What You Should Know about Testing for Travel Nursing Jobs

Typically, the first week of a travel nursing job is spent in orientation. This typically consists of completing paperwork, learning hospital policies and procedures, getting acclimated to the hospital and unit, and taking tests. Everything is easy enough with the exception of the tests. The tests can sometimes get travel nurses in trouble. This is why it’s highly recommended that you ask about the hospital’s testing policies during the interview. You see, some hospitals administer tests and offer remediation which allows the tests to be retaken. Other hospitals cancel the assignment if you fail.

Why do hospitals test travel nurses?

Hospital testing policies have their genesis in the Joint Commission on Accreditation of Health-care Organizations’ (JCAHO) guidelines regarding staff qualifications and competencies. For those unfamiliar with JCAHO, it’s an independent non-profit organization that accredits and certifies healthcare organizations based on their commitment to meeting certain performance standards. With regard to staff competencies and qualifications, JCAHO’s HR.3.10 stipulates, “Competency to perform job responsibilities is assessed, demonstrated, and maintained.” JCAHO defines competency as “the knowledge, skills, ability, and behaviors that a person possesses in order to perform tasks correctly and skillfully.”

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As you can see, JCAHO does not lay out specific guidelines for meeting the requirements. As a result, hospitals establish their own guidelines based on their individual interpretations of JCAHO’s requirements. This is why different hospitals will utilize different tests and have different policies regarding remediation or contract cancellation for travelers who fail the tests. The hospitals that cancel travel nursing contracts most likely believe that in the case of travel nurses, the hospital will not be able to document proof of adequate training that results in the ability to demonstrate and maintain the skills measured by the tests. Meanwhile, hospitals that remediate clearly believe that their remediation process satisfies the requirements.

What are the common tests given to travel nurses?

In any case you’ll definitely want to know everything you can about the hospital’s tests and their policies regarding cancellation or remediation prior to accepting a travel nursing assignment. You may wish to decline assignments that cancel due to test failures. Why risk the time and money involved with getting to the assignment if you may be cancelled at the outset for failing a test? On the other hand, if you know about the tests in advance, you may be able to adequately prepare for them.

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Generic tests for travel nurses

For the most part, the tests administered by hospitals are going to be very easy for you to pass. In fact, you may have already taken many of the tests through your travel nursing company. I’ve never encountered a problem with medication tests, unit tests, OSHA tests, HIPPA tests, fire safety tests, or other standard tests administered by hospitals and companies.

PBDS, EKG, and BKAT exams for travel nurses

The tests that tend to cause problems are EKG examinations, the Performance-Based Development System (PBDS) examinations, and the Basic Knowledge Assessment Tool (BKAT) exam. Everyone may be familiar with EKG exams, but if the hospital intends to cancel your contract if you fail one, then you should most definitely study up on the topic. EKG exams may measure dysrhythmia interpretation and measurements. They are designed to assess the test taker’s ability to interpret the cardiac rhythm as presented on an EKG tracing and/or perform accurate measurements on an EKG tracing.

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Many people believe these tests will pose no problem because the material is so common to their nursing jobs. However, the use of advanced bedside monitoring technology results in an environment where nurses can forget some of the basics. The exam is not going to include the familiar beeps and alerts of the ECG monitors in wide use today. I highly recommend studying for these exams in advance. I’ve had more than a few travelers run in to trouble with them.

The PBDS exam is a whole other story. If you decide to accept a contract with a hospital that administers the PBDS, then you most certainly need to study for it. The test is unorthodox in both administration and assessment. The test taker is shown brief videos that simulate clinical situations. The test taker must then determine the primary problem or diagnosis as well as all the steps needed to address the clinical situation. The test taker will record their answers by writing them down, or typing them into a computer. This is not a multiple choice exam. It’s a written examination.

The answers are graded in 1 of 2 ways. First, the answers can be graded by the company that created and markets the test, Performance Management Services, Inc. (PMSI). PMSI’s raters are clinical educators with a Master’s degree in Nursing, and an active RN license. This is a paid service. The hospital is typically charged $100 per graded test. Second, the hospital may have members of its own staff evaluate the examinations. This is typically the case for travelers as hospitals are not interested in spending money on travel nurses and do not need the detailed rating reports that PMSI’s raters provide.

You see, the PBDS is designed to determine an individualized orientation for each newly hired clinician. The general idea is to reduce the costs of standardized orientations by determining the proficiencies and deficiencies of each new hire, and then focusing the orientation on the deficiencies. So when PMSI rates the examination, they offer a detailed report that outlines the deficiencies and recommends a plan of action for the orientation. However, hospitals are using the exam only as a means to determine if travelers will be able to perform with limited to no orientation. So hospitals don’t need PMSI’s detailed reports.

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Obviously, this exposes the fundamental problem with using the PBDS as a PASS/FAIL examination. It was never designed to be used in this manner. It’s actually designed to determine strengths and weaknesses so that the weaknesses can be focused on in an effort to improve. Using the PBDS as a PASS/FAIL exam is antithetical to its true intentions.

The good news is that there are only 500 hospitals that currently use the PBDS. And a very small percentage of them administer the test as PASS/FAIL to travel nurses. In addition, PMSI claims that travel nurses have a strong tendency to score as well as permanent hires, which is most often good enough to pass. Meanwhile, pantravelers.org claims that failure rates for travelers taking the PBDS are quite low.

I have to be completely honest. My personal recommendation is to stay away from any hospital that administers the PBDS in this fashion. There’s simply too much risk involved with taking a test that’s not even being applied in its intended manner. If you fail, you’ll certainly miss out on a few weeks worth of work. There’s the orientation week and the weeks that it will take to get to another assignment. Not to mention the stress and time involved. In addition, there’s a chance that the hospital records the result in their database and maybe even shares it with other hospitals within the same hospital organization.

If you do decide to take an assignment at a hospital that administers a PASS/FAIL PBDS, then you should take steps to limit the risk. First, you should study for the exam to the extent possible. I’m not an expert on these issues so I won’t overstep my boundaries and offer direct information here. However, there are many great resources available. Simply conduct a web search for “PBDS test” or PBDS test preparation. Second, I recommend discussing the ramifications of failure with your travel nursing company. Are they willing to cover the entire cost of travel expenses should your contract be cancelled? Do they have more available assignments in the same area or state that they could quickly transition you to should you fail? Knowing these things in advance and having a back-up plan can help keep you prepared and mitigate the risk of failure.

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The BKAT has many differences and similarities to the PBDS as they pertain to travel nursing. In contrast to the PBDS, the BKAT is more of a traditional test. It is unit specific, meaning there are different tests for different units. I’ve read that the tests are composed of 85-100 questions depending on the unit. The tests tend to cover the major body systems as well as general areas of medicine common to the respective unit. I’ve heard that the questions are very similar to the questions found on the NCLEX and cover basic every-day scenarios.

Similar to the PBDS, the BKAT was not designed for “screening, hiring, or firing situations” as the creator points out. However, some hospitals neglect the creator’s intentions and use the test for these purposes anyway. There are hospitals that will cancel a contract based what they determine to be a failing score.

As a result, I offer the same advice for the BKAT as the PBDS. However, I do believe that you should be less concerned given the nature of the exam, what it measures, and how it measures. It’s simply an easier exam to contend with. Also, the creator’s web site claims that you can order copies of the exams. The web address is bkat-toth.org. However, I’ve also heard that people have had difficulty actually obtaining copies of the exams. Therefore, I recommend getting a head start if you’re concerned. Be proactive and order a copy in advance, just so you have it on hand should you need it. This could end up saving you time and trouble in the future.