reading EKGs- an advanced privilege?

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Specializes in cardiac.

Hi all,

I'm looking for some feedback about different facilities and specifically EKG reading by NPs. I am having trouble finding anything concrete that states that this specific skill is within our scope of practice. Most wording I find is quite vague like "ordering and interpreting diagnostic tests". How does your facility's credentialing committee handle this? Is it mentioned specifically? It is considered an "advanced privilege" that you need to apply for specifically? If so how do you display competency and maintenance of competency.

Just a bit of background: I work at a fairly small, fairly rural hospital that is a bit of a "good old boys club". We are very behind the times as far as incorporating NPs into hospital practice and allowing us to work to the top of our scope. I'm afraid this recent issue that has come up is really a slippery slope that will just lead to more barriers to practice.

Thoughts and advice are much appreciated!

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Specializes in Outpatient Psychiatry.

How can you not? RNs read them.

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Hi all,

I'm looking for some feedback about different facilities and specifically EKG reading by NPs. I am having trouble finding anything concrete that states that this specific skill is within our scope of practice. Most wording I find is quite vague like "ordering and interpreting diagnostic tests". How does your facility's credentialing committee handle this? Is it mentioned specifically? It is considered an "advanced privilege" that you need to apply for specifically? If so how do you display competency and maintenance of competency.

Just a bit of background: I work at a fairly small, fairly rural hospital that is a bit of a "good old boys club". We are very behind the times as far as incorporating NPs into hospital practice and allowing us to work to the top of our scope. I'm afraid this recent issue that has come up is really a slippery slope that will just lead to more barriers to practice.

Thoughts and advice are much appreciated!

We have very broad privileges. EKG is a separate privilege. The usual issue is the report not people reading them. I had a patient with a STEMI treated sent to cath lab. Got a phone call the next day when they read the EKG that the patient was having a STEMI. Also happens with CXR. I get a call the next day the ETT is right mainstemed or the patient has a pneumothorax when its already been dealt with.

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Specializes in CEN, SCRN.

We have a similar situation at the hospital I am at. Good old boys club with an old school conservative culture. In the ER the group has decided only PAs would supplement their practice. They are treated poorly in my opinion and are not valued for the potential they could provide. When I first started there, I took an EKG to the PA for a sign off since the patient was landing in their area. They told me "it looks fine, but I'm not privileged to sign it."

It's pretty bad when you have paramedics who are fully authorized to interpret EKGs and treat patients off of their ability to read an EKG, but a graduate level practitioner can't. I personally feel moves like that are more about keeping a certain class distinction amongst providers so that physician roles don't appear diminished.

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Specializes in Outpatient Psychiatry.
We have a similar situation at the hospital I am at. Good old boys club with an old school conservative culture. In the ER the group has decided only PAs would supplement their practice. They are treated poorly in my opinion and are not valued for the potential they could provide. When I first started there, I took an EKG to the PA for a sign off since the patient was landing in their area. They told me "it looks fine, but I'm not privileged to sign it."

It's pretty bad when you have paramedics who are fully authorized to interpret EKGs and treat patients off of their ability to read an EKG, but a graduate level practitioner can't. I personally feel moves like that are more about keeping a certain class distinction amongst providers so that physician roles don't appear diminished.

Class distinction is all this is about.

When it comes do docs v. NPs v. PAs it's never about safety, scope, or any similar diatribe. It's solely about economics.

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I'm an RN at a small hospital on a tele unit. As an RN the doctors trust me to read an EKG and alert them for anything alarming but I couldn't sign it off. We have a few PAs and NPs and their scope of practice is very narrow. They can't sign off on EKGs either, it has to be either a fellow or an attending.

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When something goes wrong and someone decides to sue the hospital, the lawyer will say: Who did sign off that EKG? Will anyone be able to keep a straight face when saying the NP/PA?

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Specializes in Neurosurgery, Neurology.
When something goes wrong and someone decides to sue the hospital, the lawyer will say: Who did sign off that EKG? Will anyone be able to keep a straight face when saying the NP/PA?

Why wouldn't they be able to keep a straight face?

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Why wouldn't they be able to keep a straight face?

When you are in front of a jury, they want to know if things were done by an expert. Whether we like it or not, physicians are the expert on (almost) everything regarding medicine in the public eye. It's probably misguided, but it's the truth.

Let me be clear here: A NP/PA might know how to read an EKG better than 99% of physicians out there, but the lame public (i.e jury) won't understand that when you have a trial lawyer pounding...

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I am an fnp im family practice. All of the the nps in my

Practice, including 2 with 20+ years experience, are required to have a physician sign off on ekgs. Not sure if it is the hospital systems policy or my state's (new jersey) policy. But the state scope of practice is also vague and just says were able to order and interpret diagnostic tests.

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Specializes in Outpatient Psychiatry.
When something goes wrong and someone decides to sue the hospital, the lawyer will say: Who did sign off that EKG? Will anyone be able to keep a straight face when saying the NP/PA?

Regarding ECGs, if it's not in your everyday training and practice then why even interpret them? Why even look at it other than making sure it lacks artifact, etc. and that's merely for whoever snapped on the leads and hit print. One of the area psych hospitals has them transmitted to a third party group for interpretation just as brain CT and MRI are transmitted to radiology for interpretation.

I feel adequately prepared to buy a nebulizer and administer updrafts based on complaint and presentation,, but why in **** would I do that in an outpatient psychiatry office? Just because I was once taught to interpret ECG and can "sign off" doesn't mean squat. I'm not diagnosing hypothyroidism either even though that's one of the "somatic" disorders all psychiatry personnel need to how to diagnose and treat even though the treatment needs to occur elsewhere.

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Specializes in Operating Room.

Here is a joke:

Question: what does a random double-blind study means?

Answer: two orthopedic surgeons looking at EKG.

Unfortunately, human mind can retain certain knowledge only for a certain amount of time. Old adage goes "use it or lose it", and this is so true. In high school I used to solve matrix equations by gaussian elimination with ease (had A in math), but that was many-many moons ago. If you ask me to do it now, I won't remember how, because I haven't done it for so long.

Same with medicine, unfortunately.

I brought my intermediate EKG test strips (20 strips) to my 2 preceptors (both are MDs with 25 years of experience). They both got quite a few test questions wrong (I got all 20 questions right, but I did study for the test). Does it mean they don't know what they are doing when they sign off on the EKG strip? Absolutely not. It means that they did study EKG in depth in medical school, but since they only briefly look at EKG in their everyday practice to decide whether it is dangerous (pt sent to hospital), concerning (urgent or non-urgent referral to cardiology) or normal (no action needed), they already forgot all the "bells and whistles" that are needed to pass the EKG test in school (how to calculate degree of axis deviation, how to differentiate between LAA and RAA, how to differentiate between LAHB and LPHB, NSIVD, etc.).

Also 2 weeks ago I had an MD pedi preceptor with 20 years of experience (she is a hospitalist) who asked me to look up what "biliary atresia" means (saw it on the report sent from GI specialist) - she could not remember what it was. So? It does not make her any less knowledgeable, it just shows that being all the time in ED, and only covering outpatient pedi practice for a couple of weeks per year, she forgot that term since she did not see it in ED.

Basically, my point is that graduating from medical school or PA school or NP school does not give a person "an everlasting knowledge", because that knowledge fades over the time if not used.

In real world I would not expect primary care MD/FNP/PA to know intimate ins and outs of specialty care (psych, GU, GI, neuro, cardio, ortho, onco, surgery, radiology, etc.). Also in real world I would not expect a specialist to know a lot in true depth when it comes to primary care or any other specialty other than their own specialty.

That is why there are specialists and there are primary care providers.

Therefore, my advice is not to use generalized blanket statements about ALL practitioners out there.

:cat:

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