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Implementation of a Tiered Skills Acquisition Model to Improve EKG Interpretation and Intervention Competency in Cardiology Units2 views
Author
Dennis, Nina, Nursing Practice - School of Nursing, University of Virginia
Advisors
DeGennaro, Regina, NR-Administrative Operations, University of Virginia
Abstract
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
Degree
DNP (Doctor of Nursing Practice)
Rights
All rights reserved by the author (no additional license for public reuse)
Dennis, Nina. Implementation of a Tiered Skills Acquisition Model to Improve EKG Interpretation and Intervention Competency in Cardiology Units. University of Virginia, Nursing Practice - School of Nursing, DNP (Doctor of Nursing Practice), 2026-04-28, https://doi.org/10.18130/4jtp-kp16.