment have an answer key with the problem and list of interventions with rationales, the interventions are or should be things that the nurse would do in that situation, the key is to label the problem with a medical diagnosis and not a nursing diagnosis. Then just treat that medical diagnosis as you normally would. Example- there is a video of a patient that is septic and is showing signs of septic shock, now the interventions one would write would include things like antibiotics, blood cultures, sputum culture, etc, assessment of hemodyanmic parameters, may need vasopressor (levophed), monitor I&O closely, assess VS and of course inform the MD, then you should have rationales that will support your interventions- such as antibioitics to cover the septicemia, cultures to identify the organism, hemodynamic parameters to assess CO, CI, SVR, SV, etc, vasopressor to help with BP support....The graders have a sheet with key things that should not be overlooked by any nurse with experience....Just give this system a chance...I too have issues with it and it's subjectivity, but it does give a pretty reliable assessment of the nurse, though occasionally if the tester is not watching the video closely they might miss things and therefore not do well...At the facility I work at the new hires are given 7 minutes to write down the information for the videos (problem, interventions, and rationales) I think that is not enough time..And there are other things that I have issues with this system, but overall it is reliable baseline assessment of those who take it. Nurses with PhD's are not the enemy...
    Oh well just my two cents.....
  5. by   PJRNC2
    My, Oh, My!!! Are these interventions from a list of standing orders that the nurse may pick and choose? In the ER ,ICU/CCU and Hemodialysis we had standing orders but nothing like the variety you suggest the nurse may choose/decide for the pt. WOW and Woah- I want my physicial to be notified and decide if I am to get levophed!!!! Or is this what the nurse needs to be aware of that might be ordered for the pt. BY A PHYSICIAN!!! I'm afraid I'm out of the LOOP as far as knowledge of this program- but better bet, I'm going to learn!
  6. by   Level2Trauma
    Are physicians also required to complete a PBDS exam or is passing their medical boards sufficient for hiring purposes. Funny, I thought writing the boards tested for competency. Oh well, I guess WE don't have much control of our profession after all. Just my 2 cents.
  7. by   lever5
    Dorthy Del Bueno is a Phd, she also owns a partnership in Performance Management Services, Inc. which distributes the test. I am now in school for my masters degree and have access to a very good research library. You would expect her to have extensive research in development and a wealth of support data, but the only articles that are published by her are about PBDS. Her co-authors are statisticians, and people who do reporting on nursing. There may be one article on the effictivness of PDBS not written by her. I hope your facility runs studies on this test. It seems to me it tests on test taking ability, not on knowledge. My facility only gives you 5 minutes to complete a video sheet.
  8. by   hoolahan
    I have one simple question. Why are nurses being tested on a physician's competency level? I mean, sure we may know what to anticpate what will be ordered, but we cannot order cultures and antibiotics, nor can we insert a swan!

    Doesn't it make more sense to evaluate us on what our nursinginterventions would be? This was the way the CCRN exam is (or was) designed. You were presented with a scenario, written, and then had to choose your nursing intervention to anticipate, of course you had to make a mental "medical" diagnosis in your mind in order to determine what the correct priority nursing interventions would be. Are you saying this system actually asks you to state a medical diagnosis? This is not within our nurse practice act, at least not in NJ!
  9. by   VickyRN
    Are you saying this system actually asks you to state a medical diagnosis?
    Yes, Hoolahan. This is my understanding of this test. Thank God, I have never been required (yet) to take it, but this is what I have heard. You are presented with a video presentation and then asked "what is going on." They expect a MEDICAL DIAGNOSIS and then a bunch of interventions (at the top of the list "Call the doctor urgently..." . ) I have heard this system is very unfair. Nurses feel intimidated by it. It bothers me that this self-appointed and self-anointed lady with a PhD has such power to determine who is and isn't "competent." Who gave her this power over us and why? We nurses haven't had any say in this "screening" process. Maybe if we had, (if this system were peer-reviewed and inspected before implementation at our hospital), then I wouldn't feel so frustrated and disenfranchised. It's all these mixed signals that bother me. They say they want us on one hand, we're SO critically short, then they're slapping us in the face with the other hand, and DISCOURAGING/PREVENTING nurses from coming to our unit with this controversial screening process. It seems that common sense around our facility is in as short supply as the nurses, inversely proportional to the amount of education of the administrators. I don't know how many more of their "bright ideas" we nurses can take.
    Last edit by VickyRN on Feb 15, '02
  10. by   VickyRN
    Are you saying this system actually asks you to state a medical diagnosis?
    I talked with my unit educator about this, stating that this is not fair, expecting nurses to come up with MEDICAL DIAGNOSES in each of the scenarios on this exam. Isn't this outside of our scope of practice, I mean practicing medicine without a license? What about nursing diagnoses--wouldn't these be more appropriate? My unit educator (who is a VERY nice person) replied that we nurses have to make medical diagnoses everyday and this is just testing our critical thinking ability. She furthermore stated that nursing diagnoses were worthless . I think this attitude is very sad and disturbing. This high-falooting nurse with a PhD is forcing us into the medical model, robbing us of our very identity as nurses. Nursing diagnoses are the language of nursing, what makes us a profession, what distinguishes us from--uh, let's say, medical assistants, respiratory therapists, and DOCTORS I resent such an attitude and find it very dangerous to our profession.
  11. by   mattcastens
    Having been through PBDS three times all I can say it's a really boring way to have an skills check. I've always done well, but it takes so much energy to stay awake for.

    As for the diagnosis part, I would say we make informal medical diagnoses all the time. It helps to make suggestions to physicians as well as anticipate actions and orders that may be forthcoming.

    Nursing diagnoses, in my opinion, are useless. They don't communicate anything to anyone. "Body Image Disturbance, Altered Role Performance, Altered Cerebral Tissue Perfusion..." puh-lease. I agree that nurses have to evaluate the problems that affect their patients and form interventions for those problems, but giving them mumbo-jumbo names for the sake of academics has never made sense to me.
  12. by   lever5
    I have done further research on the theory behind competency testing. Reserach considers Dorthy del Bueno a pioneer in the competency testing field. Guess what folks, this seems to be the way of the future. Organizations, companies, and states are all scrambling to create their own competency testing. They want to test our knowledge, behavior, critical thinking and attitude among other things. And they are concerned about Doctors, they propose doing away with the CEU method and have labeled it in adaquate to monitor attainment of new knowledge. Not only are they considering competency testing new hires and new nurses but ongoing testing to make sure we are up on our skills. It will change the way we learn in nsg. school. Students will have to act out what they would do for a CHF patient. Sort like a MEGA code in the old ACLS. The PBDS makes you act it out on paper.
  13. by   VickyRN
    I say, let them keep it up and pretty soon they won't have any nurses left to "test." It's not that I am personally afraid of this test--I usually test very well (have a sixth-sense about me and invariably score high, even if [ironically] I DON'T know the subject at hand very well). However, a lot of people DO NOT test well and my contention is that this method does not accurately "size up" one's abilties and critical thinking skills. That it is UNFAIR. That, despite the big bucks expended, this method does not reliably assess competency. That we generic bedside nurses (the "front-line" troops) had NO SAY in its implementation and it was NOT PEER REVIEWED. If we at least had been given a voice, I would have a different attitude. This whole PBDS screening process shouts ***NURSE UNFRIENDLY***NURSE UNFRIENDLY***NURSE UNFRIENDLY*** and I find it very DEMEANING to our PROFESSION, especially since this test is based on the MEDICAL MODEL. However, to you nurse entrepreneurs out there--has anyone thought of developing study aids for this system--something the hapless nurse could use BEFORE taking this ridiculous exam--to help improve the scores??? Sounds like a very LUCRATIVE idea, especially since this testing system is already in place in at least 300 hospitals. I personally would buy a study aid for this test before taking it, if one were available.
    Last edit by VickyRN on Feb 16, '02
  14. by   Joules
    WELCOME to todays BRAVE NEW WORLD of nursing:
    http://www.nursingworld.org/ojin/tpc3/tpc3_3.htm

    Background Paper
    Dorothy del Bueno

    We must hold nurses accountable for changing their behavior. Then we will see change in the practice. We already know what does not work in assuring competence.
    Mandatory CEUs -- there is no evidence that it changes overall behavior.
    Credentials, there is not a measurable difference.
    Skill or job analysis is not relevant to assuring competence.
    Scores and multiple choice questions are not real life. We take care of patients not questions.
    Technical procedures.
    Policies and absolutes.
    There are three dimensions to competency: critical thinking, interpersonal skills, and technical skills. Previously, what had been evaluated was the ability to use knowledge in the context of taking care of patients. People are not equally competent in all skill dimensions. Critical thinking determines safe practice. The entry ability is what we call safe e.g. risk management. Can the nurse identify essential data indicative of acute changes in health status? If you recognize it, do you initiate actions that at least minimize the problem?

    A study was conducted over 5 years of 58 acute care hospitals. A 10% sample was drawn representing 50,000 RNs with 6 months experience in their area of practice. The findings were as follows:

    67% of the experienced nurses (at least 6 mos of experience) met at least safe practice.
    of the inexperienced nurses or new graduates, only 38% were considered safe. The manager makes a big difference to the degree to which she holds everyone accountable.
    of the unlicensed assistive personnel, 84% meet expectations.
    It is not that we ought to ensure competence, it is how we ensure it. We need to measure and look at competence, not some surrogate that is not competence.

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