To explore nurse educators’ experiences and views on nurses’ competency in electrocardiogram interpretation in Australian acute care hospitals.

Nurses are often the first responders to escalate care for patients with cardiovascular disease when rhythm abnormalities are detected; however, there is limited evidence of Australian nurses’ competency in electrocardiogram interpretation.

A nationwide qualitative exploratory study.

We conducted semi-structured interviews/focus groups with nurse educators via videoconference from September to October 2024. Inductive content analysis was conducted.

Eighteen participants participated in interviews/focus groups. Nurse educators often perceived nurses as lacking a systematic approach to electrocardiogram interpretation. Nurses showed varying levels of interest, confidence and competency in interpreting electrocardiograms, with these factors strongly associated with the critical care specialties where they worked. Opinions varied on how often nurses should be reassessed for electrocardiogram interpretation competency. Key barriers to nurses’ competency included nurses’ not recognising electrocardiogram interpretation as their responsibility, limited exposure and a low clinical culture associated with education/facilitation. Facilitators included nurses’ perceiving electrocardiogram interpretation as an expectation, collaboration between nurses and doctors, readily available time and different learning approaches. Participants expressed the need for low-cost and available electrocardiogram resources, effective teaching modalities, a consistent university approach and a standardised training program using validated tools.

The findings revealed key barriers and facilitators to Australian nurses’ electrocardiogram interpretation competency. Strategies must be developed to address those barriers and improve nurses’ competency in this area. Future research should focus on developing a standardised training program with validated assessment tools.

Competency assessment

Confidence

Electrocardiogram interpretation

Nurse attitudes

Nurse educators

© 2026 The Authors. Published by Elsevier Ltd.