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RNs typically have a job description to: assess, nursing diagnosis, plan, implement, and evaluate nuring interventions. As
workplace technology evolves, nursing must adapt to new bedside technologies, equipment and knowledge. The idea that
"basic EKG is not a requirement of their position" is irrelevant, and should not be viewed as an obstacle.
To get your nurses up to speed, a Nurse Educator needs to schedule classes in ECG. The book by Jane Huff
"ECG Workout - Exercises in Arrhythmia Interpretation" Lippincott is excellent. I would also provide each
nurse with calipers as an incentive to learn the material. EKG strips as homework assignments helps
reinforce the material. I would also test the material the end of class, and set a passing score. Those
who fall below will need to remediate with the Nurse Educator, and retake the test.
I would also suggest that the Nurse Educator introduce the nurses to the specific equipment, and have
one of the nurse's be the patient: hook up leads, loop the wires through the johnnie pocket, and
admit and discharge the mock patient. Also demonstrate how to pull a strip, paste it in a book,
and measure/record the rhythm. A big tip: encourage nurses to do this at the beginning of their
shift rather than half-way through. If your equipment allows "alarm review", I would review that as well.
Finally, I would have the nurse educator continue a presence on the floor for about a month, and
rotate shifts, so that nurses can be taught to recognize certain alarms, what they mean and how
to respond. Some of this education needs to take place extemporanously, and cannot be drilled
home in classroom setting. If you don't have an "Alarm Tech", I would encourage nurses to review
their own alarms before the end of their shift.
Also, in their nursing note, nurses should say something about the patient on telemetry i.e.
"pt remained in NSR throughout shift, HR 80s, no ectopy, no CP, no SOB".
Hope this helps.
Sincerely,
patty, MSN, RN, CMSRN
Staff Nurse
Brigham & Women's Hospital
Boston, MA
----- Original Message -----From: Tracy KaltenbacherSent: Tuesday, July 15, 2008 3:28 PMSubject: [mpoweryournurses] cardiac monitoring in Med SurgWe are exploring remote monitoring medical patients in our Medical
Surgical units. These nurses have no cardiac or even basic ecg
experience/education. I'm trying to find out how other hospitals
perform remote monitoring and how to educate/support my nurses when
basic ecg is not a requirement of their position. What happens in your
hospital? What protocols or resources do you have in place, and more
importantly what works well?
Thank you!
Tracy Kaltenbacher
Clinical Nurse Educator
Medical Surgical Module
Renown Regional Medical Center
Reno, NV
tkaltenbacher@renown.org
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