EKG Competency fail

Specialties MICU

Published

Hello everyone, I am hoping for some feedback on a work situation. I am an ICU nurse and we hold mandatory competencies annually. One component is an EKG test. It is the typical test with identifying the rhythm. I have taken countless of these tests in all my years and never had a problem. Well...this past year I failed along with 55% of the nurses on my floor. This is a large hospital and the nurses are very intelligent with a wide array of experiences. I'd like to think I am smart too, btw. Anyway, we were given the opportunity to take the test again, many of us passed. Phew!

I was then presented with a disciplinary write-up to sign.Huh? How is this action disciplineable? I was told that passing the EKG test isa job requirement so I was subject to discipline. Everyone else also was disciplined. I might add that there were a surprisingly large percentage of nurses that had to retake this test twice. They were told that their job would be in jeopardy if they failed a third time. Why are we failing the test? Strips that are marginal, difficult to read, could be sinus tach or sinus rhythm when presented with a strip with a rate of exactly 98 bpm (or is it 100?) The possibility of buried p-waves, has anyone heard of a "very slow afib" with arate of 45? Etc. Most tests I have taken, the strips are obvious, or at least fair if you know your rhythms.

I believe the test was flawed. With failure rates like this,the problem is usually the test giver, not the test taker. In this case, the test giver is a power trip kinda person. Anyway, my manager feels the same way I do. Why would she want to lose nurses over an EKG test? She is not in a position (or maybe doesn't want to be in the position) to do much about it but I am meeting with her boss...the director soon.

My goal is to get the write-up out of my file but the broader goal is to change the process surrounding this test, the punitive nature of failing and the added stress going into this. What information do you think I should bring to the director that will make her take this seriously and not just say "Well, it's been like this for a long time" or "Policy dictates,yada yada". I don't want her to blow me off

I want to bring her information like "At the University level, a high failure rate such as this would warrant a review of the test" or "Most ICU nurses are internally motivated to review knowledge regularly and do not require additional pressure of written disciplines". I'd like to have some data. Any ideas? Thanks

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Yes I have heard of slow a fib especially in the presence of dig toxicity. But with that large of a failure rate something is wrong and then to be disciplined? What is that? Are they looking to downsize without paying unemployment are are using this as a means that you were responsible and therefore they are free and clear??

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...Are they looking to downsize without paying unemployment are are using this as a means that you were responsible and therefore they are free and clear??

Thats the first thing I thought of too.

Is the test giver newly hired/promoted? Do they have something to prove? Are they in education?

I agree something is fishy there. If they are in education, it is their job to make sure the nurses are educated, not by failing them on a test, but by teaching them. Such a high failure rate is a sure sign of something not right with the test.

No idea on what you can present to your boss.

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Thanks for the replies. This has been going on for a very long time. An educator who is nearing retirement, people have just accepted this forever. I haven't heard of anyone being fired over this.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Are you new to this facility? Have you passed theirs in the past?

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Specializes in ER, progressive care.

I always learned sinus rhythm as 60-100, so therefore anything >100bpm is considered sinus tachycardia. And I too have heard (and seen) slow a fib.

I also agree, something just doesn't seem right. As far as what to suggest, what about an EKG review course?

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We have a mandatory EKG test annually also. We have practice strips to work with and the answer key contains several errors. I have pointed this out to the head of Training and Development as well as the nurse who oversees the Rhythm test but their response is that the test/practice test was put together by a former employee. I'm not sure how that addresses the problem but that is their answer. That said, we do get to repeat the test if we do not pass and as long as it is done before our anniversary date there are no repercussions. If we do not pass by that date we cannot work until we do pass but I have not experienced this, thank goodness.

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Specializes in pediatrics, geriatrics, med-surg, ccu,.

When I was actively working, we also had a mandatory EKG test annually. There were 2 different tests that were given. One year there were numerous people who failed the tests. What they found was that the tests had been copied so much that there were numerous strips that were very difficult to read. Maybe you could bring that up at your meeting as a possibility? The facility I worked at did at least look for some errors and reasons why so many had failed that year. The next year they had new tests that were more updated, a larger variety of strips and they also did self study packets that everyone could request prior to the testing. It was a big help. Hopefully you will be able to discuss the situation and have some input as to the "whys". We also never were given a disciplinary paper either. We were given 10 days to re-take the test and if failed a second time, you were removed from working until the test was passed.

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I'm wondering why you need to do an EKG competency. Aren't you all ACLS certified? Doesn't that qualify as your competency? I wonder what would happen if you'd written on the test strips "unreadable." The point of being able to read a strip is that---TA DA! You can read it!! And any educator will tell you when 55% of students fail a test there's something wrong with the test.

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Specializes in ED, Informatics, Clinical Analyst.

OP sounds like a frustrating situation where you were set up to fail. Over the years, I have seen some atrocious EKG tests where the strips are a barely readable copy of a copy of a copy and the rhythms are ambiguous like your 98bpm strip. The point of a basic rhythms test (which I'm assuming this was) shouldn't be to trick you, and continuing education and competencies shouldn't be implemented for the purpose of disciplining staff. Good for you for speaking up about it. If other nurses are concerned maybe you guys could go together? You could also suggest that they offer some continuing education on EKG reading if they feel the test is valid. That way you are offering a solution and showing that you and your coworkers have a desire to improve and take these competencies seriously. Good luck!

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You have all given me some good talking points, and my goal is to find a solution and to change this process of testing without discipline. I believe there is more underneath this situation but I'd like to see a culture change to a more non-punitive system. My coworkers are supportive, there are some very talented nurses with many years of experience and they are also failing. This should be a basic EKG test and it is extremely advanced in my opinion. We do have a review course given by the same person writing the test but there are still areas that seem grey. I am not new to this facility and have passed every other time but I didn't know about the whole hassle that comes with failing until now. I don't get why my coworkers have been quiet about this. Maybe I'll find out! Ugh!

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I have put together a few talking points for my meeting, some based on your responses. Thank you very much! I am not new to this facility and have passed in the past but like I said, this has been a problem with some of our best nurses for a while. After failing myself, I figured others have had this problem so after talking to the staff I have heard this has been a fight for a while which is why I was asking for your help. As we know, some people get 'institutionalized' in a way that they think their hospital has the right way of doing things and there is no other way. I am someone who has worked at other places but a different perspective isn't always welcomed. Anyway, thanks for suggestions!

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