Cardiac Nursing Acute/Episodic Care

Career Pathway
Competency Statements

Cardiac Nursing Competency Statements

January 2004

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Foreword by Professor David Thompson

In an era of the so-called knowledge economy, the concept of lifelong learning and
the belief that education matters, there is a need to ensure that skills (be they basic,
core or key) as well as knowledge are developed. Indeed, Skills for Health, a
government-backed body which has the support of the four UK health departments,
the independent health sector, voluntary sector and staff organisations, has as its key
aim the development of skills for all those people employed by the NHS or in the
independent health sector.
One of the key building blocks for Skills for Health is the use of competency
frameworks. These frameworks identify the skills, experience and training which will
help ensure consistency and quality across healthcare in the UK. The frameworks
comprise a set of statements identifying what people or teams need to know and be
able to do to deliver that service. These Cardiac Nursing Acute/Episodic Care
Career Pathway: Competency Statements, developed by the British Association for
Nursing in Cardiac Care (BANCC) in collaboration with the Royal Brompton and
Harefield NHS Trust and Thames Valley University, are an important contribution to
nursing and work in conjunction with the Skills for Health competency framework
being developed for prevention, heart failure and rehabilitation in coronary heart
disease.
Well-defined competencies from entry to practice through to advanced practice are
needed in nursing, and they need to be refined to ensure greater accountability to
patients and clients and their families and carers, within the profession, in relation to
other health professionals, and with regard to the various contexts of practice.
These Cardiac Nursing Acute/Episodic Care Career Pathway: Competency
Statements should certainly fulfil their purpose of guiding the career development of
nurses across acute cardiac care settings. They should also help produce cardiac
nurses who are fit for purpose, in that they are knowledgeable, clinically competent,
thoughtful, critical and articulate.

Professor David R Thompson BSc MA PhD MBA RN FRCN FESC

January 2004

Cardiac Nursing Competency Statements

January 2004

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Contents
Introduction................................................................................................................. 6
Explanation of Competency Statements..................................................................... 7
Definition of competence ...................................................................................... 7
Scope of the competency topics........................................................................... 7
Competency sections ........................................................................................... 7
Competency development stages ........................................................................ 8
Assessment of competence.................................................................................. 8
Evidence utilised............................................................................................. 8
Peer review/assessors.................................................................................... 9
Maintenance of competence........................................................................... 9
Example of use of the cardiac nursing competency pathway ............................... 9
Acknowledgements............................................................................................... 9
References ......................................................................................................... 11
Record of Peer reviewers/Assessors........................................................................ 12
Example of use of the cardiac nursing competency document................................. 13
Competency sections ............................................................................................... 15
Core Professional Competencies ....................................................................... 15
Respecting and promoting individuality ........................................................ 15
Communication patients ............................................................................ 17
Communication - multidisciplinary team ....................................................... 19
Education - patients ...................................................................................... 21
Education staff ........................................................................................... 23
Leadership .................................................................................................... 25
Managing resources ..................................................................................... 27
Standards and protocols ............................................................................... 29
Research ...................................................................................................... 31
Core Clinical Competencies ............................................................................... 33
Haemodynamic monitoring ........................................................................... 33
ECG monitoring and interpretation ............................................................... 35
Arterial oxygenation management ................................................................ 37
Delivery of oxygen therapy non-invasive ................................................... 39
Auscultation of heart sounds......................................................................... 41
Auscultation of breath sounds....................................................................... 43
Blood sampling and cannulation ................................................................... 45
Blood sample analysis .................................................................................. 47
Chest x-ray interpretation.............................................................................. 49
Underwater seal chest drains ....................................................................... 51
Wound healing.............................................................................................. 53
Assessment of cardiac chest pain ................................................................ 55
Specialised Clinical Competencies ..................................................................... 57
Delivery of oxygen therapy supportive....................................................... 57
Resuscitation/ life support............................................................................. 59
Femoral arterial sheath removal ................................................................... 61
Cardiac pacing temporary.......................................................................... 63
Cardiac pacing permanent......................................................................... 65
Cardiac Nursing Competency Statements
January 2004

Intra-aortic counterpulsation ......................................................................... 67

Elective cardioversion................................................................................... 69
Thrombolysis nurse-initiated ...................................................................... 71
Exercise tolerance testing............................................................................. 73
Tilt-table testing ............................................................................................ 75
Appendix 1................................................................................................................ 78
Feedback / comments on Cardiac Nursing Acute/Episodic Care Competency
Statements ............................................................................................................... 80

Introduction
The evolution of this career pathway has arisen from the desire to improve patient
outcome through assuring a high quality cardiac nursing service delivery. The
pathway, as illustrated in Figure 1, suggests that a balance between education,
training and practice can be achieved in a way that will advance career progression.
Driven by current professional, political and societal forces, this is in keeping with the
current strategic intentions for nursing outlined by the Department of Health in the
paper Making a Difference (Department of Health, 1999) and the Chief Nursing
Officers key roles for nurses (The Stationery Office, 2001).

Figure 1. Career development pathway of the cardiac nurse

Advanced clinical development
Higher degree/ Masters/PhD

Intermediate clinical development

Specialist study/post-graduate diploma

Immediate post-registration clinical development

Initial diploma/degree

Pre-registration clinical development

Preparation for initial diploma/degree

Cardiac nursing takes place within various spheres of health care: primary,
secondary and tertiary care. Within these, cardiac nursing expertise tends to fall into
four domains: health promotion, cardiac prevention and rehabilitation, acute/chronic
and episodic care, and palliative care (Riley, Bullock, West & Shuldham, 2003). The
focus of this document is to present cardiac nursing competency statements for
acute/episodic care that utilises the pathway described above. Appropriate settings
for the use of these competencies may include cardiac surgical and medical wards,
cardiac catheter laboratories, cardiac critical care units, coronary care units, rapid
access chest pain clinics, and echocardiography, although this list is not exhaustive.
These competencies may be utilised:
For planning career development;
For determining areas needed for further training/study/experience;
In the Individual Performance Review/appraisal process;
As assurance of professional integrity;
To ensure public safety.

Cardiac Nursing Competency Statements

January 2004

Explanation of Competency Statements

Definition of competence
Competence is defined as the possession of knowledge, skills and abilities required
for lawful, safe and effective professional practice without direct supervision (Nursing
and Midwifery Council, 2002).
However, competence is more than possessing the knowledge or psychomotor skills
necessary to perform a specific task competence means the caregiver can
integrate knowledge, skills, and personal attributes consistently in daily practice to
meet established standards of performance (Fey, 2000).
Scope of the competency topics
These competency statements are specifically related to the delivery of
acute/episodic cardiac nursing care, and as such do not include those generic acute
care nursing competency statements already in place e.g. intravenous drug
administration. They work in conjunction with the Skills for Health competency
framework currently being developed for prevention, heart failure and rehabilitation in
Coronary Heart Disease.
The topics are designed to encompass the various skills and knowledge that nurses
will require in the delivery of acute/episodic cardiac nursing care. However, not all
topics are relevant to all areas of practice e.g. underwater seal chest drains are rare
in coronary care units. It is anticipated that each clinical area will select the
appropriate competency topics relevant to the development of staff for practice within
that area. This will be under the guidance of the area manager.
Competency sections
The competency topics have been grouped into three sections.
The core professional competencies are comprised of skills and knowledge that are
generic to all areas of nursing. They are hence imperative to all aspects of cardiac
nursing and should be developed in parallel with the nurses development of
specialised cardiac clinical practice. These are relevant to all clinical areas.
The core clinical competencies contain skills and knowledge that primarily have a
practical clinical focus. They include the fundamental cardiac nursing skills likely to
be encountered in most areas of the delivery of acute/episodic cardiac nursing care.
They provide grounding skills that will enable the nurse to further specialise within
acute/episodic cardiac nursing.
The specialised clinical competencies have been identified as the skills and
knowledge required for specific areas of acute/episodic cardiac nursing. These skills
all require competence in many, yet not all, of the general skills as prerequisite for
delivering care, and hence have a focus on the management and integration of skills
and knowledge. For example, exercise tolerance testing requires competence in
ECG monitoring and interpretation, haemodynamic monitoring, auscultation of heart
sounds, blood sampling and cannulation, and resuscitation/ life support.
7

Competency development stages

Throughout the cardiac nurses career, skills and knowledge are continually
developed. It follows that the depth of understanding and practice then differs
between a newly qualified cardiac nurse and an experienced specialist cardiac nurse.
Using this competency pathway, career development can be mapped. Both clinical
and academic development progress together. It is inherent that subsequent
achievement of competence is reliant upon competence at the preceding stage. In
other words, it is impossible to be competent at a higher level without first achieving
competence at the lower levels.
The stages are differentiated and described as follows:
Clinical development
Pre-registration development

Academic development
Preparation for initial diploma/degree
Initial diploma/degree

Immediate post-registration
development
Intermediate development

Advanced development

1
2

Specialist study/post-graduate
diploma
Higher degree/Masters/PhD

Each competency topic contains competency statements appropriate to these stages

of development.
Assessment of competence
Evidence utilised
The evidence required for initial achievement and maintenance of competence will
vary according to the Competency Statement for skill and knowledge, and stage of
clinical and academic development. Specific performance criteria will be determined
at local level, and will be reliant upon the resources available. A summary of the
evidence utilised for determining competence may be written into the competency
document. One recommendation for the presentation of extensive or printed
evidence is within the nurses Personal Professional Portfolio, with reference to
specific location documented as appropriate in the Competency Statements
document.
Evidence from the workplace may include:
Observed practice assessment
Explanation of rationale
Care plans
Witness statements
Completion of self-directed worksheet
Workshops
Completion of relevant recognised
awards
Patient feedback

Publications/reports/protocols
Participation in local/national
initiatives
Participation in special interest
groups/projects
Contribution to professional
organisation
Attendance at national/international
cardiac conferences

Cardiac Nursing Competency Statements

January 2004

Reflective practice diaries

Specialised training
Audit data

Contribution at national/international
conferences

Peer review/assessors
Assessors of competence are those professionals who themselves have achieved
competence relevant to the skill/knowledge at appropriate level. They should have
adequate expertise and training relevant to the level of competence under
assessment. For example, this may be a clinical facilitator, the nurses assigned
mentor, or their manager. Assessment is ongoing with the nurses continual
professional development. Appropriate planning and review may take place within
the individual performance review/appraisal process.
Maintenance of competence
In much the same way as evidence will be provided for attainment of competence, so
too there must be provision for ongoing maintenance of competence. This may
include continuing performance of skill at required level. For example, ECG
interpretation in nurse-led thrombolysis.
Example of use of the cardiac nursing competency pathway
To construct a wall, bricks are laid upon another, and so the wall grows. So too, does
the career of a cardiac nurse. Competence is achieved in a range of topics, at
progressive stages of development, and a wall of competence as a cardiac nurse
appears. The career development of the nurse to work in the specialised area of a
Rapid Access Chest Pain Clinic is diagrammatically represented in Figure 1. The
highlighted bricks utilise exercise tolerance testing as an example in which
competence in the professional skills and knowledge form the foundation, and the
general skills and knowledge form the prerequisite components, in the development
of the specialist nurse to perform in this area.
Acknowledgements
This project developed subsequent to work undertaken at the Royal Brompton and
Harefield NHS Trust and Thames Valley University. The competencies have been
developed jointly by the British Association for Nursing in Cardiac Care (BANCC), the
Royal Brompton and Harefield NHS Trust, and Thames Valley University, and with
funding provided by the West London NHS Workforce Development Confederation.
The project steering group, experts who contributed to parts of the document, and
others who reviewed the document are listed in Appendix 1.

Figure 1. Competencies for Cardiac Nursing Career Pathway

(Highlighted bricks show the selection of competency topics required to practice in a Rapid Access Chest Pain Clinic.)

Specialised
Clinical
Competencies

Exercise
tolerance testing

Resuscitation/
Life Support

Cardiac stress
testing

Cardiac pacing permanent

Core Clinical
Competencies

Blood sample
analysis

ECG monitoring
& interpretation

Core
Professional
Competencies

Managing
resources

Respecting and
promoting
individuality

Cardiac pacing temporary

Blood sampling
and cannulation

Arterial
oxygenation
management

Education
patients

Tilt testing

Standards &
protocols

Education colleagues

10

Cardiac Nursing Competency Statements

January 2004

Femoral arterial
sheath removal

Assessment of
cardiac
chestpain

Haemodynamic
monitoring

Echocardiography

Research

Intra-aortic
counterpulsation

Auscultation of
heart sounds

Oxygen therapy non-invasive

Thrombolysis nurse-initiated

Leadership

Communication patients

Oxygen therapy supportive

Auscultation of
breath sounds

Underwater seal
drains

Communication colleagues

Elective
cardioversion

Chest x-ray
interpretation

Wound healing

References
Department of Health (1999) Making a difference. London: Department of Health.
www.doh.gov.uk/nurstrat.htm
Fey, M. & Miltner, R. (2000) A competency-based orientation program for new
graduate nurses. Journal of Nursing Administration, 30(3), pp 126-132.
Nursing & Midwifery Council (2002) Code of Professional Conduct. London: NMC.
www.nmc-uk.org/cms/content/Publications/Code%20of%20professional%20conduct.
pdf
Riley, J.P., Bullock, I., West, S. & Shuldham, C. (2003) Practical application of
educational rhetoric: a pathway to expert cardiac nurse practice? European Journal
of Cardiovascular Nursing, 2:283-290.
The Stationery Office (2000) The NHS Plan. London: Her Majestys Stationery Office
http://www.nhs.uk/nationalplan/nhsplan.pdf

11

Record of Peer reviewers/Assessors

Date

Name (print)

Signature

Designation

Relationship to Assessee (e.g. Organisation

Manager, mentor)

Feb
2000
Mar
2001

E.g. Sarah Jones

S.J.

RGN

Mentor Clinical placement

Cardiology ward, XX Hospital

E.g. Mary Brown

M.B.

RGN

Mentor

Cardiothoracic
Hospital

12

Cardiac Nursing Competency Statements

January 2004

ward,

YY

Example of use of the cardiac nursing competency document

ECG monitoring and interpretation
Competency Statements

1.1

2.1

Competence achieved

Competence maintained

Evidence utilised:

Peer
reviewed:

Evidence utilised:

Peer
reviewed:

Skill:
Demonstrates the ability to correctly prepare patient,
equipment and environment for recording of ECG e.g.
12-lead, telemetry, hard-wire monitoring.

Performed independent and

accurate patient and equipment
preparation (observed 5 times)

SJ
5/3/1998

Performed ECG recording at least

once/week.

MB
23/4/1999

Knowledge:
Describes cardiac surface anatomy for correct
electrode placement and methods for
minimising/eliminating abnormalities in recording.

Attended teaching session on ECG.

Accurately explained electrode
placement, skin preparation and
patient positioning.

SJ
28/2/1998
SJ
6/3/1998

Read article on ECG recording and

completed reflective practice (see
PPP pg 4)

MB
23/3/1999

Skill:
Demonstrates the ability to distinguish normal from
abnormal ECG trace and refer to another member of
the multidisciplinary team e.g. rhythm strips.

Correctly identified rhythms of

patient in allocation.

MB
18/4/1999

Responded appropriately when

patient haemodynamically
compromised with AF.

MB
6/3/2000

Knowledge:
Describes basic cardiac anatomy, the conduction
system and the normal PQRST complex.
Recognises basic cardiac arrhythmias.

Attended ward teaching session on

ECG interpretation.
Completed self directed package on
ECG rhythm interpretation.
Correctly identified rhythms on
rhythm identification test.

MB
8/2/1999
MB
22/2/1999
MB
7/4/1999

13

3.1

3.2

4.1

Skill:
Demonstrates the ability to analyse the ECG and
respond appropriately e.g. 12-lead ECG, rhythm strip.

Correctly analysed ECG for

patients in allocation.

MB
6/6/2000

Identified new MI from ECG of

patient experiencing chest pain.

MB
12/12/2001

Knowledge:
Examines the ECG, recognising abnormalities and
their potential causes e.g. ST changes.

Completed ECG interpretation

course and exam (over 8 weeks)

MB
10/2/2000

Completed Cardio-respiratory
course, Level 3.

MB
9/7/2001

Skill:
Demonstrates the ability to initiate treatment in
response to ECG analysis e.g. pacing, atropine, refer
to cardiologist, refer to electrophysiologist, discharge
home.

Appropriate administration of
atropine for vaso-vagal attack.

MB
7/8/2001

Provides regular teaching sessions

for nursing management of
arrhythmias.

MB
2002

Knowledge:
Critically analyses the appropriateness of varying
interventions on the ECG.

Successfully completed ALS course.

MB 8/2003

Skill:
Demonstrates the ability to evaluate the impact of
intervention on the ECG and suggests alternatives.

Contributed to protocol for the

treatment of vaso-vagal attack.

MB
11/2004

Knowledge:
Evaluates the outcomes and implications of
therapeutic interventions on the ECG.

Published journal article on Vasovagal attack the role of the

nurse

MB
10/2005

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Cardiac Nursing Competency Statements

January 2004

Competency sections
Core Professional Competencies
Respecting and promoting individuality
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to approach the patient and
their family with dignity, and treat them as unique
individuals.

Knowledge:
Describes factors that underpin interpersonal
relationships and the importance of the individual.

2.1

Skill:
Demonstrates an awareness of influences on
individual response to illness e.g. gender, culture,
ethnicity, illness, pain.

Knowledge:
Identifies factors which underpin professional nursepatient/family relationships, recognising the
implications of external factors e.g. response to crisis.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

15

3.1

Skill:
Demonstrates the ability to provide emotional support
in times of crises e.g. diagnosis of disease, referral for
surgery, bereavement.

Knowledge:
Applies consistent understanding and knowledge of
support mechanisms to individual patient situations.

4.1

Skill:
Demonstrates the ability to develop therapeutic
relationships with the patient and their family at all
times.

Knowledge:
Appreciates the importance of the individual, and
evaluates all behaviours and responses when dealing
with the patient and their family.

16

Cardiac Nursing Competency Statements

January 2004

Communication patients
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to ask for and receive
information.

Knowledge:
Describes questioning styles and methods of
communication e.g. open/closed questions and
recognises own limitations.

2.1

Skill:
Demonstrates the ability to give and receive
information in response to direct cues and refer to
another member of the multi-disciplinary team e.g.
access interpreter service, specialist nursing and other
services.
Knowledge:
Identifies theories of communication, barriers to
effective communication, appropriate situations and
locations, and recognises scope of own knowledge
base.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

17

3.1

Skill:
Demonstrates the ability to ask for and give information
in response to both direct and indirect cues e.g.
listening skills, selects appropriate methods of
communication.
Knowledge:
Applies appreciation of verbal and non-verbal cues and
differing communication techniques in communication
with patients e.g. body posture, positive feedback,
maintaining client-centred focus.

4.1

Skill:
Demonstrates the ability to provide guidance in
response to direct and indirect cues and external
factors at all times e.g. encourages informed personal
decision-making.
Knowledge:
Perceptive to the nuances of language e.g. written,
body posture, verbal and the effect of external factors.

18

Cardiac Nursing Competency Statements

January 2004

Communication - multidisciplinary team

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to use communication
equipment e.g. written, computer, telephone, fax.

Knowledge:
States communication equipment available in local
area.

2.1

Skill:
Demonstrates the ability to clearly and accurately
record all nursing interventions using local
communication equipment e.g. written, computerised.
Demonstrates a developing ability to communicate with
other members of the multidisciplinary team.
Knowledge:
Identifies local proforma to document care, and
understands the professional and legal requirements
for accurate record-keeping e.g. confidentiality, Data
Protection Act. Comprehends and recognises own
limitations in communication e.g. gaps in knowledge.
Differentiates roles and responsibilities of the multidisciplinary team.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

19

3.1

Skill:
Demonstrates the ability to communicate clearly and
effectively with other members of the multidisciplinary
team, in varying situations e.g. ward rounds,
emergency situations, case conferences, presentation
at study days.
Knowledge:
Applies appreciation of verbal and non-verbal cues
(e.g. body posture) and professional issues affecting
communication techniques.

4.1

Skill:
Demonstrates the ability to use a wide range of
communication skills (e.g. professional presentations,
writing for publication) with organisational structures
(e.g. committees, national/international bodies,
professional associations).
Knowledge:
Perceptive to the nuances of language (e.g. written,
body posture, verbal) and the effects of external
factors (e.g. interprofessional working)

20

Cardiac Nursing Competency Statements

January 2004

Education - patients
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to recognise that the patient
and their carers have educational needs.

Knowledge:
Describes why the patient and their carers have
learning needs in context of current situation e.g.
hospitalisation, limited knowledge of cardiac problems.
2.1

Skill:
Demonstrates the ability to recognise own limitations in
cardiac patient education, and refer to another member
of the multidisciplinary team.
Knowledge:
Explains common cardiac patient and family learning
needs related to acute/episodic cardiac problems, and
identifies appropriate sources of information.

2.2

Skill:
Demonstrates the ability to participate in cardiac
patient education and training e.g. with delivery of
care, formal sessions.
Knowledge:
Identifies learning opportunities for cardiac patients.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

21

3.1

Skill:
Demonstrates the ability to identify patient learning
needs and initiate cardiac patient and carer education.

Knowledge:
Interprets patient learning needs and the need to
modify delivery methods to suit the individual.

3.2

Skill:
Demonstrates the ability to contribute to and apply
appropriate educational materials for cardiac
patient/carer education.
Knowledge:
Differentiates and applies principles of adult education
and behaviour change, theories of learning and
educational materials appropriate for cardiac
patients/carers e.g. retention of information,
reinforcement of knowledge and skills.

4.1

Skill:
Demonstrates the ability to develop, utilise and
evaluate innovative and relevant cardiac patient/carer
educational strategies and materials e.g. leaflets,
posters, videos, role modelling, interactive IT
Knowledge:
Evaluates and researches the outcomes of educational
strategies and implications of external factors on
education of cardiac patients/carers e.g. rapid changes
in healthcare, governmental policy.

22

Cardiac Nursing Competency Statements

January 2004

Education staff
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to recognise own learning
needs against specific outcomes.

Knowledge:
Describes own learning needs in context of defined
curriculum guidelines.

2.1

Skill:
Demonstrates the ability to recognise learning needs in
others, limitations of self, and teach staff.

Knowledge:
Identifies appropriate educational materials for cardiac
nursing e.g. environment, resources, knowledge of
subject.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

23

3.1

Skill:
Demonstrates the ability to contribute to and apply
appropriate educational materials for cardiac nursing.

Knowledge:
Differentiates and applies theories of learning and
educational materials appropriate for cardiac nursing.

4.1

Skill:
Demonstrates the ability to develop, utilise and
evaluate innovative and relevant educational materials
for cardiac nursing, and utilise in teaching junior staff
across healthcare disciplines.
Knowledge:
Evaluates the outcomes and implications of external
factors to education in cardiac nursing e.g. multidisciplinary nature of healthcare, governmental policy.

24

Cardiac Nursing Competency Statements

January 2004

Leadership
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to take the lead for allocated
tasks.

Knowledge:
Describes the contribution of effective leadership to
their immediate scope of practice/work area.

2.1

Skill:
Demonstrates the ability to lead a team on a short-term
basis to achieve clearly defined local goals.

Knowledge:
Recognises leadership skills and their impact on
patient, team and local work area.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

25

3.1

Skill:
Demonstrates the ability to lead a team to determine
local goals in conjunction with achieving external
goals.

Knowledge:
Critically analyses and applies a range of leadership
skills, delegation/collaboration, principles of leadership
theory, and methods for managing change.

4.1

Skill:
Demonstrates the ability to act as a professional leader
within cardiac nursing, the organisation and across the
wider healthcare setting.

Knowledge:
Evaluates the outcomes and implications of leadership
on the strategic direction of cardiac nursing.

26

Cardiac Nursing Competency Statements

January 2004

Managing resources
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to participate at local level in
identifying resource needs.

Knowledge:
Recognises the impact that the ineffectual use of
resources can have on service delivery.

2.1

Skill:
Demonstrates the ability to assist in the planning of
individual components of workload/caseload for local
environment.

Knowledge:
Identifies basic principles of resource management.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

27

3.1

Skill:
Demonstrates the ability to take responsibility and
accountability for a defined caseload.

Knowledge:
Applies an understanding of the business planning
process.

4.1

Skill:
Demonstrates the ability to evaluate available
resources to enhance service delivery to practice
within the clinical governance framework e.g. assure
and improve quality of care, individual and
organisational objectives/accountability.
Knowledge:
Evaluates and produces effective plans for the
management of resources.

28

Cardiac Nursing Competency Statements

January 2004

Standards and protocols

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to use protocols and
standards in clinical practice.

Knowledge:
Defines standards and protocols for cardiac nursing
practice.

2.1

Skill:
Demonstrates the ability to implement standards and
protocols in relevant cardiac nursing situations.

Knowledge:
Identifies factors that impact on the implementation of
standards and protocols in cardiac nursing practice.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

29

3.1

Skill:
Demonstrates the ability to critically analyse standards
and protocols relevant to cardiac nursing practice and
contribute to multi-disciplinary development.

Knowledge:
Applies standards and protocols relevant to cardiac
nursing practice, recognising areas for development
and change.

4.1

Skill:
Demonstrates the ability to take the lead in devising
and writing protocols and standards relevant to cardiac
nursing, in response to external factors e.g. against
National targets, patient group directions, current
research.
Knowledge:
Evaluates outcomes and implications of standards and
protocols with consideration of external factors.

30

Cardiac Nursing Competency Statements

January 2004

Research
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to read research reports.

Knowledge:
Identifies the research paradigm e.g. quantitative,
qualitative.

2.1

Skill:
Demonstrates the ability to implement findings of
research studies relevant to cardiac nursing practice.

Knowledge:
Recognises the rationale for research in changing
nursing practice.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

31

3.1

Skill:
Demonstrates the ability to critically analyse existing
research, identify areas of practice that could lead to
primary research opportunities, and co-ordinate
research studies relevant to cardiac nursing practice.
Knowledge:
Discusses the implications of appropriate research for
clinical practice e.g. appropriate methodologies.

4.1

Skill:
Demonstrates the ability to supervise, collaborate,
seek funding for, generate original research, and
disseminate findings in accordance with
approved/recognised standards. Demonstrates the
ability to disseminate and support implementation of
findings.
Knowledge:
Devises and conducts appropriate research studies,
including decisions regarding sources of funding,
ethical approval, and alternatives in the construction,
implementation and evaluation processes.

32

Cardiac Nursing Competency Statements

January 2004

Core Clinical Competencies

Haemodynamic monitoring
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to correctly prepare patient
and equipment, and monitor and report reading from
non-invasive haemodynamic monitoring. e.g. NIBP.
Knowledge:
Describes the equipment required, anatomical
locations for measurement, and normal ranges of
pulse and arterial blood pressure.

2.1

Skill:
Demonstrates the ability to analyse and intepret
readings from non-invasive haemodynamic monitoring.
Knowledge:
Recognises and describes the reasons for abnormal
readings and potential causes e.g. changes in patient's
condition, incorrect cuff placement, troubleshooting.

2.2

Skill:
Demonstrates the ability to correctly prepare patient
and equipment, and monitor and interpret waveforms
from invasive haemodynamic monitoring e.g. CVP,
arterial, PA, RA, PAWP, LA.
Knowledge:
Describes the equipment and safety considerations
required for measurement of invasive haemodynamic
monitoring, and the normal waveforms and value
ranges produced by invasive intracardiac pressures
e.g. CVP, arterial, PA, RA, PAWP, LA.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

33

2.3

Skill:
Demonstrates the ability to analyse readings from
invasive haemodynamic monitoring.
Knowledge:
Recognises and describes the reasons for abnormal
traces/readings and potential causes e.g. changes in
patient's condition, troubleshooting.

3.1

Skill:
Demonstrates the ability to utilise interventions which
affect haemodynamic parameters in response to
patient requirements according to protocols e.g.
inotrope titration, antihypertensives.
Knowledge:
Analyses impact of interventions on haemodynamic
parameters e.g. titration of inotropic support.

3.2

Skill:
Critically analyses the impact of interventions against
similar alternatives e.g. inotropes, fluid replacement.
Knowledge:
Critically analyses the differences in interventions and
their applicability to varying situations.

4.1

Skill:
Demonstrates the ability to critically analyse waveform
patterns from haemodynamic monitoring in order to
identify underlying pathology e.g. c waves.
Knowledge:
Evaluates waveform patterns and pathological and
physiological causes of waveform alterations, and
identifies implications for haemodynamic monitoring
e.g. c waves.

34

Cardiac Nursing Competency Statements

January 2004

ECG monitoring and interpretation

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to correctly prepare patient,
equipment and environment for recording of ECG e.g.
12-lead, telemetry, hard-wire monitoring.

Knowledge:
Describes cardiac surface anatomy for correct
electrode placement and methods for
minimising/eliminating abnormalities in recording.

2.1

Skill:
Demonstrates the ability to distinguish normal from
abnormal ECG trace and refer to another member of
the multidisciplinary team.

Knowledge:
Describes basic cardiac anatomy, the conduction
system and the normal PQRST complex.
Recognises basic cardiac arrhythmias.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

35

3.1

Skill:
Demonstrates the ability to analyse the ECG and
respond appropriately.

Knowledge:
Examines the ECG, recognising abnormalities and
their potential causes e.g. ST changes.

3.2

Skill:
Demonstrates the ability to initiate treatment in
response to ECG analysis e.g. pacing, atropine, refer
to cardiologist, refer to electrophysiologist, discharge
home.
Knowledge:
Critically analyses the appropriateness of varying
interventions on the ECG.

4.1

Skill:
Demonstrates the ability to evaluate the impact of
interventions on the ECG and suggest alternatives.

Knowledge:
Evaluates the outcomes and implications of
therapeutic interventions on the ECG.

36

Cardiac Nursing Competency Statements

January 2004

Arterial oxygenation management

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates ability to perform and interpret oxygen
saturation monitoring.

Knowledge:
States normal oxygen saturation range and recognise
variations.

2.1

Skill:
Demonstrates ability to interpret arterial blood gas and
refer to another member of the multi-disciplinary team.

Knowledge:
States normal arterial blood gas ranges and
recognises variations.

2.2

Skill:
Demonstrates the ability to analyse findings of arterial
blood gas, determine cause of changes and refer to
another member of the multi-disciplinary team.
Knowledge:
Examines arterial blood gas results and differentiates
respiratory/metabolic causes.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

37

3.1

Skill:
Demonstrates the ability to use guidelines/algorithms
to initiate treatment in response to findings of arterial
blood gas analysis e.g. extubation.

Knowledge:
Identifies different methods of treating abnormalities in
arterial blood gas results.

3.2

Skill:
Demonstrates the ability to evaluate the impact of
interventions on arterial blood gas results and consider
alternative interventions.

Knowledge:
Critically analyses varying interventions and their
impact on arterial blood gas results.

4.1

Skill:
Develops protocols/guidelines/algorithms for the
management of arterial oxygenation in a variety of
clinical situations.

Knowledge:
Evaluates the outcomes and implications of the
management of arterial oxygenation for clinical
practice.

38

Cardiac Nursing Competency Statements

January 2004

Delivery of oxygen therapy non-invasive

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to correctly prepare patient
and equipment for non-invasive oxygen therapy e.g.
nasal speculae, face mask.

Knowledge:
Describes the advantages and disadvantages of
different types of non-invasive oxygen equipment, their
appropriate placement, and safety considerations.

Pre-requisite competence:
Arterial oxygenation
2.1

Skill:
Demonstrates the ability to recognise patient need for
the administration of oxygen therapy e.g. shortness of
breath, decreased oxygen saturation, cardiac chest
pain.
Knowledge:
Identifies factors in the patients clinical presentation
that will be affected by the administration of oxygen
therapy e.g. arterial oxygenation, respiratory rate.

Level 1.1 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

39

2.2

Skill:
Demonstrates the ability to analyse patient response to
non-invasive oxygen therapy.

Knowledge:
Applies understanding of the physiological response to
oxygen delivery.

3.1

Skill:
Demonstrates the ability to initiate changes to oxygen
therapy in response to patient condition, utilising
patient group directions and protocols.

Knowledge:
Relates changes in non-invasive oxygen therapy to
expected patient responses e.g. flow rates,
humidification, delivery system.

3.2

Skill:
Demonstrates the ability to evaluate the impact of noninvasive oxygen therapy on the patients condition.

Knowledge:
Critically analyses the effect of changes in noninvasive oxygen therapy to the patient.

40

Cardiac Nursing Competency Statements

January 2004

Auscultation of heart sounds

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to position stethoscope in
appropriate location for auscultation of heart sounds.

Knowledge:
Describes cardiac anatomy and cardiac surface
anatomy for auscultation of heart sounds.

2.1

Skill:
Demonstrates the ability to recognise normal heart
sounds.

Knowledge:
Explains physiology of normal heart sounds.

3.1

Skill:
Demonstrates the ability to detect abnormal heart
sounds and refer to another member of the multidisciplinary team
Knowledge:
Explains causes for abnormal heart sounds.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

41

3.2

Skill:
Demonstrates the ability to recognise different types of
abnormal heart sounds e.g. murmurs, rubs, clicks,
snaps.

Knowledge:
Applies understanding of abnormal cardiac function to
differentiate types and causes of abnormal heart
sounds.

4.1

Skill:
Evaluates the significance of abnormal heart sounds
with patients clinical condition, and initiates
appropriate referrals e.g. echocardiography.

Knowledge:
Synthesises understanding of abnormal heart sounds
with the clinical symptoms of the patient and rationale
for further investigation.

42

Cardiac Nursing Competency Statements

January 2004

Auscultation of breath sounds

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to position stethoscope in
appropriate location for auscultation of breath sounds.

Knowledge:
Describes respiratory anatomy and respiratory surface
anatomy.

2.1

Skill:
Demonstrates the ability to recognise normal breath
sounds.

Knowledge:
Explains causes of normal breath sounds.

2.2

Skill:
Demonstrates the ability to detect abnormal breath
sounds, and refer to another member of the multidisciplinary team.
Knowledge:
Explains causes of abnormal breath sounds.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

43

3.1

Skill:
Demonstrates the ability to differentiate types of
abnormal breath sounds e.g. wheeze, crackles.

Knowledge:
Applies understanding of abnormal respiratory function
to differentiate types and causes of abnormal breath
sounds.

3.2

Skill:
Demonstrates the ability to evaluate the significance of
abnormal breath sounds with patients clinical
condition, and plan/change treatment in accordance
with protocols/patient group directions e.g. refer for
chest x-ray, changing medications.
Knowledge:
Synthesises understanding of abnormal breath sounds
with the clinical presentation of the patient and
rationale for appropriate referral/further
investigation/changes in management regimen.

44

Cardiac Nursing Competency Statements

January 2004

Blood sampling and cannulation

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to identify surface anatomy
relevant to the circulatory system e.g. location of
appropriate arteries/veins.

Knowledge:
Describes the anatomy of the circulatory system.

2.1

Skill:
Demonstrates the ability to collect blood for sampling
from pre-existing access in accordance with protocol
e.g. arterial line, central venous line.

Knowledge:
Describes access routes appropriate for collection of
blood samples.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

45

3.1

Skill:
Demonstrates the ability to collect blood for sampling
in accordance with protocol e.g. venepuncture, arterial
stab, venous cannulation

Knowledge:
Assimilates knowledge of blood sampling and
cannulation techniques and safety considerations.

46

Cardiac Nursing Competency Statements

January 2004

Blood sample analysis

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to interpret the blood sample
results and refer to another member of the multidisciplinary team.

Knowledge:
States the normal ranges and recognises
abnormalities in blood sample results.

2.1

Skill:
Demonstrates the ability to analyse the blood sample
results and respond appropriately.

Knowledge:
Identifies potential causes of abnormalities in blood
sample results.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

47

3.1

Skill:
Demonstrates the ability to initiate blood sampling and
treatment in response to patients clinical condition.

Knowledge:
Applies knowledge of patients clinical condition in
relation to results of blood sample analysis.

3.2

Skill:
Demonstrates the ability to evaluate treatment in
response to blood sample analysis.

Knowledge:
Critically analyses the appropriateness of treatment.
Discuss implications of abnormal blood sample results.

48

Cardiac Nursing Competency Statements

January 2004

Chest x-ray interpretation

Competency Statements

Competence achieved
Evidence utilised:

2.1

Skill:
Demonstrates the ability to prepare patient for chest xray e.g. positioning, potential causes of interference,
safety issues.

Knowledge:
Describes thoracic surface anatomy for appropriate
positioning, safety issues, and methods of minimising
interference.

2.2

Skill:
Demonstrates the ability to interpret the chest x-ray,
and refer to another member of the multidisciplinary
team.

Knowledge:
Recognises basic thoracic anatomy on the normal
chest x-ray.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

49

3.1

Skill:
Demonstrates the ability to analyse the chest x-ray and
respond appropriately.

Knowledge:
Examines the chest x-ray, recognising abnormalities
and their potential cause e.g. atelectasis, positioning of
endotracheal tube, chest drains.

3.2

Skill:
Demonstrates the ability to initiate events in response
to chest x-ray analysis e.g. order repeat chest x-ray,
referral to physiotherapy, changes in mechanical
ventilation, discharge home in accordance with
protocols/patient group directions.
Knowledge:
Critically analyses the appropriateness of varying
interventions in response to chest x-ray analysis.

50

Cardiac Nursing Competency Statements

January 2004

Underwater seal chest drains

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates ability to accurately record drainage and
suction.

Knowledge:
Describes types of drainage and units of suction.

2.1

Skill:
Demonstrates the ability to interpret chest drainage/ air
leak, recognise abnormal, and refer to another
member of the multi-disciplinary team.
Knowledge:
Describes thoracic anatomy and principles of chest
drainage e.g. location of chest drains. Recognises
abnormal volumes of drainage/air leak relevant to
patient condition, and identifies units and range of
suction.

2.2

Skill:
Demonstrates ability to manage chest drains e.g.
position patient, change bottles, wound care.

Knowledge:
Analyses and applies understanding of need for
intervention from drainage assessment e.g. full bottle.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

51

3.1

Skill:
Analyses findings and initiates appropriate treatment in
response e.g. remove chest drains as per protocol,
orders bleeding/clotting screen/chest xray as per
protocol.
Knowledge:
Assimilates knowledge of chest drain protocol in
determining appropriate course of action.

52

Cardiac Nursing Competency Statements

January 2004

Wound healing
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to perform simple clean
dressings.
Demonstrates the ability to perform simple aseptic
wound dressings, recognises changes in wound
condition and refer to another member of the
multidisciplinary team e.g. tissue viability team.
Knowledge:
Describes normal wound healing. Explains the
principles of asepsis and describes the causes, signs
and symptoms of wound infection.

2.1

Skill:
Demonstrates the ability to perform complex aseptic
wound management and assess risk factors for wound
healing.

Knowledge:
Identifies varying methods of wound management and
risk factors to impaired healing e.g. co-morbidities,
poor nutrition.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

53

3.1

Skill:
Demonstrates the ability to initiate changes in wound
management in response to wound condition.

Knowledge:
Applies and analyses varying methods of wound
management in determining appropriate action.

3.2

Skill:
Demonstrates the ability to evaluate the impact of
wound management on wound healing.

Knowledge:
Evaluates the outcomes and implications on wound
healing of current guidelines and research.

54

Cardiac Nursing Competency Statements

January 2004

Assessment of cardiac chest pain

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to identify the significance of
chest pain and refer to another member of the multidisciplinary team.
Knowledge:
Lists the signs and symptoms of chest pain.

Pre-requisite Competence:
Haemodynamic monitoring
2.1

Level 2.1 YES/NO

Skill:
Demonstrates the ability to recognise cardiac chest
pain from patient verbal and non-verbal cues/
physiological effects and refer to another member of
the multidisciplinary team.
Knowledge:
Identifies physiological effects and descriptors of
cardiac versus non-cardiac chest pain.

Pre-requisite Competence:
Blood sample analysis
ECG monitoring and interpretation
3.1

Skill:
Demonstrates the ability to interpret cardiac pain from
patient description/history, physiological effects and
investigative results e.g. ECG, troponin levels.

Level 2.2 YES/NO

Level 3.1 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

55

Knowledge:
Assimilates results from clinical investigations and
patients clinical presentation e.g. ECG, troponin
levels.
Pre-requisite Competence:
Blood sample analysis
Delivery of oxygen therapy - non-invasive
3.2

Level 3.1 YES/NO

Level 2.1 YES/NO

Skill:
Demonstrates the ability to initiate therapeutic
interventions for managing cardiac pain e.g. STEMI,
non-STEMI, acute coronary syndrome.
Knowledge:
Discusses the appropriateness of varying interventions
on cardiac pain e.g. oxygen, nitrates, opioids, patient
education, patient transfer, thrombolysis.

3.3

Skill:
Demonstrates the ability to evaluate the effects of
therapeutic interventions on cardiac pain e.g. decrease
in pain, decrease in ischaemia, changes in ECG.
Knowledge:
Critically analyses the effects of therapeutic
interventions on patient condition and outcomes.

4.1

Skill:
Demonstrates the ability to co-ordinate, evaluate and
make recommendations for clinical practice involving
the processes and management of cardiac chest pain
e.g. audit, development of protocols/patient group
directions.
Knowledge:
Evaluates the outcomes and implications of
therapeutic interventions on cardiac pain with respect
to external factors e.g. local/governmental policy.

56

Cardiac Nursing Competency Statements

January 2004

Specialised Clinical Competencies

Delivery of oxygen therapy supportive
Competency Statements

Competence achieved
Evidence utilised:

Pre-requisite competence:
Delivery of oxygen therapy non-invasive
2.1

Level 2.1 YES/NO

Skill:
Demonstrates the ability to correctly prepare the
patient and equipment for supportive oxygen therapy
e.g. CPAP, endotracheal intubation, tracheostomy.
Knowledge:
Describes different types of supportive oxygen therapy,
and the equipment necessary.

Pre-requisite competence:
Arterial oxygenation
Auscultation of breath sounds
2.2

Skill:
Demonstrates the ability to recognise patient need for
the administration of supportive oxygen therapy e.g.
sedation, respiratory failure, worsening arterial blood
gases.
Knowledge:
Identifies factors in the patients clinical presentation
that will be affected by the administration of supportive
oxygen therapy e.g. arterial oxygenation, spontaneous
respiration, safety concerns.

Level 2.2 YES/NO

Level 2.2 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

57

2.3

Skill:
Demonstrates the ability to analyse patient response to
supportive oxygen therapy.
Knowledge:
Applies understanding of the physiological response to
oxygen delivery.

Pre-requisite competence:
Arterial oxygenation
Auscultation of breath sounds
3.1

3.2

Level 3.1 YES/NO

Level 3.1 YES/NO

Skill:
Demonstrates the ability to initiate changes to oxygen
therapy in response to patient condition, utilising
patient group directions and protocols e.g. weaning,
extubation.
Knowledge:
Relates changes in supportive oxygen therapy to
expected patient responses e.g. mechanical ventilation
modes, pressure support/PEEP, spontaneous
breathing.
Skill:
Demonstrates the ability to evaluate the impact of
supportive oxygen therapy on the patients condition.
Knowledge:
Critically analyses the effect on patient condition of
changes in supportive oxygen therapy.

4.1

Skill:
Demonstrates the ability to develop protocols and
guidelines for the delivery of supportive oxygen
therapy e.g. weaning, extubation.
Knowledge:
Identifies implications and makes recommendations for
clinical practice regarding the delivery of supportive
oxygen therapy e.g. in response to current research.

58

Cardiac Nursing Competency Statements

January 2004

Resuscitation/ life support

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to perform Basic Life Support
utilising the Resuscitation Council (UK) guidelines.

Knowledge:
Describes the Resuscitation Council (UK) guidelines
for Basic Life Support.

Prerequisite Competence:
ECG monitoring and interpretation
Haemodynamic monitoring
Arterial oxygenation
Delivery of oxygen therapy - non-invasive
2.1

Skill:
Demonstrates the ability to perform Immediate Life
Support utilising the Resuscitation Council (UK)
guidelines.
Knowledge:
Identifies resuscitation requirements, including mask
ventilation, defibrillation and drug management, in
accordance with Resuscitation Council (UK)
guidelines. Recognises implications of ethical and legal
issues of resuscitation e.g. not for resuscitation orders.

Level 2.1
Level 2.1
Level 1.1
Level 2.2

YES/NO
YES/NO
YES/NO
YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

59

Prerequisite Competence:
Arterial oxygenation
Blood sample analysis
Delivery of oxygen therapy - supportive
3.1

Level 2.2 YES/NO

Level 2.1 YES/NO
Level 2.3 YES/NO

Skill:
Demonstrates the ability to initiate and lead Immediate
Life Support utilising Resuscitation Council (UK)
guidelines.
Knowledge:
Applies understanding of patient's condition in relation
to Resuscitation Council (UK) guidelines, the
identification of patients at risk of deterioration/prearrest situations, and initial post-resuscitation care.

Prerequisite Competence:
Haemodynamic monitoring
Arterial oxygenation
Blood sample analysis
Blood sampling and cannulation
3.2

Level 3.1
Level 3.1
Level 3.2
Level 2.2

YES/NO
YES/NO
YES/NO
YES/NO

Skill:
Demonstrates the ability to perform Advanced Life
Support utilising Resuscitation Council (UK) guidelines.
Knowledge:
Analyses patient's condition and applies appropriate
measures in accordance with the Resuscitation
Council (UK) guidelines.

4.1

Skill:
Demonstrates the ability to evaluate the process and
management of resuscitation/life support e.g. analyse
audits, make recommendations for improved practice.
Knowledge:
Evaluates the process of resuscitation/life support with
respect to external factors e.g. local/National policy.

60

Cardiac Nursing Competency Statements

January 2004

Femoral arterial sheath removal

Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to perform environmental and
patient preparation for femoral arterial sheath removal.

Knowledge:
Identifies patient preparation and equipment required
for femoral arterial sheath removal.

Pre-requisite Competence:
Haemodynamic monitoring

Level 2.1 YES/NO

ECG monitoring and interpretation

Level 2.1 YES/NO

Blood sample analysis

Level 2.1 YES/NO

2.1

Skill:
Demonstrates the ability to utilise protocol for femoral
arterial sheath removal, and refer appropriately to
another member of the multi-disciplinary team.
Knowledge:
Describes relevant anatomy of femoral region and
physiology of haemostasis. Recognises deviations in
patient condition from protocol for femoral arterial
sheath removal e.g. potential for complications.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

61

Pre-requisite Competence:
Blood sample analysis
2.2

Level 2.2 YES/NO

Skill:
Demonstrates the ability to initiate and perform femoral
arterial sheath removal in accordance with protocol.

Knowledge:
Differentiates methods of achieving haemostasis after
femoral arterial sheath removal and applies
appropriately to situation e.g. digital pressure,
mechanical compression device. Recognises safety
considerations associated with femoral arterial sheath
removal e.g. post-procedure management.
3.1

Skill:
Demonstrates the ability to evaluate the effective
management of femoral arterial sheath removal e.g.
assessment of complications.
Knowledge:
Evaluates the management of femoral arterial sheath
removal including recognition of complications e.g.
bruising, bleeding, vasovagal response.

4.1

Skill:
Demonstrates the ability to develop protocols and
guidelines for femoral arterial sheath removal e.g.
auscultation for bruits.
Knowledge:
Identifies implications and makes recommendations for
clinical practice regarding nurse-led femoral arterial
sheath removal e.g. early identification of femoral
aneurysm.

62

Cardiac Nursing Competency Statements

January 2004

Cardiac pacing temporary

Competency Statements

Competence achieved
Evidence utilised:

Prerequisite Competence:
ECG monitoring and interpretation
1.1

Level 1.1 YES/NO

Skill:
Demonstrates safety when caring for patients requiring
temporary pacing e.g. environment, infection.

Knowledge:
Describes appropriate care considerations for patient
safety e.g. environment, infection risks.

Prerequisite Competence:
ECG monitoring and interpretation

Level 2.1 YES/NO

Blood sample analysis

Level 2.1 YES/NO

2.1

Skill:
Demonstrates the ability to prepare patient e.g. check
INR, and remove temporary pacing wires (e.g.
epicardial, transvenous) as per area protocol.
Knowledge:
Describes principles of temporary cardiac pacing e.g.
location of wires. Describes the equipment and patient
preparation required for safe removal of pacing wires
e.g. INR check.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

63

2.2

Skill:
Demonstrates the ability to recognise a pacing spike
on ECG trace.
Knowledge:
Describes the pacing spike on an ECG.

2.3

Skill:
Demonstrates the ability to commence temporary
pacing.
Knowledge:
Explains the rationale and theory of pacing.

Pre-requisite Competence:
ECG monitoring and interpretation
3.1

Level 3.1 YES/NO

Skill:
Demonstrates the ability to routinely check sensitivity/
threshold, different modes of pacing.
Knowledge:
Understands the concepts of threshold and sensitivity,
and the need for regular assessment. Discuss the
different modes of pacing e.g. DDD, VVI.

3.2

Skill:
Demonstrates the ability to effectively troubleshoot
temporary pacing problems e.g. wire fracture, battery
failure and evaluates appropriateness of
troubleshooting actions.
Knowledge:
Analyses causes of problems, explains reason of
chosen intervention, and critically analyses the impact
of various troubleshooting interventions on identified
problem.

64

Cardiac Nursing Competency Statements

January 2004

Cardiac pacing permanent

Competency Statements

Competence achieved
Evidence utilised:

Prerequisite Competence:
ECG monitoring and interpretation
1.1

Level 1.1 YES/NO

Skill:
Demonstrates safety when caring for patients requiring
permanent pacing e.g. environment, infection.
Knowledge:
Describes appropriate care considerations for patient
safety e.g. environment, infection risks.

Prerequisite Competence:
ECG monitoring and interpretation
2.1

Skill:
Demonstrates the ability to give general patient
information regarding pacing.
Knowledge:
Describes the normal cardiac conduction system.
Explains the rationale and physiology of pacing.

2.2

Skill:
Demonstrates the ability to recognise a pacing spike
on ECG trace.
Knowledge:
Describes the pacing spike on an ECG and its cause.

Level 2.1 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

65

2.3

Skill:
Demonstrates the ability to recognise pacing failure (to
capture/sense).
Knowledge:
Discusses the different modes of pacing (e.g. DDD,
VVI).

3.1

Skill:
Demonstrates the ability to provide psychological care
for the person requiring a permanent pacing system.
Knowledge:
Applies knowledge of permanent pacing systems to
choice of pacemaker and the impact on lifestyle.

3.2

Skill:
Demonstrates the ability to perform pacing check in
Outpatients Clinic.
Knowledge:
Understands the concept of pacemaker complications
e.g. threshold/ sensitivity, runaway pacemaker, and the
need for regular assessment.

4.1

Skill:
Demonstrates the ability to evaluate the
appropriateness of actions and consider alternatives
for management of patients with permanent pacing
systems e.g. managing pacing clinics.
Knowledge:
Critically analyses the impact of various actions on the
management of patients with permanent pacing
systems.

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Cardiac Nursing Competency Statements

January 2004

Intra-aortic counterpulsation
Competency Statements

Competence achieved
Evidence utilised:

Pre-requisite competence:
Haemodynamic monitoring

Level 2.2 YES/NO

ECG monitoring and interpretation

Level 2.1 YES/NO

2.1

Skill:
Demonstrates the ability to interpret waveforms and
record pressures from intra-aortic counterpulsation.

Knowledge:
Describes the anatomy/ physiology related to intraaortic counterpulsation.

2.2

Skill:
Demonstrates the ability to recognise changes in
patients clinical condition related to intra-aortic
counterpulsation e.g. peripheral circulation, reduced
urine output.
Knowledge:
Recognises and describes safety issues and
complications surrounding intra-aortic counterpulsation
e.g. patient positioning, puncture site management.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

67

Pre-requisite competence
Haemodynamic monitoring
3.1

Level 3.1 YES/NO

Skill:
Demonstrates the ability to analyse waveforms from
intra-aortic counterpulsation.

Knowledge:
Recognise and describe the reasons for abnormal
traces and their potential causes for intra-aortic
counterpulsation.
3.2

Skill:
Demonstrates the ability to critically analyse patient
responses to intra-aortic counterpulsation and
manipulate according to protocols e.g. timing.
Demonstrates the ability to troubleshoot equipment
problems.
Knowledge:
Discusses impacts of various manipulations on patient
response to intra-aortic counterpulsation e.g. timing,
mechanical failure, gas leaks.

4.1

Skill:
Demonstrates the ability to develop protocols and
guidelines for the management of patients receiving
intra-aortic counterpulsation.
Knowledge:
Evaluates outcomes and implications of nursing
management on intra-aortic counterpulsation.

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Cardiac Nursing Competency Statements

January 2004

Elective cardioversion
Competency Statements

Competence achieved
Evidence utilised:

1.1

Skill:
Demonstrates the ability to prepare equipment and the
environment for cardioversion.
Knowledge:
Lists equipment necessary for elective cardioversion.

2.1

Skill:
Demonstrates the ability to prepare patient for elective
cardioversion e.g. explain the basic procedure to the
patient.
Knowledge:
Describes procedure of elective cardioversion with
anatomy/physiology.

Pre-requisite Competence:
ECG monitoring and interpretation

Level 2.1 YES/NO

Blood sample analysis

Level 2.1 YES/NO

2.2

Skill:
Demonstrates the ability to interpret diagnostic tests
prior to cardioversion according to protocol e.g. INR,
potassium level.
Knowledge:
Explains results/condition of patient necessary for
elective cardioversion within stated
protocols/guidelines e.g. therapeutic INR.

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

69

Pre-requisite Competence:
ECG monitoring and interpretation
3.1

Level 3.1 YES/NO

Skill:
Demonstrates the ability to correctly position paddles
and perform elective synchronised cardioversion.

Knowledge:
Applies understanding of safety and complications
surrounding elective cardioversion.

Pre-requisite Competence:
Resuscitation/ life support
3.2

Level 3.1 YES/NO

Skill:
Demonstrates the ability to recognise those patients
who may benefit from elective cardioversion and refers
appropriately.
Knowledge:
Critically analyses clinical indicators and patient group
directions for elective cardioversion.

4.1

Skill:
Demonstrates the ability to evaluate effective
management of elective cardioversion e.g. managing
cardioversion clinics, auditing of results/process.
Knowledge:
Evaluates the process of elective cardioversion with
respect to external factors e.g. local/governmental
policy.

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Cardiac Nursing Competency Statements

January 2004

Thrombolysis nurse-initiated
Competency Statements

Competence achieved
Evidence utilised:

Pre-requisite Competence:
Haemodynamic monitoring

Level 2.1 YES/NO

ECG monitoring and interpretation

Level 3.2 YES/NO

Blood sample analysis

Level 3.1 YES/NO

3.1

Skill:
Demonstrates the ability to recognise and differentiate
STEMI, non-STEMI, and acute coronary syndrome.

Knowledge:
Discusses the anatomy and physiology of plaque
rupture and thrombus formation. Identifies signs and
symptoms of MI e.g. ECG abnormalities, pain
assessment (cardiac/non-cardiac), cardiac markers,
differentiate diagnosis from dissecting aortic aneurysm.
Pre-requisite Competence:
Blood sampling and cannulation
3.2

Skill:
Demonstrates the ability to initiate treatment with
correct thrombolytic utilising patient group directions
and protocols.
Knowledge:
Discusses the appropriateness of thrombolytic therapy
e.g. pharmacology of agent, contra-indicators of
thrombolysis, consent.

Level 2.2 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

71

3.3

Skill:
Demonstrates the ability to evaluate the impact of
thrombolytic therapy on the ECG and patient clinical
condition.

Knowledge:
Critically analyses the effects of thrombolytic therapy
on patient outcomes e.g. complications.

4.1

Skill:
Demonstrates the ability to audit data and develop
protocols/ guidelines for improving nurse-initiated
thrombolysis.

Knowledge:
Evaluates outcomes and implications of thrombolytic
therapy e.g. against National targets, patient group
directions.

72

Cardiac Nursing Competency Statements

January 2004

Exercise tolerance testing

Competency Statements

Competence achieved
Evidence utilised:

Pre-requisite Competence:
Haemodynamic monitoring
3.1

Level 2.1 YES/NO

Skill:
Demonstrates the ability to perform preparation of the
patient and the environment for exercise tolerance
testing.
Knowledge:
Discusses rationale for performing exercise tolerance
testing. Identifies patient preparation and equipment
required for exercise tolerance testing e.g. consent,
pre-procedure checks.

Pre-requisite Competence:
ECG monitoring and interpretation
Auscultation of heart sounds
Blood sampling and cannulation
Resuscitation/ life support
3.2

Skill:
Demonstrates the ability to obtain consent and initiate
exercise tolerance testing using patient group
directions and protocols.
Knowledge:
Applies knowledge of contraindications and risk
stratification to assess appropriateness for nursesupervised exercise tolerance testing.

Level 3.1 YES/NO

Level 3.1 YES/NO
Level 2.2 YES/NO
Level 3.1 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

73

Pre-requisite Competence:
ECG monitoring and interpretation

Level 3.2 YES/NO

Resuscitation/ life support

Level 3.2 YES/NO

3.3

Skill:
Demonstrates the ability to effectively troubleshoot
equipment problems, interpret and evaluate patients
condition and pre-, during and post-test results, and
communicate results e.g. to patient, make appropriate
referral.
Knowledge:
Discusses factors which impact upon the results of
exercise tolerance tests e.g. haemodynamic response
to exercise, drugs, age, upsloping/planar, end-points of
testing.

4.1

Skill:
Demonstrates the ability to audit data, make
recommendations and develop protocols/ guidelines
for improving nurse-initiated exercise tolerance testing.

Knowledge:
Evaluates outcomes and implications of nurse-led
exercise tolerance testing with respect to external
factors e.g. against National targets,
local/governmental policy.

74

Cardiac Nursing Competency Statements

January 2004

Tilt-table testing
Competency Statements

Competence achieved
Evidence utilised:

Pre-requisite Competence:
Haemodynamic monitoring
3.1

Level 2.1 YES/NO

Skill:
Demonstrates the ability to perform environmental and
physical patient preparation for tilt-table testing.

Knowledge:
Identifies patient preparation and equipment required
for tilt-table test e.g. consent, pre-procedure checks.

Pre-requisite Competence:
ECG monitoring and interpretation
Auscultation of heart sounds
Blood sample analysis
Blood sampling and cannulation
Resuscitation/ life support
3.2

Skill:
Demonstrates the ability to initiate tilt-table testing
using patient group directions and protocols.

Knowledge:
Applies risk stratification in relation to indications and
contraindications for tilt table testing.

Level 3.1 YES/NO

Level 3.1 YES/NO
Level 3.1 YES/NO
Level 2.2 YES/NO
Level 3.1 YES/NO

Competence maintained
Peer
reviewed:

Evidence utilised:

Peer
reviewed:

75

3.3

Skill:
Demonstrates the ability to effectively troubleshoot
equipment problems, and evaluate patients condition
throughout tilt table testing procedure.

Knowledge:
Discusses factors which impact upon the results of tilttable testing e.g. haemodynamic response, drugs, age.

4.1

Skill:
Demonstrates the ability to audit data, make
recommendations and develop guidelines for nurseinitiated tilt-table testing.

Knowledge:
Evaluates outcomes and implications of nurse-initiated
tilt-table testing with respect to external factors e.g.
local/government policy.

76

Cardiac Nursing Competency Statements

January 2004

(Blank)

77

Cardiac Nursing Competency Statements

January 2004

Appendix 1
The project steering group consisted of:
Maree Barnett
Department of Health Project Manager & Specialist Nurse
Advisor; non-voting BANCC council member
Lyndell Brodie
Cardiac Nursing Competencies Project Nurse, Royal
Brompton & Harefield Hospital/Hammersmith Hospitals NHS
Trusts; BANCC member
Helen Chan
Cardiology Unit Nurse Manager, Northwest London NHS
Trust
Gill Eyers
Clinical Nurse Lead for Specialist Nursing, Chelsea and
Westminster Hospital NHS Trust
Richard Hatchett
South Bank University; BANCC member
Alison Hunt
Lecturer Practitioner, St Marys Paddington Hospital NHS
Trust/Thames Valley University; BANCC member
Jillian Riley
Cardiac Nursing Competencies Project Lead; Senior
Lecturer, Thames Valley University; past-President BANCC
Caroline Shuldham
Cardiac Nursing Competencies Project Lead; Director of
Nursing and Quality, Royal Brompton & Harefield Hospitals
NHS Trust; BANCC member
Molly Teoh
Head Nurse, Hillingdon Hospitals NHS Trust
Experts who contributed to parts of the document:
Celine Adams
Sister, St Marys Hospital NHS Trust
Linda Blue
Heart Failure Nurse Co-ordinator, Western Infirmary Glasgow
Ian Bullock
Head of Education & Training, Royal Brompton & Harefield
NHS Trust
Elaine Coady
Cardiac Nurse Consultant, Guys and St Thomas Hospital
NHS Trust
Ian Jones
Lecturer in Cardiac Nursing, University of Salford
Debbie Hughes
Cardiac Nurse Specialist, Torbay Hospital
Belinda Linden
Cardiac Nurse Medical Information Unit, British Heart
Foundation
Alison Pottle
Consultant Nurse, Royal Brompton & Harefield NHS Trust
Tom Quinn
Professor of Cardiac Nursing, Coventry University
Jill Rowe
Service Manager for Cardiac & Neurosciences, Morriston
Hospital
Jennifer Tagney
Cardiology Nurse Consultant, United Bristol Healthcare Trust
David Thompson
Professor of Clinical Nursing, The Chinese University of Hong
Kong
Pat Thomson
Lecturer, University of Stirling
Lucy Wright
Nurse Facilitator, University of Oxford
Acknowledgement to other reviewers of the document:
Elizabeth Allibone
Denice Gately
Rachel Matthews
Chris Mutton
Marina Nicholas
Janette Palmer

Nurse Teacher, Royal Brompton & Harefield NHS Trust

Head Nurse, Hammersmith Hospitals NHS Trust
Lead Patient Care Advisor, London Chest Hospital
Senior Nurse Cardiology, Torbay Hospital
Practice Educator, Royal Brompton & Harefield NHS Trust
Programme Organiser - Specialist Nursing, Glasgow
Caledonian University
Cardiac Nursing Competency Statements
January 2004

78

Sue Pearson
Karen RawlingsAnderson
Martin Regan
Alison Reddock
Cathy Ross

Senior Nurse, Royal Brompton & Harefield NHS Trust

Senior Lecturer, St Bartholemews School of Nursing &
Midwifery, City University
Practice Education Nurse, Wythenshaw Hospital
Acting Senior Sister, Hammersmith Hospitals NHS Trust
Cardiac Nurse Medical Information Unit, British Heart
Foundation

And with grateful thanks to those that piloted the document.

79

Cardiac Nursing Competency Statements

January 2004

Feedback / comments on Cardiac Nursing Acute/Episodic Care

Competency Statements

The Cardiac Nursing Acute/Episodic Care Competency Statements is not a static

document. As practice changes, review and revision will be necessary. Comments and
feedback on this document are most welcomed. Please complete the form and return to
the address provided overleaf.
Name
Job Title
Organisation
Contact Address

Telephone
Email
Please use this section to provide feedback/comments on the Cardiac Nursing
Competency Statements:

Many thanks for your contribution.

Cardiac Nursing Competency Statements

January 2004

80

Please return to:

British Association for Nursing in Cardiac Care (BANCC)
C/o BCS
9 Fitzroy Square
LONDON W1T 5HW
Email: bancc@bcs.com
Or

81

Jillian Riley
Department of Education
Britten Street Wing
Royal Brompton Hospital
Sydney Street
LONDON SW3 6NP

Cardiac Nursing Competency Statements

January 2004