Capability of Emergency and Critical Care Nurses in Electrocardiogram Interpretation: A Mixed-Methods Systematic Review

Background Electrocardiogram (ECG) interpretation is a time-critical competency for emergency and critical care nurses. Accurate recognition of life-threatening arrhythmias and ischemic changes is essential for timely intervention and improved patient outcomes. However, evidence suggests substantial variability in nurses’ ECG interpretation capability across clinical settings. Objective This study aimed to systematically synthesize evidence on the competency of emergency and critical care nurses in ECG interpretation and to identify factors influencing performance. Methods A mixed-methods systematic review was conducted. Databases including PubMed/MEDLINE, Scopus, Web of Science, Science Direct, and Google Scholar were searched from inception to March 2025. Empirical studies assessing ECG interpretation knowledge and skills among registered nurses in emergency or critical care settings were included. Quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results The synthesis revealed that while nurses possess foundational knowledge, proficiency in identifying complex arrhythmias and acute myocardial infarction remains inconsistent. Performance is significantly influenced by years of specialized experience, frequency of exposure to cardiac monitoring, and the level of advanced life support training. According to Benner’s framework, a majority of practitioners function at the novice or advanced beginner stages, highlighting a gap between clinical requirements and actual competence. Conclusion This review demonstrates that ECG interpretation capability is a developmental skill requiring targeted institutional support. The researchers recommend the implementation of simulation-based longitudinal training and standardized competency assessments. Furthermore, nursing leadership should prioritize mentorship programs to bridge the gap between theoretical knowledge and expert clinical practice, thereby enhancing patient safety in high-acuity environments.