Performance Based Development System (PBDS) - page 4

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? ... Read More

  1. 2
    I really appreciate your input on this issue. I understand exactly where you are coming from. As of today, 2 recruiters are contacting the hospital that did this and ask why I received the ICU "competency exam" instead of the med/surg which is my background. I spoke with a large agency today, and they had just had a meeting, in which they decided to no longer send their staff to this hospital because of the problems this "wonderful" test is causing. They also said, it is NOT an indicator for how well the nurse will do. All it does is prove they can take a test. If you fail that test, you are considered "unsafe"...well heck yea I would probably be "unsafe" in a way if I walked into an ICU to work without any training. And that is another issue. The hospitals dont want to "waste" their time educating a traveler, or agency nurse. They can't see the forest for the trees. They want improvedments in patient care, and yet they cut off their nose to spite their face!
    That is something I complete don't understand. If you are in the profession for the right reasons, then I would think if you have a travel nurse that comes to work in a facility on a NEED basis, that the hospital would be more than eager to help this nurse if she wants or needs to learn some things. That is the type of action that makes nursing better for everyone.
    So what this boils down to is the test results stated the obvious; I failed the test because I am not (as of yet) competent to work in an ICU ( and I wasnt applying for an ICU job Grrrr). well they could have saved 150.00 and just asked me! I am competent in Med surg/tele and that is all so far!
    After this ordeal, I have made a decision to NOT even consider working at a facility that uses this test to hire and fire job candidates. And apparently, agencies are trending towards this as well as nurses!
    luvRNs and dtyallen like this.

    Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  2. 0
    Im stating the obvious. I won't ever take that test again lolo
  3. 1
    Vicky RN,

    This is the first time I heard of the PBDS. Some of my friends in NY usually take a pharmacology/med math exam. Then,Depending on the unit he or she is given a tailored competency test. I am not sure if that the PDBS, but I will find out additional information and let know. This article was very informative and shocking at the same time. We have become a society of evidences-based practice. If research doesn't back of Del Bruno PBDS---why is it still in use???
    luvRNs likes this.
  4. 1
    The only things we know (and read the specific language I use): PBDS- scoring well can possibly mean you are a good nurse, but I'm sure there are nurses with poor knowledge who pass. Scoring poorly does not necessarily mean you are a bad nurse.

    I can understand about ADD making this test difficult.

    Hospitals are giving this test to travelers before they can work. The hospitals that would send a nurse home for doing poorly are catching on to the bad press and dismissing them passive-aggressively. Some states have the legal right to dismiss anyone for any reason--except discrimination of women or minorities. These travelers came to their city at some personal expense and time expense. Read this, Hospitals: It is unethical to send someone home based on these criteria. I would not trust my loved one in a hospital that would do this to people. The PBDS test has to be given by the hospital and they do not have permission to proctor it out to different cities. If you are going to do this, find a way to do the "right" thing and test people in other cities before they travel. It is wrong to have them travel, then dismiss them based on a test. Even if you no longer fire nurses based on this test, you will judge the person based on the test. Great foot to start off on for a nurse. Do the right thing and find a way to test in other cities.

    To anyone thinking of travel: hold these hospitals to a standard. Voice a concern with testing after a nurse travels. Even if one is a poor nurse with poor knowledge, they deserve the right not to be sent home after traveling to a hospital. Education departments: you can be as militant as you want to about flushing out bad nurses..or you can have a real nurse's attitude as one who builds other people up instead of tearing them down. Be someone who shares knowledge and helps the profession rather than damaging the profession. If this test is a reliable indicator of a quality nurse, the nurses should be drilled and trained in this exact method. Otherwise, you're puffing your chest out and being vindictive. This kind of bravado has got to end in nursing, or we will always be fighting for status.
    dtyallen likes this.
  5. 3
    I find it interesting that two of the three research references are by del Bueno. I'm curious as to her background. My institution consists of five hospitals in southwest Florida and subscribes to PBDS. I've known nurses, as you have stated, who are exceptional but have had difficulty with PBDS, thusly have had to jump through all manner of hoops to secure and maintain employment. Conversly, I also know of nurses who exhibit poor skills and nursing judgement that have sailed through PBDS. Until otherwise proven a reliable tool, I'm of the mind that PBDS is just another fad.
    dudette10, oldnurse1990, and dtyallen like this.
  6. 0
    I just love it when a PBDS discussion surfaces... same arguments every time.

    I work with a very large health care system. We have used PBDS for a Loooooonnnggg time. We have sufficient evidence to support continued use. It adds enormous value to our onboarding process. It enables us to identify performance gaps that need to be addressed - or to see that someone is "good to go" and only needs to become familiar with our P&P.

    Dr. del Bueno is retired from day-to-day operations, but the company has stayed true to her model. Materials have been updated to please folks that don't realize that basic concepts are unchanged even though the 'look' may be dated. Since the assessments are rated by actual human beings, we are able to customize so that the 'satisfactory' responses are congruent with our organizational standards.

    Our multifactorial data provides evidence (replicated this each time a hospital joins our organization) that PBDS is instrumental in reducing clinical error due to nursing practice problems. It also has an 'incidental' effect of reducing turnover that we see ~ 24-30 months after a facility begins to use PBDS.. the effects of improved onboarding & providing clear pathways for competency.

    Competitors to PBDS have come and gone. They try to replace the human (highly trained) raters with software algorithms & it doesn't work. Participants are asked to view a 3-5 minute video of a clinical scenario and describe what it is, what they are going to do, why they are going to do those things, and what they should do first. Not very difficult - none of the scenarios are uncommon. The human raters base their ratings on the individual's background - for instance, a new grad is not expected to anticipate physician orders in the same way that an experienced nurse would.

    BTW, there are NO multiple choice or any other forced selection items in a PBDS assessment. Everything is free text - 'downloaded' from the nurse's brain. This alone is a very scary thing for a lot of people.

    The effectiveness of PBDS can be derailed by a lack of organizational commitment to the competency development process. If they do not provide adequate educational resources, sufficient numbers of trained preceptors, and attentive managers... it will likely become just a 'flavor of the month' that is quickly abandoned in favor of the next greatest thing.
  7. 1
    I respectfully disagree with my houtx colleague above. I have also worked in facilities with PBDS and as a director often had to step in to " save" excellent staff who would have been terminated due to PBDS performance. I am a masters prepared nurse with published articles in decision-making. I have to wonder how cueing, past experience ( both as a nurse and in test- taking) come into play. I alsowonder if outdated scenarios create cognitive dissonance in answering situations. i have read, and respect, much of Delbueno's work....her testing program, no so much.
    dtyallen likes this.
  8. 1
    I was offered a job recently at a hospital where I had completed numerous travel contracts. I was tested by my agency using the Prophecy testing. As a new hire by the hospital directly, I was given the PBDS test. They did not like my results and want me to repeat it,

    If they thought I was so "dumb" why were they always renewing me and asking for FT hours on my contracts? Registered Nurses need to smarten up and SUPPORT each other instead of stabbing each other in the back!

    Del Bueno is just that. A woman with lots of alphabets behind her name, Why the PhD? She might as well just go to Medical School!

    The sooner I can retire from nursing the better. I want peace. Costco pays well and has excellent benefits and incentives.
    morte likes this.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top