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?
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.
Ya think? Come on, your statements are embarrassing.
"Interpreting" an EKG by simply looking to see whether the machine dx includes any different words than it did last time is BS. Picking up on more detailed changes goes beyond having "a little understanding."
This NP clearly doesn't know what she's doing and so has tried to impugn this nurse as a means of covering up her own inadequacy.
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. [/Quote]
HUGE difference between reading a monitor/tele strips than a 12-lead EKG.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
I've been a telemetry nurse for a year and a half, and I still go and talk to my monitor techs sometimes to ask them what the heck they think is going on with a particular patient. They stare at multiple monitors all shift, every shift.... they know their stuff inside and out. I glance at the monitor when passing by the nurses' station or if I hear an alarm going off... I'm good, but not as good as someone who does nothing but watch tele monitors!
You did what you were supposed to. It irresponsible for the NP to ask you to compare EKG readings. She needs to review and compare and decide what to do with it. You really only need basic knowledge of the life threatening rhythms
I work on a floor where we all are expected to measure, interpret, and save strips. However, if we have to have a stat EKG done for chest pain protocol, we always have to call the provider to let them know and also ask for stat cardiac enzymes. We even have a number to call where we can fax the strip to a cardiologist and they will look at it if it is necessary (i.e. doctors aren't calling you back and/or the results seem weird).
OP: You did the right thing. I hope you documented it too.
This. I work tele, not quite ICU (but hopefully one day?). EKGs are pretty common on our floor, but they have a readout that says "abnormal ___, consider ischemia". I look at that reading and the reading on any previous EKGs, as well as any obvious T wave changes. Our EKGs are always kept in the same place: inside or on the top of the chart, as well as copied into the computer. I always tell the doc what the EKG reads and if it says anything different than the previous one. Sometimes, depending on the cardiologist, I'll order troponin levels as scope of practice, but it depends on the doc.
Don't let her grumpiness get to you. Whenever docs get irritated at me calling them, I tell them that I have to notify them, and that I'm just doing my due diligence. Heck, I've even called a doc with "everything looks and sounds normal, but she's just really short of breath and I'm not sure why or what to suggest, but it's got me worried." It's all kind of part of establishing yourself as a conscientious nurse who does what needs to be done. It seems to me that once you've developed that reputation, the docs and NPs are more willing to answer questions and calls.
HUGE difference between reading a monitor/tele strips than a 12-lead EKG.
Any corrections nurses feel free to correct me if I'm wrong....
Another quick point that didn't occur to me before: a corrections nurse wouldn't have pts on tele. In an emergency, the nurse would initiate BLS and call for an ambulance. Any of us are going to be rusty with skills we don't use -- and again, I'm talking tele. It is wildly unreasonable to expect an RN/LPN to interpret a 12-lead.
The jail needs to have a policy for dealing with patients with chest pain for the nurses to follow. If you are not interpreting EKG's on a regular basis you will not be proficient and therefore it is not in your scope of practice. There should be a policy allowing you to fax the EKG to the NP to review and of course everyone needs to learn how to find the previous EKG if one was done.
Speak up and request a policy and procedure for patients with chest pain.
I work in an icu and other icu nurses often look to me for advice on rhythm and ekg interpretation - it's one of my niches. And there's still all kinds of stuff on a 12 lead that i need a cardiologist's opinion to sort out correctly. 12 lead interpretation is complicated. Accurately interpreting one is not a reasonable expectation of you, regardless of what any NP says.
That said, the NP was likely more asking you to find the old ekg and tell her if the machine readout was the same as the new one. Though thats not really enough information for her to fully evaluate the patient, it is reasonable for her to expect you to know how to find things in the patient's chart and read them over the phone. Not sure how she found the previous ekg, but if she did you should probably know how to as well.
JKL33
7,031 Posts
Ya think? Come on, your statements are embarrassing.
"Interpreting" an EKG by simply looking to see whether the machine dx includes any different words than it did last time is BS. Picking up on more detailed changes goes beyond having "a little understanding."
This NP clearly doesn't know what she's doing and so has tried to impugn this nurse as a means of covering up her own inadequacy.