Performance Based Development System (PBDS)

Few subjects have stirred up as much controversy within the nursing community as the Performance Based Development System (PBDS) nursing "competency" assessment. What exactly is this test and why is it so controversial?

Performance-Based Development System (PBDS) is the creation of Dorothy del Bueno, the founder of Performance Management Services. PBDS is a commercial competency exam that can be individually tailored to evaluate hospital personnel. In practice, it is almost exclusively used to test the competency of nurses. At least 500 hospitals nationwide currently use the PBDS system.

The test can address one of four nursing specialty areas: medical surgical, critical care, neonatal ICU, and OB.

Within the designated specialty, a variety of methods are used to assess competency in three key areas: critical thinking, interpersonal relations, and technical skills.

The vast majority of the assessment addresses critical thinking skills. Short video clips (“vignettes”) are used to portray abnormal clinical situations (such as a case of digoxin toxicity or a blood transfusion reaction). The nurse examinee is expected to deduce the probable medical diagnosis and then decide what nursing interventions should be immediately performed.

Del Bueno defines four components for interpersonal skills: conflict resolution, customer relations, team building, and issue versus content. The nurse is asked to write responses to such problems as: (1) a patient says to you, “I don’t want that nurse to take care of me” (customer relations); and (2) the physician tells you, “Add 80mEq of potassium chloride to present IV bag” (conflict resolution).

The PBDS is used mainly for two purposes: to facilitate orientation of new nurse hires by pinpointing areas of weakness for remediation and to “weed out” suspect travel nurses. 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.

Del Bueno's method of assessing "critical thinking" in nurses has never been satisfactorily shown to be valid and reliable. The PBDS website makes frequent mention of "research," but fails to offer documentation for critical appraisal of the PBDS method.

These few “research” references are:
Whelan, L. (2006). Competency assessment of nursing staff. Orthopaedic Nursing, 25(3), 198-202.
Del Bueno, D. (2001). Buyer beware: The cost of competence. Nursing Economic$, 19(6), 250-257.
Del Bueno, D. (2005). A crisis in critical thinking. Nursing Education Perspectives, 26(5), 278-282.

The need to critically appraise a nurse’s critical thinking ability and competency (as discussed in these articles) is indisputable. However, I know of NO research that backs up Del Bueno’s method as an accurate appraisal of the above.

There are many nurses with years of experience and otherwise stellar work records who score poorly on this test. Until adequate validation by research is provided, there will always be controversy and a big question mark surrounding PBDS. Also, the use of the "medical model" and requiring nurses to make "medical diagnoses" is troubling.

Here are some valuable resources concerning the PBDS assessment:

PBDS Corporate Website

Cross-Country Staffing Guide to PBDS

Freedom Healthcare PBDS Test & Study Guide Information

HRN Performance Based Development System Study Guide

PBDS Sample Exam

Clinical One Resource on PBDS

PBDS Information (need to register to receive this one, but registration is free)

Reference

Tong, V., & Henry, D. (2005). Performance-based development system for nursing students. Journal of Nursing Education, 44 (2), 95-96.