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.