Question of the Month: To What Degree Should ECG Interpretation be Taught?

[VickyRN, MSN, DNP, RN]

As most are aware, there is a move towards "the nurse generalist" in undergraduate nursing programs and a move away from the tyranny of "additive curricula." Nursing educators are veering away from in-depth teaching for specialty areas and are now concentrating on the "basics" for a graduate to make a safe, effective beginning level registered nurse.

Consultants from our board of nursing are suggesting to nursing programs throughout the state that we cut out everything but very basic ECG interpretation from our curriculum. We have serious reservations with this, as most floors in acute care facilities have patients on telemetry (med-surg, pediatrics, step-down units). We approached our main stakeholder and employer of our students (a prominent teaching hospital) about their thoughts on very basic ECG content, and they do not agree with this at all.

I am also asking you, fellow educators and others on the board - What do you feel about this issue? Thank you in advance for your valuable insights :)

[purplemania, BSN, RN]

Many nursing schools require ACLS certification before graduation. Therefore I believe we ought to teach as if everyone would need the knowledge.

[Tweety, BSN, RN]

ECG interpretation is something of an art, and if you don't use it, you loose it. I would think to thoroughly teach it would be too time consuming. I've taken it as a separate 3 hour credit course the last time I took it.

I say teach the electrical conduction system. The normal rhythm and what each part of the pqrstu means, and some common variants like a fib., and esp. the lethal ones and leave it at that.

I've taken ECG interpretation courses three times over the course of my career because I don't use it everyday and forget. I really got a handle on it when I started working in telemetry.

[UM Review RN, ASN, RN]

ECG interpretation is something of an art, and if you don't use it, you loose it. I would think to thoroughly teach it would be too time consuming. I've taken it as a separate 3 hour credit course the last time I took it.

I say teach the electrical conduction system. The normal rhythm and what each part of the pqurstu means, and some variants, esp. the lethal ones and leave it at that.

I've taken ECG interpretation courses three times over the course of my career because I don't use it everyday and forget. I really got a handle on it when I started working in telemetry.

I agree.

[live4today, RN]

I voted to teach the full gamut of it due to the various hospital units I've worked on as staff, as a travel nurse, and as an agency nurse. Each hospital is different, but in the past couple of years I've worked in university hospitals that require their nurses to be able to take their own ECGs on the unit (must learn placement of the leads, etc.) as well as EKG monitoring and be able to call the docs with the readings. In some places I've worked, more is being required of the nurse so might as well give them a full monty on these things because it will be one less thing the nursing grads will have to be anxious about when they do begin working. The exposure in clinicals during school is great to have. Helps ease the transition into the real thing when they graduate and pass boards. The more they know, the better.

I've had PALS...never used it. I've had ACLS....never used it but it is still active. Heck, I've always had BCLS for the healthcare professional, and in eighteen years of nursing have never used that either. Annual training in these things is important because the more knowledge the nurse has in the care of a patient, the more capable the nurse will feel when floating or changing units within the hospital. My motto is always be prepared with whatever training is available to you.

Telemetry monitored patients (with the actual monitoring of those patients) is becoming more and more commmon on medical and/or surgical floors. Those floors are getting the "step down" icu patients per se. The patients are sicker and more complex today, so it is no longer the icu/er nurses that need to know said things, but your "nurse generalist" on the floors.:)

[KaroSnowQueen, RN]

I am not an educator but I vote for a thorough education. After several (MANY) years as a nurse, I took a job on a telemetry unit, and what little I had previously learned only frustrated me. I had to take a complete course to supplement what little I had been taught.

With the advances in technology and more and more units and situations requiring cardiac monitoring, I vote for the whole enchilada. If you never use it, well a little extra knowledge never hurt anyone, but if you do need it, and even if you need a refresher course, there's a WHOLE base to draw from and not just some bits and pieces.

[llg, PhD, RN]

I speak from the perspective of a staff development educator (who has a little university faculty experience) ... not from the perspective of a full time faculty person.

Any nurse who needs more than the basic, introductory material SHOULD get it in their orientation program. If the employer does not provide that education, then the employer is deficient. Because many nurses do NOT need the more advanced material in their jobs, it is unreasonable (and unsafe) to assume that everyone they hire will have expertise in this specialized skill. Those who went to school a few years ago and not used it since will have forgotten much of what they learned, etc.

Therefore ... if an employer should be providing it, the more advanced content need not be included in a standard undergraduate course -- though, it could be included in an elective for those nurses who plan on working in areas in which they will use the content.

By omitting that sort of advanced -- but specialized -- content, it leaves room in the program for more emphasis on the skills that are needed by every nurse -- OR for their being an "empty space" in the program into which some elective, specialized content could be placed.

I like the idea of a generalized curriculum for all students that would expose all students to the basic, introductory content for all areas with an emphasis on basic principles and skills --- PLUS --- some room in the last year for an elective or two in which students could choose the areas in which they would get more advanced content.

As a NICU nurse, I never used 75% of the specific stuff I had to learn as an undergrad. All that adult med-surg stuff just didn't apply in the NICU. ... And there are many other areas of practice that are not built upon adult med-surg stuff, too. While we all need the basics, we don't all need adult med-surg content in-depth.

Adult med-surg should be recognized as the specialty that it is -- and not be assumed to be the basis for all nursing practice.

llg

[pickledpepperRN]

I think at minimum a registered nurse should know rhythms well enough to be an ACLS provider.

[craigrah]

I think that basic EKG interpretation is sufficient for the general nursing graduate. Advanced courses should be taught for nurses working in specialized areas, or for whom ACLS is required as a part of their job description.

[doliveri]

Vicki,

I think that only the life threatening arrhythmias need to be taught. I do understand that students spend clinical time on medsurg floors that have telemetry capabilities on them, but I still think that the life threatening ones are sufficient for them. The students that get jobs on telemetry floors after graduation go through orientation courses and they are given a course in arrhythmia detection.

Just my two cents

Dee