Electrocardiogram interpretation competence among nursing students and registered nurses: a cross-sectional study

Background/Introduction Cardiovascular diseases are a major cause of mortality in Italy, making nursing competence in electrocardiogram (ECG) interpretation a healthcare priority. This study aims to evaluate the progressive acquisition of ECG competencies among nursing students across all three academic years at the University of Parma. Secondarly, it compares final-year students’ performance with that of critical care nurses. Methods/Approach This cross-sectional study compared nursing students from the University of Parma with nurses from Azienda USL of Piacenza using an online questionnaire on REDCap. The tool assessed socio-demographics, theoretical knowledge (15 items), and rhythm interpretation on simulated ECG tracings (11 items). Data analysis, utilized non-parametric tests (Mann-Whitney; significance p < 0.05 with Bonferroni correction). The study was approved by the Ethics Committee AVEN, all participants provided online informed consent, and anonymity was strictly guaranteed. Results/Conclusions A total of 124 questionnaires were completed, 83 by nursing students (66.94%) and 41 by nurses (33.06%). The median total score of correct answers progressively increased from the first-year students (11.5) to the second- (12) and the third- year (15) students, peaking among nurses (18). In the theoretical questionnaire, students showed significant progression across academic years on questions 4, 5, 6 (p < 0.05), while nurses significantly outperformed third-year students on questions 9, 13, and 14 (p < 0.05). In the practical assessment, students differed significantly only on question 5 (p = 0.038). Nurses demonstrated superior tracing interpretation skills compared to final-year students on questions 1, 2, 4 (p ≤ 0.002). Discussion/Implications Findings align with literature, confirming that ECG competence peaks with clinical experience and specialized unit affiliation, driven by consolidated pattern-recognition. While descriptive scores showed a promising upward trajectory throughout the academic years, the sample size and convenience sampling primarily affected the statistical power. Moreover, the distinct gap between third-years and nurses demonstrates that academic preparation is further consolidated by clinical practice. This underscores the value of integrating innovative educational methodologies, such as blended learning and high-fidelity simulations, into nursing curricula, while highlighting the essential role of continuous professional education for nurses to sustain advanced emergency competencies. Conclusion ECG interpretation competence progressively improves throughout nursing education, consolidating with experience. The instrument used in this study to assess the competences could be implemented within curricula as a learning and self-assessment tool after clinical placements. Finally, future RCTs are needed to overcome cross-sectional limitations and evaluate the efficacy of innovative versus traditional educational strategies.