ICU uses BKAT spinoff to test its pediatric nurses

Nurses in the pediatric ICU at Pennsylvania State University Geisinger Children’s Hospital in Hershey have been successfully using a basic knowledge assessment tool that is believed to be the first devised to specifically assess nursing skills in pediatric critical care.

What began as a research study into developing criteria for a test similar to the widely used adult Basic Knowledge Assessment Tool (BKAT) has led to a standard BKAT in pediatric ICU nursing.

The hospital uses the PEDS-BKAT to test all nurses, including recent graduates and those completing the hospital’s two-year internships in critical care, according to Jody Stabinski, RN, CCRN, acting nurse manager for the seven-bed pediatric ICU. "Everyone takes the test every two years," she notes.

In 1992, Penn State nurse educators looked at the possibility of developing a BKAT in pediatrics after determining that the adult BKAT fell short of covering necessary pediatric skills. The PEDS-BKAT is a 100-item written test that contains questions in three major content areas, according to Stabinksi: 1) patho-physiology; 2) disease processes; and 3) technical components of pediatric ICU care.

Individual questions fall into eight categories of body systems disorders, including cardiovascular, pulmonary, neurology, renal, and parental. Many of the questions either were adopted or modified from the standard adult BKAT Version 4.

A nine-member educational task force at the hospital composed of ICU RNs validated the test’s content for accuracy and relevance to the pediatric ICU.1 The hospital has been using the test to evaluate nurses since 1995.

To achieve a passing grade, nurses must get at least 85% of the answers on the test correct. The written test is composed of a series of multiple-choice and true-false questions. Typical test questions include:

• An early sign of decreased cardiac output in infants and children is:

    1) Hypotension
    2) Decreased level of consciousness
    3) Tachycardia
    4) Cyanosis

• Your patient is on a ventilator. The low-volume alarm sounds. This may be due to:

    1) Pulmonary edema
    2) Decreased secretions
    3) A disconnected tube
    4) Biting the tube

"The test is helpful because it pinpoints problems involving where a nurse’s skills are lacking. Once we’ve determined these deficiencies, we can work with a nurse individually on improving knowledge areas," Stabinski says.

Nurses who score below 85% on the test are assigned for help to a nurse educator and are required to take on-the-job training before being allowed to retake the exam.


1. Runton NG, Toth JC. Introducing the basic knowledge assessment tool for pediatric critical care nursing (PEDS-BKAT). Crit Care Nurs 1998; 18:67-72.