Date of Graduation

Winter 12-17-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

Carla Martin

Second Advisor

Cathy Coleman

Third Advisor

Cynthia Huff



Problem: Rapid and accurate interpretation of an EKG rhythm is an advanced-level competency required for all acute care nurses working in a cardiac monitored/telemetry unit. Observational data collected over a 4-month period by the facility clinical nurse educators identified that less than half of the nurses required to take the EKG exam passed on the first attempt.

Context: The education department at the facility onboards approximately 550-600 nurses annually for the 241-bed community hospital in the San Francisco Bay Area of Northern California, part of a larger healthcare organization.

Interventions: A total of 19 nurses from various departments across the facility were recruited to evaluate the current EKG assessment tool. Participants ranked the EKG exam questions on a 1-3 Likert scale based on their perceived level of difficulty. The information was collated and used to create an addendum to the study guide.

Measures: Improve first-time pass rates for the EKG exam in newly-hired nurses at the time of onboarding by 25%.

Results: The study guide was revised with implementation beginning the week of October 23, 2021. Of the 15 new nurses onboarded since implementation, first-time pass rate improvement was not demonstrated.

Conclusions: As educators, there is a need to build competencies within a framework that recognizes the continuum of knowledge ranging from novice to expert and what the appropriate minimum competency is for nurses to practice safely and within their scope and at every level. Keywords: EKG, competence, competency assessment, telemetry, onboarding