The Performance Based Development System (PBDS) is a customized competency assessment process that evaluates the hospital personnel’s ability to do their jobs. This test has gained a foothold in many large hospital systems throughout the country, and many travel nurses at some point in their careers may encounter this test for consideration for a temporary travel nursing assignment.  
The PBDS addresses staff or travel nurses’ competency in three skill sets: critical thinking (problem recognition, risk management, priority setting), inter-personnel relations (team building, conflict resolution, customer satisfaction) and technical skills (safe, effective, efficient skills). The responses travel registered nurses (RN’s) give to this test are then evaluated against standards set forth by the hospital.
Used effectively, the PBDS test can supplement orientation efforts in an area that a new RN may be weak in; however, for travel nurses, an unsatisfactory completion of the test results in termination of the temporary travel nurse jobs.
What the authors of PBDS are looking for is critical thinking skills.  Can this nurse think on his or her feet, recognize a problem and take the appropriate actions? Problem recognition is usually manageable by many RN’s, but the ability to give complete normal and abnormal data so an MD can manage problems over the phone will help RN’s anticipate orders as well as help their overall patient care management.  
If someone has done the test before, then they do not have to redo it.
If you have taken this test before then you do not have to retest.  Just supply your name, where you took the test and the date, and the hospital will confirm the test results and if you have passed then you will not have to test again.  
Personal Guidelines
  1. Dress up and be neat and groomed – your appearance is being judged.  If you look inefficient, unkempt, hair a mess, the test will not go well as they will judge you on this. 
  2. Do not express anxiety – this is graded against you, nursing RN’s are expected to be cool, calm and efficient under pressure while saving lives.Take a copy of your work history with you and give it to them.  The instructor grading the PBDS is making a value decision on your abilities so knowledge of your past work experience helps.
  3. This is a subjective test.  They can give you a few more minutes to finish or not. 
  4. There is a time limit for each video.  The computerized PBDS will cut off after 7-8 minutes

What they want the nurses to know is that they are going to have to do this test first thing on Monday morning and there is no re-testing. 

General Guidelines
1.     Follow the instructions – this is the most important!!!  Here are the Instructions:
a.       Watch the video.  You have a 30-45 second video that you CANNOT re-see so you need to concentrate on what is going on.  Look at the vital signs, the urine bag, the time on the clock, the change of time, the patient’s complaints and appearance.  MAKE NOTES.
                                                              i.      Do not read the script while the video is playing.  Read the script after you see the video as the script does not have all of the information on it. 
                                                             ii.      Remember the script is like the overview of their chart and chief complaint.  The problem that the patient develops is going to be a different issue from the diagnosis.  The patient will be in the hospital for one reason and then something will occur that causes another set of problems.  Identify the acute problems – not what they were admitted to the hospital for which is on the sheet they hand out.  Example: the patient will be in for a bowel resection; suffered bleeding in the OR in the script, but what the video shows will be clear symptoms of pulmonary embolism. 
                                                          iii.      Remember the patient will be having a problem or reaction that will require critical thinking skills to save his life or to intervene.  Assess the critical thinking.  Look at the history, why is the patient there and identify what is the critical data.  Class this by what problem is most urgent, second urgent and so on. 
b.      Identify the abnormal signs, symptoms and problems. Do not worry about medically diagnosing because you can write renal failure or you can write down the abnormal signs and symptoms like decreased urine output, abnormal labs – bun, creatinine.
c.       Notice abnormal signs and symptoms and what you, as a RN in nursing, want to communicate to the MD.  It is critical that every abnormal result in the video is communicated to the MD so that the decision that the MD makes is the right one. 
d.      List what abnormal issues or results you would report to the MD and the urgency of each of these. 
                                                               i.      Example: If the patient is not breathing, this takes priority over decreased urine output (this would be simple if you are at the bedside but becomes harder to decide what is important when you are on paper or computer). 
2.       If you do not follow the instructions about urgency you will fail.  Ask questions if you do not understand.  Get it in your head to try to relax, listen to the instructions and do what you have to do for your patient. Identify all essential data for each problem the patient has and get the information down. 
a.       Remember that patient’s safety is the number one most important thing.
b.      Urgency is second important.  List out the critical urgent issue. Detail out the list of what is going on with the patient. 
c.       Problem recognition is critical, but you must join that with problem management.
                                                               i.      What is your nursing assessment?
1.       What assessment would you do?  Close your eyes and imagine you are actually at the bedside and what would you do first? 
                                                             ii.      Use clinical judgment. 
                                                            iii.      Be specific.
                                                           iv.      Record abnormal signs and symptoms and communicate these to the MD.
                                                             v.      What would be the follow up monitoring?
                                                           vi.      Determine the urgency. Example: Make sure the patient gets O2.  Unspecific urgency is a significant error. You must outline what is the most important action that you will take. 
                                                          vii.      Communicate all abnormal events to the physician and anticipate his or her orders. 
1.       What would the MD order and why?  What is his or her rationale?  Why?  Why not? 
4.       Make sure that what you write is complete.
5.       Critical thinking skills pertaining to problem management is what the test-givers are looking for. 
6.       Follow the directions EXACTLY. 
The test will look like this:
What’s Wrong?                                What will you do?           Why? (Rationale)            

Hospitals will usually create training programs for their staff after they look at the results and what their learning needs are. Hospitals are unwilling to do this for any travel nurses from a healthcare staffing agency. Nationally there is a 60 – 70% pass rate. Most hospitals DO NOT allow re-testing for traveling nurses.

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