Electrocardiographic (ECG) monitoring including the 12‑lead ECG and bedside cardiac monitoring is essential for tracking heart rate changes, detection of ischemia, diagnosis of arrhythmias, and identification of long QT interval. ECG monitoring is also vital for the treatment and continuous follow up of these conditions. Nurses working in hospital units where ECG monitoring is high priority such as the emergency department and the critical care unit are required to be skillful in ECG monitoring, understand basic electro-physiological concepts, and able to identify specific ECG abnormalities [1,2].

Despite the great importance of assuring adequate nurses' proficiency in ECG monitoring which is directly related to patient's safety, there is little research available on the adequacy of nurses to perform this task. Previous research only examined specific aspects of nurses' ECG proficiency such as ECG recording, [3] and QT interval measurement and correction [4]. Only few studies, conducted primarily in the United States, have examined more than a single aspect of nurses' proficiency in ECG monitoring. In one study, conducted recently by Funk and colleagues [5], the authors examined nurses' proficiency in ST segment and QT interval monitoring in addition to 12 lead ECG interpretation and arrhythmia monitoring. That was a multisite randomized control investigation that enrolled participants from three different countries; US, Canada, and China. The study included an online educational intervention which improved nurses' knowledge but, that improvement did not sustain 15 months later.

However, these studies that have examined nurses' proficiency in ECG monitoring reported on serious inadequacies related to ECG recording, identification of life-threatening ventricular arrhythmias, QT interval measurement and correction, and determining the width of the QRS complex. In one study, only 41% of nurses identified the correct placement of the precordial lead, V1 [3]. In another study, most nurses working in coronary care units were unable to identify life threatening ventricular arrhythmias when they were presented to them during an ECG proficiency test [6]. In a third study, mean nurses' QT interval knowledge test score was only 46%. In that study, only 6% of nurses were able to calculate the corrected QT interval [4]. In another study, while most nurses were able to identify widened QRS complex, they were unable to measure its width [7]. Nevertheless, the patient is likely to suffer or even face a life threatening event if nurses' mastery of ECG monitoring is under question. Because of the nature of their work, nurses are likely to be the first to witness a very time sensitive event related to electrical activity of the heart.

In this study we aim to assess ECG proficiency among emergency department and critical care nurses using important domains of ECG monitoring and to explore whether nurses' proficiency in ECG monitoring is related to some other factors such as education, years of experience, or the clinical area currently working in.