Pbds

I remember my CCRN exam many years ago. It seemed every patient was on a vent, had a Swan, and was on multiple drips. The answer options included changing vent settings, adjusting drips, and other things that require orders. So I guess I don't understand your comparison of the CCRN and PBDS.

You're used to protocols. Here's a patient with a history of HTN, admitted for angina, clutching his chest and left arm with rhythm changes on the monitor. Sounds like an MI, right?

Well what would the protocol for an AMI require? Assessment data such as VS, full description of pain/symptoms. Independent actions such as applying O2, assuring IV patency. Notifying the physican of findings. Anticipating orders (if not already done via protocol) for ASA, NTG, Morphine; 12-lead EKG; full lab panel to include cardiac enzymes; 2nd IV site; PCXR; etc. Anticpate transfer to Cath Lab or administration of fibrinolytics. Ongoing reassessment of VS, pain, rhythm, etc.

That's not asking you to play doctor. It's asking you recognize what's probably wrong with the patient and anticipate management to facilitate treatment.

I'm sure you were (and still are) a very good nurse. This doesn't mean you aren't. You've been away from direct care for a few years and probably need (and want) a more thorough orientation. If your facility uses PBDS as it's designed, your orientation will focus on the areas you seemed to struggle, be it the recognition of problems, prioritization, and/or management of problems.

And part of that management includes anticipating the medical management. If you called a doctor for someone with acute mental changes after a fall, you'd expect an order for a CT scan, right? Look at PBDS that way, instead of it asking you to play doctor.

PBDS has it's advantages but by no means do I think it's perfect. But...until one of us comes up with another method of objectively measuring competency...it's what many facilities are deciding to use.

Good luck to you and welcome back to the bedside!

Sun - I also had to take it and had no clue what it was before. In my hospital, there is no "failing" I didnt' do that great on it and just had to go in and talk to someone in the education who went over the ones i missed with me, then i took one that lasted abou 4 hours that was related to my unit (OB) my job was always safe, they just do it so they can see what all you need to do on orientation. Say you do good realizing one thing (there is air in IV tubing, but you miss the question about when to give a diuretic) so they go over that with you and adjust your orientation according to that. No worries!