Implementation of a Tiered Skills Acquisition Model to Improve EKG Interpretation and Intervention Competency in Cardiology Units 2 views

Background: Transition to practice is a critical period for new graduate nurses (NGNs), particularly in high-acuity cardiology settings requiring rapid rhythm recognition and intervention. Problem: Variability in orientation across cardiology units contributed to inconsistent development of EKG interpretation and escalation readiness among NGNs. Approach: A Tiered Skills Acquisition Model (TSAM) was implemented using the Iowa Model for Evidence-Based Practice and Plan-Do-Study-Act cycles. TSAM-based orientation included structured competency milestones, standardized EKG validation checkpoints, scenario-based simulation reinforcement, and “Think-It-Out, Talk-It-Out” clinical reasoning prompts. Outcomes were evaluated using a pre- and post-intervention 5-item Likert-scale confidence survey. Outcomes: NGNs reported higher levels of confidence in EKG interpretation, appropriate escalation, and preparedness to respond to rhythm-related patient deterioration, with an overall shift toward higher confidence categories across measured domains. Conclusions: TSAM implementation was associated with improved self-reported confidence and greater consistency in orientation. Structured, tiered orientation models may support safer transition to practice and enhance nursing care quality in high-acuity cardiology environments. Keywords: orientation; clinical competence; decision making; patient safety; professional transition

DNP (Doctor of Nursing Practice)

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2026-04-28