PBDS Update

[VickyRN]

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.

[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.

[Brynn93]

Our hospital just began using PBDS 6 months ago. All of Administration is harping at us to be supportive of its use. But I find that difficult when it makes competent, experienced nurse doubt their judgement. I don't care if it does say they aren't safe, I have worked with many of them and would trust them with my life.

In addition to the damage it is doing to experience RN's--news has already spread "word of mouth" to the area nursing schools. And guess what? GN's are looking for other facilities rather than have to face PBDS.

Has anyone worked at an institution that discontinued its use? If so, what justification did they use to accomplish that?

[judy ann]

quote:

pathophysioolgy and treatment of the diseases has not changed drastically in the last 30 years

I don't know about other specialties, but Labor and Delivery 30 years ago would be unrecognizable today. I know, I was there. Fetal heart tones were auscultated every hour for 15 seconds and multiplied by 4. You never listened just after a contraction as they would be slower at that time! Blood pressures were taken every 4 hours even on pre-eclamptics. Few nurses knew how to access DTR's, that was a doc's territory. There were no monitors, no dads at delivery, (let alone grandmas and neighbors and passers by) no epidurals, and the closest to "natural childbirth" was Robert Bradley's Childbirth without Fear. (Having worked with him, he scared me more than childbirth.) Moms stayed in bed for one to two days, and went home on the third. Babies lived in the nursery, and went out to moms to feed. If they were bottle fed, they did not go out at night, and the breast fed babies could be fed in the nursery if mom requested, or her nurse felt she looked tired. C-sections often stayed in house for a week, and once a c-section, always a c-section. Most docs did not want their moms to have more than three sections, because their uterus would rupture. The entity of HELLP had not been discribed yet. Many researchers thought that toxemia was caused by too much protien, or too much salt in the diet. This was just the tip of the iceberg of OB nursing 30 years ago. If nurses in this specialty must be judged on those standards today, only those of us that have been around a long long time could even begin to pass.

[MayoRN]

Has anyone taken the PBDS nursing exam at a UPMC hospital or anywhere? Are there any nursing sites to review for this exam? I have to take this exam soon, and really scared.

[debRNo1]

Originally posted by MayoRN

PBDS nursing exam

I took the PBDS last year prior to starting my job at the hospital.

It was described as an "assessment" and it is used to consider how much orientation you will need ??

Mine was at a sister hospital (during a blizzard) and there had to be 200 nurses there. Not the ideal setting.

Im sure its pretty much standardized this is how mine was......

First was a response type questions-How would you reply if the patient said,...............mostly common sense answers.

Then there were priority questions- what would you do first, second, ect, and what could you leave for the next shift. Common sense again like you wouldnt continue to punch your card while a visitor is clutching his chest in the hallway

Then there was the video portion where you must identify what is happening with the pt. They give you very little info and you must pretty much make a dx and list your interventions. MI, renal failure, CVA, transfusion reaction, DKA, ect. They were timing it and thats where I thought I could have used a little more time to write everything down.

Lastly there were pics of all kinds of IV problems and they needed to be ID'd. infiltration, cracked bottles, leaky sites, ect.

Maybe review the above mentioned dx's to be able to ID them its not really something you can study for and its mostly common sense and they shouldnt count it against you just teach you more on the job.

lots of luck

deb

[Larlar81]

I have never heard of them before, but now as I look over the schedule for my orientation that starts this Monday at Pennsy, I see PBDS on the first day! Yikes...did not even know what they were!

Laurie

[CC NRSE]

i have taken it a couple of times. some hospital require it (like someone else said) to determine how much orientation you will nees. others require it (in my case as a traveler) to determine if they will hire you for short term work. it basically gives them an idea of your assessment skills. don't worry,...it's not that bad!! :)

[Jill - Pa]

I work for a UPMC hospital and had to take the PBDS prior to starting employment ( 2+ years ago).

Deb provides a great summary.

My advice would be to sit close to the television for the vignette portion.

It is supposed to be a measure of employee competence. It is supposed to help tailor your orientation to best meet your individual needs.

[xantha31669]

I had to take them during orientation as well. There were a few tricky ones in there. One of the IV's was a cracked bottle, which it was hard to see. The biggest thing is get as close to the TV as you can because some of the things are hard to pick up. Good luck they are not that bad.

Lori

[Teyrnon]

I was wondering if any one had to take this PBDS assessment over again. I thought this was an assessment tool for one's orientation program. I have taken this assessment at another job. It was handled very differently. This new hospital is making me take it again? I have 18 year experience in critical care. I have a BSN and CCRN. I am really confused to the point of this. DebRNo1 has really painted the whole show. Any ideas?

Cathy

[judeebea]

I've taken the PBDS once before as a traveler. I was told, also, that it's a tool to assess your orientation (not a pass or fail). The next job I take as a traveler depends on my passing this. Go figure!

[caroladybelle, BSN, RN]

As a new grad/regular staff, they assess your level of knowledge and note areas to work on.

As a traveler, they are assessed to indicate whether you can work for them or not, not the original intent with which they were created.

There are several threads (long ones), that can be easily accessed by doing a search for PBDS.