EKG Technician Training in North Carolina

Formal EKG technician training, certification, and licensing in North Carolina is not required by government agencies. A technician may be considered an unlicensed member of the patient care team who must be supervised by a registered nurse, practical nurse, or licensed physician who has accepted responsibility for the patient care outcomes that result from the delegation of nursing tasks to the technician. Most facilities have detailed procedures and protocols that determine how and when tasks can be delegated to unlicensed personnel.

Delegation Regulations

Like most other states, the Board of Nursing in North Carolina has adopted regulations that establish guidelines for how to manage and supervise unlicensed members of the medical team. Because an EKG technician is unlicensed, it is very important for licensed healthcare professionals to evaluate the competence of technicians before delegating tasks such as electrocardiogram administration, telemetry, Holter monitoring, and procedure preparation. This approach to patient care delivery ensures that technicians are qualified to perform tasks and serves to protect the health and safety of those who are receiving care. Individuals who are responsible for supervising technicians must be prepared to accept responsibility for all of the health outcomes that result from the delegation of care.

Section 21 NCAC 36 of state law outlines the roles of unlicensed personnel. According to this piece of legislation, a licensed nurse, registered and practical, may delegate nursing care activities to unlicensed personnel, regardless of title, that are appropriate to the level of knowledge and skill of the unlicensed personnel and are within the legal scope of practice as defined by the Board of Nursing for unlicensed personnel. Tasks that can be delegated by law are subject to the following parameters…

  1. Knowledge and skills of the unlicensed personnel
  2. Verification of clinical competence by the employing agency
  3. Stability of the client’s condition
    • Predictability
    • Absence of risk of complication
    • Rate of change
  4. Variables in each service setting
    • Complexity and frequency of care
    • Proximity of clients to staff
    • Number and qualifications of staff
    • Accessible resources
    • Policies, practices, and channels of communication

According to 21 NCAC 36.0221, tasks may be delegated to an unlicensed person if they…

  • frequently recur in the daily care of a client or group of clients
  • are performed according to an established sequence of steps
  • involve little or no modification from one client-care situation to another
  • may be performed with a predictable outcome
  • do not involve ongoing assessment, interpretation, or decision-making

A registered nurse or licensed practical nurse is not allowed to delegate the professional judgment required in order to implement treatment or pharmaceutical regimen which is likely to produce side effects, toxic effects, any type of allergic reaction, or other unusual effects. When a task is delegated, the licensed or practical nurse assumes all of the responsibility for the adverse effects that develop. This obligation is designed to protect the health and safety of patients and reduce the impact of liability claims that result from the negligence of medical personnel.

Education and Training Requirements

As an unlicensed field of medical practice, the EKG technician profession rarely requires anything more than a high school diploma or GED, in-house training, and the completion of a nationally recognized certification exam. Since the state of North Carolina has not established competency requirements for technicians practicing in this specialty, it is the responsibility of the employer to assess the knowledge, skills, and abilities of each technician. This means that the hiring requirements are likely to vary between different medical establishments. In addition, increased accountability initiatives within the healthcare sector have led many administrators to provide preference to applicants who have at least two-years of college education and prior experience with direct patient care in a more generalized area.

Those who have not worked in healthcare and who are having difficulty securing employment as a technician in the cardiac care unit may want to consider working in a generalized area of practice for a few years while they acquire the knowledge and skills needed to become successful in a specialized area of practice. Two of the most popular options include that of the medical assistant and the nurse aide. These options provide opportunities to gain exposure to a range of tasks and expose individuals to many different specialty areas of practice.

State Contact Information

North Carolina Department of Health

Phone:         (919) 855-3968
Alternate:   (919) 855-3750
Email:          dhsr.webmaster@dhhs.nc.gov

North Carolina State Seal2709 Mail Service Center     Raleigh, NC 27699

North Carolina Board of Nursing

Phone:         (919) 782-3211
Fax:             (919) 781-9461
Email:          practice@ncobn.com

4516 Lake Boone Trail     Raleigh, NC 27607

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