scope of practice, the EKG/ECG?

[wtpsych]

long story short,

i had a patient complain of chest pain. he presented OK, except the EKG was abnormal. the person does have cardiac issues. so i called the nurse practitioner covering and she asked me:

"does it look similar to the previous ekg done?"

i responded "i have no idea? i do not know where the previous ekg is located. we just started a new computer charting system so i have no clue where to even look." he doesn't even have a paper chart i was able to locate.

she said "what do you think we should do?"

i told her "he looks great, but i have to relay ALL abnormal ekgs to you." she didn't even want me to read the present ekg.

she said she'll be there in 10 minutes. she was on the floor (i work in a prison). so 40 minutes later, she arrives, assesses the patient, and reviews the ekg.

it was similar to the previous EKG done a couple days ago. give or take a couple of lines (on the description). she was irritated i couldn't find the previous EKG and relay it to her. she told me i wasted her time.

i am not a cardiac nurse nor do i know know to read the strips. is it in my scope of practice to compare these ekgs? i wanted to tell her everything is ok and he could go back to his cell, but what if those lines that differed were significant? what should i have done differently?

[offlabel]

Try not calling that NP and see how she likes it.

[nursej22, MSN, RN]

I do Not know your work place policies, but from the information you provided I would say this is out of your scope of practice. There is a lot more to EKG interpretation than comparing it to an old one and/or reading the computer's interpretation.

I think you did the right thing.

[LovingLife123]

You need to learn to read an EKG. That's part of being a nurse. You need to be able to recognize an MI so you can call the NP and relay what you have read.

How have you never learn the basics of EKG interpretation?

[elkpark]

At my facility, the EKG printouts include a statement about the findings, like "normal sinus rhythm," "atrial fibrillation," whatever. I would not be willing to go any further than to read to the NP over the phone the findings printed on the two EKG printouts. I would certainly not offer any opinion about whether the new EKG "looks similar" to the previous EKG. I think you did the right thing. The NP needs to do her job, and come evaluate the individual herself.

[KatieMI, BSN, MSN, RN]

When I was working in acute, it would be absolutely my scope of practice because I rarely had a patient who was not on tele. Not all nurses could calculate axis or tell from 12-lead stripe where elevated RV pressure came from, but to compare two strips and give a provider clear info over the phone was an everyday task.

Since you work in prison where you probably only deal with ECGs every so often, it may not be your scope of practice. Nevertheless, knowing baseline norms and changes at least within ACLS collection would be a very useful skill to master. It is not at all that difficult. And, of course, knowing where the old strips are kept is always nice.

[offlabel]

You need to learn to read an EKG. That's part of being a nurse. You need to be able to recognize an MI so you can call the NP and relay what you have read.

How have you never learn the basics of EKG interpretation?

You can have an unremarkable EKG while having an MI. That's why we send troponin levels. Besides, a greater than "basic" skill level is required to consistently interpret 12 lead EKG's accurately. That's not part of being a "nurse". I'd say only a quarter of the ICU nurses I work with are comfortable cold reading an EKG and the ones that are have EP or cath lab experience.

[MunoRN, RN]

You need to learn to read an EKG. That's part of being a nurse. You need to be able to recognize an MI so you can call the NP and relay what you have read.

How have you never learn the basics of EKG interpretation?

To clarify, I would assume you're referring to very basic interpretation; basic recognition of arrhythmias, STEMIs, and the like.

I don't think complex 12 lead interpretation such as differentiating non-significant morphology changes from potentially significant ones is an expected part of every nurse's scope of practice. The majority of hospitalists I've worked with don't have this ability. It's not a competency that can really be effectively established and maintained unless you work with 12 leads regularly.

[Orion81RN]

You need to learn to read an EKG. That's part of being a nurse. You need to be able to recognize an MI so you can call the NP and relay what you have read.

How have you never learn the basics of EKG interpretation?

In this situation, it seems to have been more than basic EKG interpretation. The NP wanted her to compare EKGs, where scope of practice becomes blurred. There were minor differences. That should be left up to the NP or MD to decide if it is significant or not. She did the proper thing. She relayed the EKG results to the NP, which is her job. The NP was annoyed bc to her, it wasnt annormal ENOUGH to have contacted her. That's not up to us. We relay all results.

[nursej22, MSN, RN]

You need to learn to read an EKG. That's part of being a nurse. You need to be able to recognize an MI so you can call the NP and relay what you have read.

How have you never learn the basics of EKG interpretation?

I really disagree with this. 12 lead interpretation takes training and practice. Very few 12 leads look like a classic STEMI. But left bundle branch block and implanted pacemaker rhythms can fool the inexperienced.

And 12 leads are not just for acute MI, just as not all chest pain is ischemia or infarction.

Pulm. embolism, pericarditis, aortic dissection, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy can elicit subtle changes, and kill you because someone thought the 12 lead was normal.

If your facility doesn't have a policy, I would suggest you get one, so when cranky NP tries to blow you off, you can point to the paper and say "not my job."

[LovingLife123]

That's why I stated basic ekg interpretation. It's something we all learned in nursing school. And yes, I know all about how not every MI shows up, but for the ones that do, the OP needs to recognize it in case of emergency especially being in a prison.

The OP doesn't need to be able to map it out, but at least understand a little of what they are looking at. Plus, I've never seen a 12 lead ekg machine that doesn't tell you what is going on. But I've also seen doctors disagree with those readings, so just having a little understanding is important.

In icu as our patients are always hooked up, we have to be able to read them. I take dysrhythmia tests every year to ensure my competency on it.

I completely disagree that the OP doesn't need to know this. Being able to recognize there is an issue and get treatment is a must in this type of population where they don't have access to what the nurse in the acute setting has.

[JKL33]

You need to learn to read an EKG. That's part of being a nurse. You need to be able to recognize an MI so you can call the NP and relay what you have read.

How have you never learn the basics of EKG interpretation?

Baloney.