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Why Do Some Nurses Find PBDS Controversial?

Higher Education Articles August 19, 2013

The Performance Based Development System, or PBDS, is an individually customized exam that evaluates the competency of hospital staff, particularly that of nurses. The exam focuses on three main areas of critical thinking, inter-personal relations and technical skills in one of four nursing specialties: medical surgical, critical care, neonatal ICU, and OB.


After studying a report of an abnormal clinical scenario, relying primarily on photos and video clips, nurses are required to diagnose the problem, determine the best immediate response and provide reasoning for that response. In addition to accuracy on the test itself, an individual’s performance on the PBDS is based on attention to detail, level of anxiety and several other behavioral factors. Since final scores are evaluated against the performance standards of a particular hospital, a passing score may vary by location.


The PBDS nursing hospital program is often used as a supplement to orientation processes for new nurses. After studying a nurse’s responses to the exam’s questions, hospital administration is able to pinpoint areas in which improvement may be necessary. If nurses fail the exam, they are frequently required to undergo remedial training. This process can last up to six months, or until they are able to pass the exam. However, when used as an evaluation of temporary, or travel nurses, a performance considered unsatisfactory by the hospital will generally result in a cancellation of the nurse’s contract.

Accuracy Issues

The controversy over the PBDS is not related to its utilization in various scenarios, but to the validity of the test itself; most individuals claim that a nurse’s performance on the exam does not provide an accurate competency assessment. Although the PBDS official website claims that the test’s content has been researched by qualified organizations, no official documentation has been provided. At least in part for this reason, most individuals argue that hospitals that base employment decisions on the PBDS are relying on an exam that not only lacks credibility itself, but is often graded by unqualified individuals. This claim is supported by the fact that most experienced nurses have failed the test despite outstanding personal records, resulting in a possibly unjust cancellation of their contracts or an unnecessary reorientation process. Some examinees also claim that the reorientation process does not provide the information necessary to pass the exam the second time, such as study tools, indications of areas requiring improvement and so on.

Relevancy Issues

In addition to its accuracy, the relevancy of the test has also been called into question. The PBDS is an appraisal of a nurse’s critical thinking, relational and technical skills. The results of the exam are intended to be indicative of a nurse’s competence in actual clinical scenarios. But many argue that determining advanced medical diagnoses and the like requires the expertise of a doctor, not a nurse. The knowledge and experience necessary to provide accurate responses to the scenarios depicted in the video clips does not necessarily fall under a nurse’s expected skill set. As a result, most individuals argue that the PBDS cannot accurately predict realistic behavior, since the skills tested are not relevant to a nurse’s responsibilities.


In spite of these concerns, most other individuals do consider the PBDS to be a reliable test of a nurse’s competence. By posing challenging, abnormal scenarios to examinees, the PBDS can indicate the way that nurses would react in actual high-pressure situations. This ability of the exam can be beneficial regardless of its technical relevancy. If nurses respond to challenging scenarios with anxiety or confusion, they will likely respond that way in reality, whether or not realistic problems are similar to those depicted in the PBDS.

For this reason, the PBDS, although controversial, remains one of the most popular orientation and competency exams available. Currently, there are over 500 hospitals nationwide administering the exam and use its results to determine the most logical methods of nurse training, positioning and employment.

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