Digital Repository Masters Projects Spring 2025 Enhancing Nurse Self-Efficacy When Reassigned to be Telemetry Technicians Ethan Young Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Young, E. 2025. Enhancing Nurse Self-Efficacy When Reassigned to be Telemetry Technicians. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Enhancing Nurse Self-Efficacy When Reassigned to be Telemetry Technicians Project Title by Ethan Young, BSN, RN Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 04/26/2025 Ogden, UT Date Ethan Young, BSN, RN 04/26/2025 Student Name, Credentials (electronic signature) Date Anne Kendrick, DNP, RN, CNE 04/26/2025 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. 04/26/2025 Date 1 Enhancing Nurse Self-Efficacy When Reassigned to be Telemetry Technicians Ethan Young, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: Continuous cardiac telemetry is essential for detecting abnormal heart rhythms, yet nurses reassigned as telemetry technicians often receive minimal training. This project evaluates whether additional education enhances their confidence in this role. Rationale/Background: Competent staff are crucial for patient safety. Nurses proficient in rhythm interpretation are frequently reassigned to telemetry monitoring but often lack specialized training, leading to feelings of unpreparedness. Addressing this gap through targeted education may improve nurse confidence and care quality. Methods: A literature review identified the importance of self-efficacy in nursing performance. Nurses within a hospital cardiac unit will complete a pre-training survey assessing their confidence in telemetry monitoring. A virtual training, including a PowerPoint presentation and question and answer session, will be developed. A reference sheet summarizing key concepts will be provided. A post-training survey will measure confidence changes. Results: Nurses will rate their confidence in rhythm analysis, software use, protocols, and overall performance using a Likert scale (0–5) and include open-ended responses for additional insights. Higher post-training scores will indicate improved confidence and intervention success. Conclusions: Targeted training is expected to significantly enhance nurses' self-efficacy in telemetry monitoring, leading to a more prepared workforce and improved patient outcomes. Keywords: telemetry technician, cardiac monitoring, nurse self-efficacy, nursing education, patient safety Enhancing Nurse Self-Efficacy When Reassigned to be Telemetry Technicians 3 Continuous cardiac telemetry is crucial in monitoring patients at risk for abnormal heart rhythms. Nurses reassigned to the telemetry technician role often receive insufficient training beyond basic rhythm analysis, leading to decreased confidence and performance when they assume the role without formal orientation (Shorey & Lopez, 2021). This project aims to determine whether providing additional training to nurses improves their confidence and selfefficacy in performing as telemetry technicians. Ensuring that nurses are adequately trained enhances their performance and improves patient safety and outcomes (Perpetua et al., 2023). In nursing, confidence directly influences the accuracy of rhythm interpretation and response to cardiac events. Studies show that targeted training can significantly improve nurses' competency in these tasks (Antonanzas-Baztan et al., 2020). Addressing the training gap for nurses reassigned to telemetry monitoring is essential for building a more confident and capable workforce, ultimately enhancing patient care. Statement of Problem In hospital settings where continuous cardiac monitoring is crucial, nurses are frequently reassigned to the telemetry technician role without adequate role-specific training. This lack of formal preparation decreases confidence and competence when these nurses are expected to perform critical monitoring tasks (Kukielka et al., 2019). The clinical problem is particularly evident among nurses in cardiac care units, where real-time rhythm interpretation and rapid responses to adverse cardiac events are necessary to prevent complications (Perpetua et al., 2023). This project will be piloted in a 40-bed cardiac unit at a Level 1 trauma center in Northern Utah. The gap in training and preparation for the telemetry technician role is significant, as it directly affects patient safety. 4 The size of the problem is substantial. Across many healthcare facilities, there is a chronic shortage of telemetry technicians, leading to the frequent reassignment of nurses who may have completed basic ECG training but are not proficient in continuous ECG monitoring of patients. Sandau et al. (2017) reported that errors in telemetry monitoring, including missed arrhythmias or delayed responses to alarms, are associated with a lack of training. These errors have been linked to adverse patient outcomes, including unnecessary ICU admissions and even preventable cardiac events. The telemetry education gap affects patient safety and nurse wellbeing, as reassigned nurses often feel overwhelmed by the responsibilities they are not fully equipped to manage (Funk et al., 2021; Kukielka et al., 2019). Significance of the Project This project is essential for several reasons: it addresses a critical gap in nurse training, improves patient safety through enhanced nurse competency, and contributes to the body of knowledge on nursing self-efficacy and role transition in healthcare settings. This project builds upon existing literature and introduces a structured solution to a pervasive clinical issue by providing formalized training for nurses reassigned to the telemetry technician role. First, this project addresses the critical training gap for nurses assuming the telemetry technician role. Current literature emphasizes the importance of role-specific education in improving nurse performance and reducing errors (Perpetua et al., 2023). Telemetry technicians monitor and interpret cardiac rhythms, tasks directly influencing patient outcomes. However, when nurses are reassigned to this role without appropriate training, their lack of confidence and proficiency can lead to mistakes, such as misinterpreting arrhythmias or missing alarms. This project aims to fill a significant gap by providing focused training that equips nurses with the skills they need to perform effectively in this critical role. 5 Second, this project directly contributes to improving patient safety. Studies have demonstrated that training interventions can significantly reduce errors related to telemetry monitoring (Kukielka et al., 2019). Inadequate training has been linked to missed cardiac events, delayed responses to alarms, and preventable complications in patients requiring continuous monitoring (Sandau et al., 2017). Enhancing nurse confidence and competence through structured education can reduce these errors and improve patient outcomes. Enhanced training in rhythm interpretation, software navigation, and protocol adherence equips nurses to respond more quickly and accurately to cardiac events, which is crucial in acute care settings. Third, this project contributes to the body of knowledge on nurse self-efficacy, a key factor in job performance and satisfaction. In nursing, self-efficacy has been linked to improved patient outcomes and greater job satisfaction (Perpetua et al., 2023). This project builds on that foundation by demonstrating that targeted, role-specific training can increase nurses' confidence in their abilities, thus reducing anxiety and improving job performance when reassigned to the telemetry technician role. Research has shown that nurses with higher self-efficacy are more likely to engage in proactive problem-solving and exhibit better clinical decision-making skills (Abusubhiah et al., 2023). Finally, this project offers practical benefits to nursing staff and healthcare organizations. Hospitals can create a more competent and adaptable workforce by addressing the knowledge gaps in telemetry training. The structured training approach can also serve as a model for other areas in nursing where role transitions are common, ensuring that reassigned nurses are better prepared to meet the demands of their new responsibilities (Alshammari and Alenezi, 2023; Cantarelli et al., 2023). Furthermore, providing resources for this project ensures that nurses have 6 ongoing support in their roles, contributing to long-term competency and improved clinical outcomes. This project aims to fill a critical training gap, enhance patient safety, and contribute to the broader understanding of nurse self-efficacy in specialized roles. The targeted intervention provides a sustainable solution to an ongoing issue in healthcare, with implications that extend beyond the immediate context of telemetry monitoring. Review of the Literature This literature review explores existing evidence relevant to the further investigation into nurse self-efficacy among nurses reassigned to the telemetry technician role. This section will discuss the project framework, analysis of the literature, search strategies, synthesis of the literature, and a summary of the literature review and its application to the project. Framework Kurt Lewin’s Change Management Model will serve as the guiding framework for this project. This model is well-suited for the project because it offers a simple structure for managing change in healthcare settings. Lewin’s model comprises three phases: unfreezing, changing, and refreezing. These phases align well with the steps needed to improve the confidence of nurses reassigned to the telemetry technician role (Shirey, 2013). In the unfreezing phase, the focus is on identifying the training gaps and the lack of confidence experienced by nurses reassigned to the telemetry technician role. This phase involves raising awareness of the need for change and challenging the current state. Here, the existing gap in telemetry-specific knowledge and the resulting reduced self-efficacy represents the status quo that must be disrupted. 7 During the changing phase, the actual implementation of the training takes place. For this project, the initial step includes pre-surveying nurses and identifying their comfort levels and proficiency in telemetry monitoring before any intervention. This phase also involves introducing the new one hour virtual training curriculum to the nurses, focusing on improving their skills in rhythm analysis, software navigation, and following protocols. A post-training survey will then be given to measure any changes in the nurses’ confidence in telemetry monitoring. The results of these assessments will highlight the need for additional training and justify the upcoming changes (Shirey, 2013). The changing stage is the critical transition point where new behaviors and knowledge are introduced, giving nurses the tools they need to succeed in their reassigned roles (Wojciechowski et al., 2016). The final phase, refreezing, focuses on solidifying the changes and ensuring that the new skills and behaviors become part of the nurses’ routine practice. In this stage, the effectiveness of the training will be evaluated through follow-up assessments, and the training will be integrated into the hospital’s ongoing educational programs for nurses likely to be reassigned. Reinforcing the newly acquired competencies ensures that nurse confidence and patient safety improvements are sustained over time (Cummings et al., 2016). The refreezing phase ensures the changes are maintained long-term by embedding the training into standard staff development protocols. This structured model helps mitigate resistance to change by gradually moving nurses from uncertainty to confidence in their new roles. By carefully guiding them through these phases, the project ensures that the training intervention will be implemented successfully and sustained, leading to lasting improvements in nurse confidence and patient care outcomes. Strengths and Limitations 8 Kurt Lewin’s Change Management Model offers several strengths that make it a valuable framework for guiding clinical change projects. One of its primary strengths is its simplicity and clarity. The model’s three phases, unfreezing, changing, and refreezing, provide a straightforward approach that is easy for healthcare teams to understand and apply (Wojciechowski et al., 2016). This clarity is particularly helpful in healthcare settings, where change initiatives can be complex and involve multiple stakeholders. Additionally, Lewin’s model emphasizes the importance of preparing individuals for change (unfreezing) and reinforcing new behaviors (refreezing), which helps ensure that changes are both adopted and sustained over time (Cummings et al., 2016). For this project, these strengths are crucial, as the goal is to ensure that nurses not only gain new skills through training but also retain and integrate these skills into their ongoing practice. However, one potential weakness of Lewin’s model is its perceived rigidity. The linear, step-by-step approach may not be flexible enough to account for the dynamic and unpredictable nature of healthcare environments, where changes often occur rapidly and require constant adaptation (Burnes, 2020). In such settings, the need for continuous adjustment can make distinguishing between the stages of change and refreezing challenging. Moreover, the model's simplicity may overlook the complexities of human behavior and resistance to change that require more nuanced strategies for engagement and motivation (Cummings et al., 2016). In summary, Lewin’s model provides an effective framework for initiating structured change and is highly applicable to the training intervention in this project. However, the potential rigidity of its linear phases requires consideration of more adaptive strategies in dynamic healthcare environments to ensure long-term success. Analysis of the Literature 9 A literature review was conducted to understand existing evidence relevant to the PICOT question: For nurses reassigned to the role of telemetry technician, does additional training, compared to no training, affect nursing telemetry role confidence? This literature review examines the impact of targeted education and training programs on improving nurses' preparedness and overall job satisfaction. Search Strategies A literature search was conducted to identify current evidence using Weber State University’s Stewart Library’s OneSearch and CINAHL to direct initial exploration. PubMed was used to find evidence to set the basis for the need for the intervention. Most articles are taken from the last five years, with only a couple of older articles included due to their high level of evidence. The search included keywords and phrases such as ECG, telemetry monitoring, telemetry nursing, nurse satisfaction, nurse orientation, education interventions, clinical education, and self-efficacy. Synthesis of the Literature Three themes identified in the literature were strategies addressing knowledge gaps in ECG and telemetry-related skills, the effectiveness of targeted education programs in enhancing nursing confidence and patient safety, and the impact of training on nurses’ self-efficacy and overall job satisfaction. Each of these themes will be addressed in this section. Addressing Knowledge Gaps The critical role of nurses in detecting and responding to arrhythmias in acute care settings cannot be overstated. However, recent studies have consistently revealed significant knowledge gaps in arrhythmia recognition and ECG monitoring, which can lead to adverse patient outcomes. Research by Eggenberger et al. (2019) identified widespread deficiencies in 10 arrhythmia knowledge among acute care nurses, attributing these gaps to inadequate training and insufficient ongoing education. Their study, which utilized a cross-sectional survey design, found that many nurses lacked the confidence and skills to accurately interpret ECG results, which is crucial for timely and effective patient care. Similarly, a study by Koning et al. (2019) emphasized that these knowledge deficits are not isolated incidents but are prevalent across various healthcare settings. This study conducted a regional education program to assess nurses' baseline knowledge of dysrhythmias and found that many participants could not correctly identify life-threatening arrhythmias. This study's robustness is highlighted by its large sample size and rigorous pre- and post-intervention assessments, which provided clear evidence of the urgent need for enhanced educational programs. Adding to this, Funk et al. (2021) explored the impact of these knowledge gaps on patient safety, illustrating how inadequate ECG training can result in delayed arrhythmia detection. Their findings, derived from a mixed-methods approach, show that nurses with limited ECG monitoring knowledge are more likely to miss critical arrhythmias, leading to potentially severe patient consequences. This study's methodological strength lies in its combination of quantitative data and qualitative insights, offering a comprehensive view of the issue. Similarly, a study by Garcia et al. (2022) concluded that inadequate training led to more telemetry-related errors. The consistent evidence across these studies underscores the importance of addressing these knowledge gaps through targeted education and training initiatives. By ensuring that nurses are well-equipped with the necessary skills and knowledge to perform accurate arrhythmia recognition and ECG monitoring, healthcare organizations can significantly reduce the risk of adverse cardiac events. 11 Effectiveness of Targeted Education In response to the identified knowledge gaps, recent literature highlights the effectiveness of targeted education programs in improving nurses' competency in ECG monitoring and arrhythmia recognition. These programs are shown to enhance clinical skills and improve patient safety outcomes. For instance, Koning et al. (2019) implemented a dysrhythmia education program that significantly improved nurses' ability to recognize and respond to arrhythmias. The program included simulation-based training, allowing nurses to practice their skills in a controlled environment, increasing confidence and proficiency in clinical practice. Kukielka et al. (2019) further supported these findings by demonstrating the positive impact of ongoing education on nurses' ability to utilize advanced monitoring technologies. Their study revealed that nurses who participated in continuous ECG education programs were more adept at recognizing complex arrhythmias and managing patients with cardiac conditions. This study utilized a longitudinal design, tracking the participants' progress over time, providing strong evidence of continuous education's long-term benefits. Moreover, Sandau et al. (2022) conducted a comprehensive study on the role of standardized education in improving ECG monitoring practices across hospital settings. They found that hospitals implementing structured ECG training programs saw a marked decrease in undetected arrhythmias and related adverse events. The study’s robustness is reflected in its large-scale, multi-site design, which allowed for a broad analysis of the program’s effectiveness across different healthcare environments. Research conducted by Liu et al. (2021) further corroborates the effectiveness of these targeted education programs. The study focused on the long-term impact of ECG monitoring training on nursing competency and found that nurses who received regular updates and 12 refresher courses were more likely to maintain high proficiency levels in ECG interpretation. The study's large sample size and use of quantitative and qualitative data provide a comprehensive view of the benefits of continuous education in maintaining and enhancing clinical competencies. These studies provide compelling evidence that targeted education programs are essential for improving nurses' competency in arrhythmia recognition and ECG monitoring, leading to better patient outcomes and safer care environments. By investing in such educational initiatives, healthcare organizations can ensure that their nursing staff remains competent and confident in their critical roles. The Impact of Training Recent evidence underscores the significant impact of targeted training on enhancing nurses' self-efficacy and job satisfaction. As healthcare environments become increasingly complex, the need for well-trained, confident nurses is critical to patient outcomes and workforce stability. Perpetua et al. (2023) and Shorey and Lopez (2021) found that nurses who received specialized training in arrhythmia detection and ECG monitoring reported increased selfefficacy. Perpetua et al. (2023) used pre- and post-training assessments to demonstrate that nurses who felt better prepared were more confident in their ability to manage complex cardiac situations, directly contributing to higher job satisfaction. Recent research by Liu et al. (2021) supports these findings, noting that nurses who participate in structured training programs report higher levels of job satisfaction and reduced burnout. This study, which included a large sample of acute care nurses, found that continuous education is a key factor in maintaining a motivated and effective nursing staff. Furthermore, Brown et al. (2022) demonstrated that training programs focused on specific clinical skills, such 13 as pain management and patient communication, significantly improve nurses’ confidence and job satisfaction. This study employed longitudinal data to show that nurses who feel competent are more likely to stay engaged and satisfied in their jobs. Several other studies, including Abusubhiah et al. (2023), Alshammari and Alenezi (2023), and Cantarelli et al. (2023) concluded a similar positive correlation between increased training and improved job satisfaction. Together, these studies highlight the crucial role of comprehensive training in enhancing nurses' self-efficacy and job satisfaction. By investing in targeted educational programs, healthcare organizations can ensure that their nursing staff is competent and content, ultimately leading to better patient care and reduced turnover. Summary of Literature Review Findings and Application to the Project A thorough review of the literature relevant to this project highlighted critical insights into the challenges and solutions for improving telemetry nurses' self-efficacy and job satisfaction when reassigned as telemetry technicians. The literature consistently underscores the significant gaps in nurses' knowledge and competency regarding ECG monitoring and arrhythmia detection, which can jeopardize patient safety. These gaps are often linked to inadequate initial training and ongoing education, leading to decreased confidence and increased potential for errors in clinical practice. To address these issues, the literature suggests that targeted, evidence-based educational interventions effectively enhance nurses' self-efficacy and job satisfaction. Studies demonstrate that nurses receiving comprehensive, continuous ECG monitoring training are better equipped to identify and respond to cardiac events, resulting in improved patient outcomes and a more fulfilled nursing workforce. 14 Drawing from these findings, this project aims to develop and implement a robust educational program for telemetry nurses, focusing on advanced ECG monitoring techniques and the role-specific skills necessary for telemetry technicians. By leveraging the evidence presented in the literature, this project will create a curriculum that can empower nurses, enhance their clinical competencies, and ultimately contribute to safer, more effective patient care. Project Plan and Implementation A well-structured planning and implementation process is essential to gaining nurses' support for any organizational change in healthcare. This initiative focuses on training nurses for the telemetry technician role, aiming to boost their confidence and competence when assigned to this position. This section outlines the project plan and implementation strategy, detailing the interdisciplinary team, key deliverables, and the proposed timeline. Plan and Implementation Process The intended recipients of the training are registered nurses working in a cardiac unit at a Level 1 trauma center in Northern Utah. These nurses have previously completed basic ECG training but have not undergone a formal orientation to the telemetry technician role. To initiate the project, materials necessary for the pre- and post-assessment of the training and the training content were developed. A pre-training and post-training survey was designed to measure participants’ baseline knowledge, attitudes, and confidence levels before and after the educational intervention. The training will include a PowerPoint presentation delivered during a scheduled staff meeting for nurses on a telemetry unit. These nurses are the pool of potential staff that can be reassigned when a tele vacancy exists. This presentation covers essential knowledge and competencies required for the telemetry technician role, including expectations and protocols. 15 Specific topics include technical processes, such as logging into the telemetry software, admitting and discharging patients from the system, filtering alarms, utilizing hemodynamic trend tools, and performing basic system troubleshooting. To enhance long-term retention and usability, the key points from the PowerPoint presentation will be summarized into a concise, double-sided laminated reference guide. This "cheat sheet" will serve as a practical aide for nurses reassigned to the telemetry technician role during their shifts, providing quick access to critical information covered in the training. Interdisciplinary Team Several disciplines will play pivotal roles as stakeholders in this project. Nurse managers will be responsible for recognizing the need for enhanced training and facilitating the allocation of time, resources, and materials necessary for its implementation. Nurse educators will take the lead in developing and delivering the educational content. A clinical nursing coordinator will conduct ongoing audits to assess the training's short- and long-term effectiveness on nurse confidence within the telemetry technician role. Collectively, these disciplines will collaborate to evaluate the need for additional education and adjust training materials to address the evolving needs of nurses. Floor nurses will serve as key stakeholders, both as the primary recipients of the training and as the individuals reassigned to the telemetry technician role. Telemetry technicians will provide critical input by identifying essential content for inclusion in the training and assisting with updates to ensure the materials remain relevant and practical. Other interdisciplinary team members, such as physicians, advanced practice providers, and physical/occupational therapists, may indirectly benefit from the project, as the training ensures that staff members are well-prepared to monitor patients on telemetry systems. 16 Ultimately, patients will experience the most significant benefit, as they will be cared for by confident and well-trained nurses capable of accurately monitoring and responding to cardiac rhythms. Description and Development of Project Deliverables This MSN project will be supported by three key deliverables: (1) a PowerPoint presentation for telemetry role orientation, (2) a quick reference "cheat sheet" available at each telemetry station to assist nurses in their assigned roles, and (3) pre-and post-surveys designed to assess nurses' growth in confidence and competence. The following sections will detail these deliverables and their role in enhancing the confidence and proficiency of nurses reassigned into a telemetry role. PowerPoint Presentation. The first deliverable is a PowerPoint presentation outlining the essential guidelines and expectations for nurses transitioning into the telemetry technician role (see Appendix A). This presentation will be a valuable resource for nurses new to the role, those needing a refresher, and those seeking clarification on relevant procedures and policies. The slides will be presented during a virtual staff meeting. They will be available to any nurse interested in the training, as well as unit managers, educators, and new providers who wish to gain insight into the responsibilities of telemetry technicians. The presentation will cover key job functions, including patient admission and discharge, rhythm analysis, and event reporting. Additionally, it will provide practical tips and highlight tools designed to help nurses succeed in this role. Screen sharing with the EMR may also engage visual learners to demonstrate charting practices. A dedicated question-and-answer session will follow the presentation to address any questions or concerns. 17 Reference Guide. The second deliverable is a laminated, double-sided 8.5 by 11-inch reference guide designed to support nurses reassigned to the telemetry technician role (see Appendix B). This guide condenses key information from the PowerPoint presentation into a simplified, easy-to-reference format, focusing on essential details. Additionally, includes step-by-step instructions for complex tasks, such as admitting and discharging patients, reporting events, and logging into the phone software. By providing clear, written guidance, this resource aims to reduce the need for nurses to seek clarification from other telemetry technicians, ultimately easing their workload and promoting efficiency. Pre- and Post-Training Surveys. The final deliverables for this project are the pre- and post-training surveys (see Appendix C). The pre-survey will be administered to participants attending the training to establish a baseline assessment of their prior experience in the telemetry technician role, their confidence in performing role-related tasks, and their ability to locate necessary resources for success. Both surveys will ask whether participants have previously been reassigned to the telemetry technician role. The questions will utilize a Likert scale to measure nurses’ confidence levels in performing the role's responsibilities, ranging from no confidence to extremely confident. A similar scale will evaluate participants' confidence in finding the resources required to perform well. In the post-survey, an additional question was included to gather feedback on the training, specifically asking participants what they would like clarified, any unnecessary information, or topics they believe should have been covered. Timeline 18 This MSN project will follow a structured timeline over approximately six to eight weeks to ensure effective planning, implementation, and evaluation (see Appendix D). In the first week, the project lead will meet with the unit manager and nurse educator to assess the unit’s needs and determine how this initiative aligns with those objectives. This meeting will also serve as an opportunity to schedule the training session, allowing participants sufficient time to plan for attendance. During the second and third weeks, participants will complete a pre-training survey to assess their baseline confidence, familiarity with the telemetry technician role, and ability to locate necessary resources. Collecting this data will provide a reference point for evaluating the effectiveness of the training. In the fourth week, the project coordinator will reconvene with the unit manager and nurse educator to review the pre-survey results and finalize the presentation. Any necessary adjustments will be made to ensure the training materials comprehensively address the identified needs. The training will be conducted in the fifth week as part of a virtual staff meeting via Microsoft Teams. This session will cover key guidelines, role expectations, and critical job functions related to the telemetry technician position. After the presentation, participants will complete a post-training survey to reassess their confidence in performing telemetry-related responsibilities and their ability to access necessary resources. The final phase of the project, spanning weeks six to eight, will focus on data analysis and evaluation. The pre- and post-survey results will be compared to determine whether the training led to measurable improvements in nurses’ confidence and competency in the telemetry technician role. Findings will be shared with unit leadership to assess the project's overall impact and identify potential areas for future improvement. The project aims to enhance nurses’ 19 proficiency through this structured approach, ultimately improving patient care and workflow efficiency. Project Evaluation Evaluating an educational intervention is essential to determining its effectiveness and identifying areas for improvement. The success of this project will be assessed through a comparative analysis of pre- and post-training survey responses. Specifically, effectiveness will be measured by changes in participants’ confidence levels, as indicated by responses to two Likert scale questions (see Appendix C). An increase in confidence scores will suggest a positive impact of the intervention. The project lead will employ a paired t-test of the collected data to assess trends and shifts in nurses' confidence levels. Based on these findings, recommendations will be presented to the nurse manager and educator regarding potential modifications to the educational program and the need for follow-up training sessions. In addition to quantitative data, qualitative feedback from the short-answer section of the post-survey will be analyzed to evaluate the intervention’s practical impact. Nurses’ perspectives on the training's relevance, accuracy, and applicability to their roles will be a key metric in determining the program's effectiveness. Ensuring that participants perceive the education as valuable and beneficial to their professional practice will be critical in assessing success. Toward the project's conclusion, the project lead will discuss the intervention with the nurse manager and educator to gather anecdotal evidence regarding its influence on morale, workflow efficiency, and patient safety. This qualitative insight will complement the quantitative findings and comprehensively evaluate the program's impact. Finally, the analyzed data and key 20 findings will be disseminated to participants to promote transparency and encourage further engagement with ongoing educational initiatives. Ethical Considerations The project lead must be thoughtful about ethical considerations, especially in patient care projects. Ensuring ethical integrity throughout the process fosters privacy, accountability, and transparency while upholding professional standards. Nurses eligible for the training include those on the unit who have completed basic ECG training. Participation in the educational intervention is voluntary, ensuring nurses can opt in without undue pressure. To maintain privacy, all pre- and post-training surveys will be conducted anonymously, allowing participants to provide candid feedback without concern for personal identification. No identifiable information will be collected, and responses will be securely stored to prevent unauthorized access. Furthermore, data analysis will be conducted in aggregate form, ensuring individual responses remain confidential. In terms of accountability, all aspects of the project will adhere to institutional policies and ethical research guidelines. The project lead will ensure that data collection, analysis, and reporting are conducted with integrity and accuracy. Any potential biases in data interpretation will be minimized by using a structured evaluation framework, as outlined by the policy of the participating institution. Additionally, findings will be reviewed by the nurse manager and educator to ensure objectivity and reliability. Transparency will be upheld throughout the evaluation process. Participants will be informed of the project's purpose, benefits, and potential limitations before involvement. The final findings, including quantitative data and qualitative feedback, will be shared with relevant stakeholders, including participating nurses, to foster an open dialogue on the effectiveness of 21 the intervention. Any modifications to future educational initiatives will be based on the data collected and input from participants. By integrating these ethical considerations, the project aims to protect participant confidentiality, uphold professional accountability, and ensure a fair and transparent evaluation process. These principles reinforce the integrity of the project while contributing to evidencebased improvements in patient care. Discussion The problem addressed in this project is the lack of confidence among nurses reassigned to the telemetry technician role, which can lead to delays in identifying critical arrhythmias and initiating timely interventions. This project aims to evaluate the effectiveness of an educational intervention to enhance nurses’ confidence in the telemetry technician role. By assessing changes in confidence levels through pre- and post-training surveys, this project seeks to determine whether targeted education improves clinical readiness and supports evidence-based nursing practice. This discussion will explore possible ways to disseminate the findings, explain the project’s significance, highlight key implications for clinical education and patient safety, and recommend ideas for continued research related to this project. Evidenced-Based Solutions for Dissemination The nurses reassigned to the telemetry technician role who participated in the intervention will receive a summary of the project findings, including aggregated pre- and posttraining survey results. This will be shared through a post-intervention debriefing session led by the project lead, allowing participants to review the impact of their training and provide additional qualitative feedback. 22 The findings will be presented during unit-based meetings and continuing education sessions to promote broader knowledge translation within the nursing team. A report summarizing the effectiveness of the intervention, statistical data on confidence level improvements, and practical implications for telemetry monitoring will be shared with nurse managers, educators, and participating nurses. The project results will be shared with academic faculty and unit-level leadership through formal poster presentations and a written report. A structured report detailing the intervention, methodology, findings, and recommendations will be submitted to nursing leadership and the education department for review. Additionally, the possibility of presenting the findings at nursing conferences will be explored to contribute to the broader body of knowledge on competency-based training in telemetry monitoring. Significance to Advance Nursing Practice This project can potentially advance nursing practice by addressing knowledge and confidence gaps among nurses reassigned to the telemetry technician role. Accurately interpreting cardiac rhythms is essential for patient safety, as delays in identifying lifethreatening arrhythmias can lead to adverse patient outcomes, including cardiac arrest or delayed medical intervention (Lee et al., 2024). By implementing a structured educational intervention, this project can enhance nurses’ confidence and competence in telemetry monitoring, ultimately leading to improved patient care and workflow efficiency. One of the most pressing challenges in nursing education and professional development is ensuring that nurses are equipped with the necessary skills to transition between specialized roles efficiently. Research indicates that role-specific training programs can significantly improve clinical competency and job satisfaction, particularly in high-stakes environments such 23 as cardiac monitoring (Wright et al., 2024). This project reinforces the need for ongoing education and competency validation, supporting evidence-based practice and aligning with the American Nurses Association’s emphasis on lifelong learning and professional development (American Nurses Association, n.d.). Furthermore, by integrating pre- and post-training surveys, this project provides quantifiable evidence of the impact of structured education on nursing confidence levels. These findings can guide future educational initiatives within the institution, supporting a data-driven approach to professional development. Implications This project has important implications for nursing education, clinical practice, and patient safety. By addressing the confidence gap among nurses reassigned to the telemetry technician role, the intervention strengthens their ability to accurately interpret cardiac rhythms, leading to earlier detection of critical arrhythmias and timely intervention. However, as with any educational initiative, this project has strengths, limitations, and potential obstacles that must be considered for broader application. One of the key strengths of this project is its evidence-based approach to role-specific training. By integrating structured pre- and post-training assessments, the project measures selfreported confidence levels and can provide quantifiable data to assess the effectiveness of the educational intervention. This data-driven approach ensures that training programs can be continuously refined and improved based on participant feedback and outcomes. Additionally, the intervention’s application aligns with patient safety priorities in telemetry monitoring. Enabling quicker recognition of telemetry findings facilitates more efficient interdisciplinary collaboration, reduces treatment delays, and improves patient 24 outcomes. As a result, this project advocates for continuous professional development focusing on patient safety through strengthened interdisciplinary teamwork. Despite its strengths, this project has several limitations. First, the sample size is relatively small, potentially limiting the generalizability of the findings. The outcomes may vary based on individual learning styles, previous exposure to telemetry monitoring, or nurse-specific workflows. Another limitation is the reliance on self-reported confidence measures, which may not fully capture clinical competency. While nurses may report increased confidence, it does not necessarily equate to improved accuracy in ECG interpretation. To mitigate the limitations identified in this project, several strategies can be implemented to enhance the effectiveness and sustainability of this educational intervention. Future training iterations could be expanded across multiple units or healthcare institutions to increase participation and obtain a more representative dataset to address the limitation of having a small sample size. Additionally, because self-reported confidence measures may not fully reflect actual competency in ECG interpretation, incorporating hands-on simulation training and post-training competency assessments would provide more objective evidence of skill improvement. This project underscores the importance of structured, role-specific training in nursing practice. As healthcare environments evolve, nurses are often required to transition into new roles with minimal preparation. This intervention highlights the need for proactive educational strategies to ensure that nurses are adequately trained and confident in their responsibilities before assuming specialized roles. Moreover, the project supports the broader nursing framework of lifelong learning by advocating for continuous professional development to improve individual competency and the quality of patient care. Implementing structured telemetry 25 training programs can serve as a model for other role-specific nursing education initiatives, ensuring that nurses remain well-equipped to deliver high-quality patient care. Recommendations For the implementation of this project, several recommendations should be considered to optimize its effectiveness and ensure meaningful outcomes. The anticipated impact of this educational intervention is an improvement in nurses’ confidence and competence in the telemetry technician role. To maximize its effectiveness, this program could add a practical application component in addition to the didactic instruction provided. Another key consideration is the need for long-term follow-up assessments to evaluate whether improvements in confidence are sustained over time. Conducting periodic evaluations, such as three- and six-month post-training assessments, could provide insight into knowledge retention and identify areas where refresher training may be beneficial. Future research could explore the relationship between increased confidence in telemetry monitoring and actual improvements in patient safety outcomes, providing data to support the necessity of structured role-specific training further. By implementing these recommendations, this project has the potential to significantly enhance nurses' confidence and effectiveness in telemetry monitoring, ultimately contributing to better patient outcomes and improved workflow efficiency. Conclusions This project highlights the importance of role-specific training in improving nurses’ confidence and competence when reassigned to the telemetry technician role. Structured educational interventions can positively impact nurses' self-reported confidence levels, essential for accurate and timely ECG interpretation in patient care. By comparing pre- and post-training 26 survey results, this project provides quantifiable evidence supporting the effectiveness of targeted education in enhancing clinical readiness and promoting patient safety. One of the key outcomes of this project is the reinforcement of evidence-based education as a necessary component of nursing professional development. Nurses who feel more confident in telemetry monitoring will likely make faster and more accurate clinical decisions, ultimately reducing delays in recognizing critical arrhythmias. Additionally, including qualitative feedback from participants further supports the practical value of the training, ensuring that the education is relevant, engaging, and applicable to real-world clinical settings. Despite its strengths, the project also identified several limitations, including sample size constraints and self-reported confidence measurements. To mitigate these obstacles, recommendations include expanding the training program, incorporating simulation-based learning, and implementing longitudinal follow-ups to assess long-term competency retention. In conclusion, this project underscores the importance of structured, role-specific training as integral to nursing education and workforce development. This initiative contributes to improved patient outcomes, enhanced clinical efficiency, and a stronger foundation for evidencebased nursing practice by equipping nurses with the knowledge, skills, and confidence needed for telemetry monitoring. 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Continuing education for advanced practice nurses: A scoping review. Journal of Advanced Nursing, 80(8), 3037-3058. https://doi.org/10.1111/jan.15911 30 31 Appendix A Telemetry Training PowerPoint RN TELEMETRY TRAINING ETHAN YOUNG, BSN, RN, MSN-E STUDENT WEBER STATE UNIVERSITY • • • • 32 • • • • • • • • 33 • • • • • • • • • 34 • NOTIFY NURSES OF TELEMETRY EVENTS PROMPTLY. THIS IS THE TIME TO RELY ON THE TELE TECHS SITTING WITH YOU ON WHAT TO NOTIFY FOR. ERR ON THE SIDE OF NOTIFYING NURSES OF YOUR CONCERNS • WHEN YOU NOTIFY, SAVE THE STRIP OF THE EVENTS. IN THE COMMENT SAY ‘(INSERT RN NAME) RN NOTIFIED’, THEN YOUR INITIALS • CHART IN THE ‘TELE TECH’ FLOWSHEET • EXAMPLES OF COMMON EVENTS TO CALL ABOUT... • VTACH (GREATER THAN 6 BEATS) • TACHYCARDIA OR BRADYCARDIA • PAUSE (INFORM RN AND CHART RR LENGTH) • RHYTHM CONVERSIONS (INCLUDING BACK TO NSR) • INCREASE IN FREQUENCY OF ECTOPY 35 • • • 36 Appendix B Reference Guide 37 38 Appendix C Pre- and Post-Surveys 2/2/25, 11:21 AM Telemetry Training for Nurses - Initial Survey Telemetry Training for Nurses - Initial Survey Please complete this form prior to receiving the telemetry education. * Indicates required question 1. Have you ever been pulled to tele for a shift? * Mark only one oval. Yes No 2. How confident do you feel about your ability to perform if assigned to tele for a shift? * Mark only one oval. 1 - Not Con dent at All 2 - Slightly Con dent 3 - Moderately Con dent 4 - Very Con dent 5 - Extremely Con dent https://docs.google.com/forms/d/1iAS40p9ufEly0AMTz58Ew56fw4lJYL-qzFHcQyF4fdk/edit?pli=1 1/3 39 40 2/2/25, 11:21 AM Telemetry Training for Nurses - Post-survey Telemetry Training for Nurses - Postsurvey Please complete this form after receiving the telemetry education. * Indicates required question 1. Have you ever been pulled to tele for a shift? * Mark only one oval. Yes No 2. How confident do you feel about your ability to perform if assigned to tele for a shift? * Mark only one oval. 1 - Not Con dent at All 2 - Slightly Con dent 3 - Moderately Con dent 4 - Very Con dent 5 - Extremely Con dent https://docs.google.com/forms/u/1/d/1UcxoeSbmjzlM9iWx2-AyyElpVtr8OhxHRaJcyuoGv_0/edit?ntd=1&usp=forms_home&ths=true 1/3 41 42 Appendix D Timeline Enhancing Nurse SelfEfficacy When Reassigned to be Telemetry Technicians Summary of Timeline of Project Implementation Plan Week 1 Meet with unit leadership to assess needs and plan training details. Assess Week 2 Conduct pre-training survey to determine baseline data for project. Assess week 3 Continue data collection of nurses' attitudes of the telemetry technician role. Week 4 Meet with leadership to discuss pre-survey data and finalize presentation. week 5 Present the PowerPoint to participants and collect post-training survey data. week 6-8 Analyze post-training data to assess project success. Prepare Educate Evaluate