Bobbi-Jean Plummer, CEN, CCRN, APRN, BC, who is a cardiac clinical nurse specialist, recently contributed an article on ECG interpretation for the June issue of the American Journal of Nursing. She is located at St. Joseph’s Regional Medical Center in Paterson, New Jersey.

Tell us about your role as a cardiac clinical nurse specialist at St. Joseph’s Regional Medical Center. What is a typical work day like for you?
       Let me start by saying there is no such thing as a “typical day.” Theoretically, my role as CNS has four facets: direct care, education, research, and consultation, but how each of these components plays out varies with the job responsibilities and unit activities. Direct patient care may be as part of a consult on a complex case or in assisting a new nurse to learn sheath removal. Research may include implementation of evidence-based practice or quality review of cardiac arrest codes. As leader of the Rapid Response Team, all aspects of the CNS job are combined in different degrees.

What are some of the daily challenges you encounter?
       The daily challenges I encounter are the same as most nurses. Restrictions in the current health care situation of staffing, resource and time are challenges at all levels. Delivering patient care as it should be done to meet the needs of patient, staff, administration and regulating agencies presents a challenge that at times seems insurmountable.

How did you get into the field of cardiology?
       I actually started in emergency care, and through job changes around me, had cardiology given to me as part of “other duties as assigned.” Once I was immersed in the field I found it difficult to walk away, and began expanding my role within cardiology to include telemetry, then ICUs, and finally, invasive cardiology and open-heart surgery.

Is there a particular patient case that was most challenging or memorable for you? Please describe.
       There have been many memorable cases in my career, but I think the most challenging patient case may have been my father. He was a very strong and healthy individual until his early 80s, when he was diagnosed — after a series of “incidental” findings — with severe cardiac disease. Trying to fulfill the role of cardiac CNS while still being a daughter presented challenges for both of us. Fortunately, we had an excellent cardiologist who provided insight and great humanity to us, especially at the end of my father’s life.

In your recent article “ECG Challenge: How strip savvy are you?”, what tips do you provide about interpreting ECGs? What do you think are some of the common mistakes made when understanding ECGs?
       In the article, and when I teach arrhythmia interpretation, I try to bring the learner back to basics, to take a rhythm strip as a whole and then to dissect it. Rhythm interpretation is a puzzle that needs to be taken apart and then have the pieces put together and labeled. I think the most common mistake made is that individuals often get caught up in what is the proper label; they forget what the rhythm is telling you about the physiology of the heart and, more importantly, the status of the patient.

What advice can you give for those just starting out in the medical field?
       When I started in nursing, I remember being upset over the loss of a patient, and a more seasoned nurse told me that in time I would “get used to it.” I vowed then that if I ever “got used to it,” I would change professions. I feel the same today after many years of experience. My best advice to newcomers is to learn to work around those difficult moments, but to never distant yourself so much that you “get used to it.”

For more information about this article, please see:
Plummer BJ. ECG Challenge: How strip savvy are you? Am J Nurs 2007;107(6):72A-72C.