what the HECK is PBDS?

Editorial Team / Admin · Aug 13, 2006

hello texascowgirl,

review these threads. should answer your question/s.

performance based development system

texascowgirl · Aug 13, 2006

well i looked at those threads but i still dont really understand what it is or which states use it. i have NEVER EVER heard of it or taken it and i have practiced in many states, but mostly Texas. to me it seems silly, you pass the NCLEX and you get your RN licensure...that should be enough, huh? what states use this????????

Editorial Team / Admin · Aug 13, 2006

Hello again

It isn't state-mandated. It is according to entities.

texascowgirl · Aug 13, 2006

well i figured it wasnt state mandated, but am curious as to what entities seem to like to use this? certain big hospital systems? if so, which ones? e.g. HCA, Tenet?

nightingale, RN · Aug 13, 2006

When you get a contract, I would strongly recommend calling the facility you are going to and see if they require it. It would be nice to think the Agency will tell you about it but that does not always happen. There have been stories on the BB that Nurse travel to facilities, take the test and fail, then are not accepted to that facility and are cancelled.

Please take the time to read the articles and links (thanks siri) that have been offered by siri.

NurseguyFL · Aug 13, 2006

well i looked at those threads but i still dont really understand what it is or which states use it. i have NEVER EVER heard of it or taken it and i have practiced in many states, but mostly Texas. to me it seems silly, you pass the NCLEX and you get your RN licensure...that should be enough, huh? what states use this????????

Let me try to clarify it for you. I had to take this test when I took my first nursing job, and even though we were prepped for it there were many people who still did not pass. It is supposedly a test to assess your nursing competency. I say "supposedly" because it really does nothing of the sort.

You are shown a series of video vignettes, each with a different scenario involving a patient with some type of acute illness. The vignettes are very short, only about 30 seconds long. During that time, you have to try to figure out what is going on with the patient based on the what the patient says, how the patient is acting, and the lab values and or medications the patient recently took (all of which will be flashed in front of you for only a few seconds.) Then the video ends and you have no more than about 5 minutes to write down a medical diagnosis for the patient and to state exactly what your immediate interventions will be for that patient. You have to keep your eyes on the video without looking away even for a split second otherwise you will miss some of the clues that are flashed on the screen. Also, they give you a small area on the paper on which to write the interventions so you have to write like an ant to make it all fit. The other thing is that you must stop writing and look back up at the screen when the next vignette begins otherwise you will surely miss out on some of the clues that are given for that one as well.

I don't see PBDS as an appropriate tool for evaluating a person's nursing skills. You could be the most brilliant and efficient nurse with 30 years of experience and still not do well on this test because of the way it is administered. They get you for stupid things like 'you didn't write down that you called the doctor for orders', or 'you didn't write down that you obtained IV access', or 'you didn't write down that you would hold the next dose of dig (for a person with dig toxicity)', 'you diagnosed the patient incorrectly'. I doubt that most nurses would neglect to do these things, its just that one would assume that some of these things are already done. Surely you are not going to attempt to give an IV medication to a patient who doesn't have IV access, surely you are not going to give another dose of dig to a person with dig toxicity, and surely you are not going to arbitrarily give medications to a patient without an order. There is just no way you are going to remember to write every single detail down when you're rushing to do it in only a few minutes.

Also, I don't agree with challenging nurses to write up medical diagnoses on any patient. Just because we may think we know what is happening with to patient doesn't mean that's what it is. Diagnosing patients is outside the scope of nursing practice in every state. In real life, no nurse would ever be asked or expected to diagnose any patient under any circumstances. This is why I say PBDS is foolishness.

NurseguyFL · Aug 13, 2006

well i figured it wasnt state mandated, but am curious as to what entities seem to like to use this? certain big hospital systems? if so, which ones? e.g. HCA, Tenet?

From what I have been told, the big for-profit operations like Tenet and HCA do not use PBDS. Reason: it is very expensive and they do not want to spend money on it so they do their own in-house nursing training and evaluation.

texascowgirl · Aug 13, 2006

this PBDS things sounds like a bunch nonsense. i would REFUSE to work for any hospital that requires me to take it. i have my TNCC, ACLS, PALS, BCLS, and 14 years RN experience in many critical care areas and a license in good standing and good referrals. if that aint enough to prove that i am worthy, i dont need em.

tddowney · Aug 13, 2006

If they give you 30 seconds to evaluate the pt, and a few minutes to diagnose, document, etc. perhaps that's what they expect from the patient loads they have on the units.

lcraigbsn · Aug 15, 2006

i have read the other threads re: pbds and am getting a bit scared. i am on my first travel assignment in reno, nv, and thankfully did not have to take that test. but what about the other places i go to? i am going to email my recruiter right now. thanks for the heads up.

loretta

NurseguyFL · Aug 15, 2006

i have read the other threads re: pbds and am getting a bit scared. i am on my first travel assignment in reno, nv, and thankfully did not have to take that test. but what about the other places i go to? i am going to email my recruiter right now. thanks for the heads up.
loretta

Loretta,

If the recruiter tells you that you have to take the PBDS just remember that the version of the test that you will be given depends on the nursing specialty area that you will be working in, and how you are graded depends on the amount of nursing experience you have. For instance, if you plan to work in ICU the videos that you will see in your test are different from the ones that would be given to a med surg nurse. The ICU test is a bit more difficult and you have to know your meds, drips, and critical lab values. If you are taking the med surg test and your patho is a bit rusty then get a med surg text and do a quick review of some of the most common conditions and treatments. Some of them are simple... things like acute pain, bowel obstruction, hypoglycemia, DKA, dig tox, appendicitis, DTs, MI, and CVA. The ICU videos include things that are a bit more complicated like acute thyroid disorders, trauma cases, post-surgical complications, arrythmias, etc. They have a video for just about every possible acute care situation and the videos are randomly selected for each administration of the test.

Make your responses to the videos be concise bullet points, not sentences (you won't have time)! Make a bulleted list of everything you can think of in classic textbook format. If you don't finish writing everything before the next video begins, stop writing and look up at the screen. They will at least see that you were on the right path and that you simply ran out of time. They do give you a few minutes after the test to go back and add things that you might not have had time to finish writing down. The important thing is that you get the dx correct and that you at least stated a few things that are appropriate to treating a patient in that condition. They do not regard the order in which the interventions are listed so don't go crazy trying to get them in perfect order. Just remember that, for every case, you MUST write that you called the doctor to inform him/her of your observations and any pertinent labs AND to obtain orders, and in some emergency situations you MUST write that you will stay with the patient and call for help. In cases where rapid administration of IV drugs is anticipated you also MUST write that you assessed for and or established IV access. If you get a video with acute pain you MUST write that you re-assessed for pain relief after giving pain meds. And, if you get a video with a patient rapidly becoming unstable and with critical labs, you MUST state stat assessment of the ABCs, stat notification of MD, and stat preparation to transfer the patient to a higher level of care (ICU). Believe me, they WILL get you for all these things if you forget them.

They will expect you to anticipate and write down the names of the drugs that the doctor will order to be given to the patient. I even got a video with a telemetry monitor showing a potentially dangerous arrythmia. I couldn't remember the name of the rhythm but I knew it was a bad one. I hardly knew anything about ACLS protocols or antiarrythmic drugs at the time so I wrote 'obtain MD order and initiate antiarrythmia protocols stat'. I got away with that one, but I'm told they would expect an experienced nurse to name the arrythmia and also the drugs that are given to control and convert it. Be careful with this one though. If the video is a code blue situation you obviously will not write that you are going to put a call out to the MD and wait for orders, but you still have to write that you notified attending MD of patient status after calling the code.

Also, the PBDS administrators ask beforehand what your level of nursing experience is, and they grade your work accordingly. Ergo, they will let a new grad with no experience slide with stuff that they would harshly criticize an experienced nurse for. When I took this test, I sat it with nurses who are far more experienced and knowledgeable than I am. I passed it with a comment "acceptable for a new graduate with limited nursing experience" but some of the others failed with comments like "sub-standard knowledge and delivery of care for a professional at this level of nursing experience." This doesn't make any sense to me because I know that some of the nurses who did not pass the test could run circles around some doctors that I've worked with when it comes to acute and emergency patient care.

After the videos, there is another part of the test that assesses your communication skills. You will be given a set of written scenarios that asks you to write down your response (as a professional nurse) to something that a doctor or a patient says to you. This is just like the communications part of the NCLEX. For instance, a psych patient asks if anyone has ever jumped out the window. What is your immediate verbal response? What is your immediate action? A doctor complains to you about the incompetence of the nursing staff on your unit. How would you respond?

Then there is another part of the test that assesses your prioritization skills. They expect you to state in each given scenario whether it is appropriate to notify the MD stat, within a relatively short period of time, whenever you have time, or whenever she/he is on rounds. They may give you a scenario with a patient complaint or some lab value that may or may not be critical (you will have to know whether the value is critical or not because they won't give any clues). Will your intervention be stat, can it be put off until later, or is it that no intervention is required because the situation is expected as a part of the patient's acute condition? Don't write 'it depends' unless you state exactly what it depends on, otherwise they WILL get you for not being thorough and for being unsafe.

PBDS is not hard, but it is the anxiety that gets some people.