Stress test ecg course

[Sally2013, BSN, RN]

I was curious how nurses at other organizations are trained to work in the stress lab. Is there a specific stress test course that you took and what was it? At my healthcare system, they take an aacn ecg course, but it doesn't seem like it goes into depth about ST changes in each lead. 

[dianah, ASN]

We had OTJ training.  That's all. 

[Sally2013, BSN, RN]

By physicians, APP, or other nurses? Did you feel like your training prepared you appropriately to stress test patients on your own without a cardiologist in the room?

[dianah, ASN]

Trained by other nurses, the Cardiologist assigned to read the studies that day, and our Paramedic in charge of the area.  He was a dynamo, well-trained and very sharp.  Although we did not have a Cardiologist in the room for each stress test, there was always one nearby in the reading room, or a Fellow was available in the Fellows' Room. 

We had a (very thick) Stress Testing Manual, which each new person was to read over, as their intro to the area.  Then we had observation days followed by hands-on, where we would perform the interviews and review the EKGs.  Repeated exposure to the routines helped new nurses gain experience.

The Cath Lab nurses were trained to assist with Treadmills and MPIs (Myocardial Perfusion Imaging).  Initial EKGs (done on each patient that day, before the ordered study) were reviewed by the RN and the Paramedic.  Sometimes, if questions remained whether to continue, we would bring the EKG to the Fellow or Cardiologist for review.

I felt, as a Cath Lab nurse making the transition, that I was both well prepared for Stress Lab, and, conversely, never could be prepared for what may pop up before, during, or after a stress test.  Our Paramedic would hold semi-annual surprise drills with the manikin, for the techs, nurse assigned that day, and the Fellows.  Kept us on our toes.  We'd compare weird EKGs and quiz each other on them.  Sometimes the Cardiologists would hold a little mini-conference if an interesting/challenging case came up.

To an observer, Stress Lab may appear boring, but there is so much going on behind the scenes that it is anything but boring.  A smooth day can change in an instant (much the same as on the floors or in the ICU!).  That's where the benefit of Cath Lab or ICU experience comes in.

[Sally2013, BSN, RN]

Dianah,

Thank you for the comprehensive response. They may be asking too much, but is there a way I could view that "very thick" stress test manual? Or is there something similar online? Our system has a policy which is a few pages long. We also have a few page reference guide which I developed from an AACN CV certification review book. However, I feel like that is lacking. I also can't find any Stress Test Certification course online, so we don't have to recreate the wheel.

[dianah, ASN]

From AHA/ACC:

https://www.ahajournals.org/doi/10.1161/01.CIR.102.14.1726 (and note the several related topics to the left of the article itself)

From NIH:

https://www.ncbi.nlm.nih.gov/books/NBK499903/

I am retired, so no longer have access to the work computers.