Travel Nursing Blog

We all know that the on-going nursing shortage has created a lot of vacant nursing jobs.  This void has been addressed not only through travel nursing but also with per diem nursing as well as permanent staff “floating” to different units.  A commonly held myth developed in healthcare that assumed this use of temporary nurses was resulting in diminished quality of care and increasing the number of adverse patient events.  Turns out this myth is totally false.

 An enlightening study by the University of Pennsylvania exposes the absolute fallacy of this myth and suggests quite the opposite in fact.  This study reveals that temporary nurses tend to have higher levels of education as well as more current educational experience than their permanent counterparts.  The addition of temporary nurses provides invaluable clinical experience and also helps minimize “burnout” of the permanent staff.  In reality, the presence of temporary nurses actually accounts for increased positive outcomes for patients and increases the quality of care that hospitals can provide. 

The bottom line is that patients are in great hands when under the care of travel nurses!

In today’s healthcare environment, most travel nursing positions come with some form of competency testing to secure the travel nursing job. While there are many different forms of testing, this article will address PBDS testing or Performance Based Development System. 

What Is The PBDS?

The PBDS was designed by competency expert, Dr.  Dorothy del Bueno. The PBDS has been around since 1985 and is currently used by approximately 500 hospitals nationwide.  The intended purpose of the PBDS was to: maintain quality of care, improve cost effectiveness of education and training, reduce and prevent risks and  enhance customer satisfaction.  The PBDS was designed to help hospitals customize an orientation program for health professionals by “smoking out” areas of weakness.  Today, however, many hospitals use it as a pass / fail assessment tool for travel nurses. 

So What Does The PBDS Focus On?

The PBDS is centered on 3 main topics:  (1) Critical thinking - doing the right things for the right reasons: problem recognition, risk & problem management, differentiating of priority and urgency and application of knowledge (2) Interpersonal Relation Skills - being a good citizen: conflict resolution, customer satisfaction and team building (3) Technical Skills - doing the right things: safe performance of procedures and effective use of equipment.

The assessment components of the PBDS include:

●Sophisticated video simulations

●Visual exercises

●Audio disks

The time usually allotted to complete the test is 4-6 hours.

What Areas Is The PBDS Used To Assess And Validate?

The PBDS can be used to assess & validate all RN’s in the following specialties:

●Adult Med / Surg

●Critical Care

●Perioperative

●Perinatal

●Mental Health Units

●Emergency Rooms

●Ambulatory Care

●Home Health

●Rehabilitation

How Do I Prepare For The PBDS?

Before we discuss how to prepare, let’ first focus on the good news.  To qualify as a traveler, you must have at least 1 year current experience in your area of specialty.  In all likelihood, you have several years experience.  So, you know your job, the typical patient population you serve, and the disease processes you will encounter in your specialty. While taking the PBDS, you will be able to call on this experience to guide you through.

While taking the PBDS, you will have to consider all aspects of the nursing process.  For example:  You will be shown a video simulation.  You will be expected to identify the problem, determine what you believe the physician will order based on the information provided, and assess what interventions you will need to take and prioritize them in order of importance.  You will need to do all this while giving consideration to patient safety, use of equipment, team building, customer satisfaction and any potential conflicts that might arise and how to resolve them. 

The test also focuses on what a prudent nurse must do, should do, and could do in a given situation. 

When answering the questions, remember to write down every step you would take to promote the best outcome for the scenario.  For example:  Your patient’s morning blood sugar level is 40.  Your patient is cold, pale, diaphoretic, anxious, and experiencing nausea.  You would probably: put the patient in bed, give some orange juice, notify the physician, hold the morning glucophage, order another blood glucose level, and document the care.   Remember all steps…it is usually the small routine actions that get overlooked.  Think in terms of a step by step manner and your rationale for each step.

Refresh your memory on traditional patient diagnoses that you would see in your specialty area.  Start with the head and work down, covering all systems and related disease processes.  

Also think of some interpersonal scenarios’ that might occur in your department:  What would you do if you witnessed another nurse being verbally abusive to a patient.  How would you respond if your charge nurse asked you to orient another nurse? 

*** The PBDS does not use multiple choice questioning***

Remember to remain calm, take deep breaths and rely on your nursing knowledge and experience.  Just trust yourself and don’t let anxiety get the best of you. 

Nurses in abundance

In this third and final installment in the series, I will be discussing “The International Nurse”. With all due respect to our friends to the north (Canada) and other parts of the world, this discussion will focus primarily on nurses from the Philippines. They are - by far - the most abundant resource pool of nurses in any country in the world.

The Philippines population is roughly 8% of the population of India - yet they take (and pass) the US NCLEX test more than twice as often as nurses from India. Based on population, the Philippines NCLEX test/pass rate is 25 times higher than India - which is the next most abundant resource outside of North America.

Clearly, the Philippines is turning out RN’s at a rate which significantly exceeds their internal demand. These nurses are destined for nursing jobs abroad. In spite of a devalued dollar - and a challenged international political image - the USA remains the destination of choice for nurses from the Philippines.

Hard Working Folks

The standing joke we have with our nurses from the Philippines is that a Filipina nurse who works 40 hours per week is a part timer. Like the immigrants who built this country, Filipinos know and respect the value of hard work. The Philippines is the top exporter of labor in the world.

The immigrant mindset is most typically one of gratitude and an appreciation for opportunity. They are a loyal and hard-working people once they are employed with you.

The Challenges

One of the challenges you may face in your quest to employ a hard working international nurse is that they are heavily recruited. Most are young and lack life experience - this recipe will sometimes produce a quagmire situation. I’ve known a number of good people in these past 10 years of recruiting abroad who have been mistreated by their recruiters and agents - many of them are forced to pay fees of up to $10,000 US Dollars - then they are put on hold and given the run around. They almost always have borrowed the money from family abroad or (God forbid) the local 5-6 man (this is a Filipino term for a loan shark - if he doesn’t get paid, there will be consequences). Most often (strangely) they are being exploited by either local Philippines agents of Filipinos who now live in America.

Another challenge is that these nurses - while tracking for the USA - ultimately have poor job prospects at home. Most new graduates must work as volunteers in order to gain experience. There is almost a cast system in the Philippines nursing infrastructure. Their ability to work (or not work) is based on the following:

• Age - if you’re a new graduate over 35 years old, you will struggle to get a paid job in The Philippines.
• Gender - Men are preferred - especially in Emergency or Critical areas.
• Board Pass Score - passing is 75% - the “top notchers” (top 1%) are usually 84-85%. These folks are guaranteed jobs.
• Complexion - lighter complexion is preferred. Those with significant acne will struggle to become employed.
• Religion - 80% of the population is Catholic - this is usually preferred.

This may seem unbelievable to an average American - but I regularly receive resumes from the Philippines which contain the following unsolicited information:

• Weight
• Religion
• Height
• Type of complexion (examples are “light” and “clear”)
• Marital status and number of children.
• Pictures always accompany resumes

If those questions were brought up in a US job interview - the employer would likely be answering to the EEOC.

Greetings from Dubai

Most of the nurses - once they start processing for the USA - are still being heavily recruited to go to the UAE, Saudi Arabia or the UK. These nurses have no other means of supporting themselves locally due to the significant nurse surplus in the Philippines. Often, they struggle to find the courage to discuss this with their US employer before they move forward.

I have gotten more than a few emails from nurses (who had been hard to reach for a while) which opened with the greeting,

“Dear Sir Matt: Greetings from Dubai!”

Because they are so strapped for cash - they take an assignment abroad before talking to their US employer. This is also due to the fact that the timelines for US immigration FAR EXCEED the timelines in the rest of the industrialized world. Fortunately, the short term Saudi or Dubai assignment usually has little impact on their US processing.

All Things Considered

Employing nurses from the Philippines is usually a very positive experience. I have experienced an occasional problem employee - but they are few and far between and are most often ostracized from the core groups due to their disrespectful actions.

Filipino nurses have been a great pleasure to work with. They are hard working, dedicated, very well trained extremely loyal - and very family and community oriented.

Lets just hope that we in the USA can get out of our own way and open immigration back up to a level which may help us head off disaster in Health Care.

Time For Some Action

If you’re a nurse living in the USA, please click on the following link: http://capwiz.com/sjhs/issues/alert/?alertid=11498866 and tell your legislator that it is time to do something about healthcare immigration reform. If you plan on accessing healthcare anytime around 2020, your life could depend on it.

For more information, email info@expedientmedstaff.com or call 877.367.8770 and ask for the Foreign Recruitment Department.