One of the areas of clinical management where nurses have the most diagnostic influence is cardiac rhythm monitoring and dysrhythmia detection. The critical care nurse must recognize that continuous monitoring is a nursing responsibility, and competence in this skill must be assured. It is essential that nurses understand the significance of accurate electrode placement in obtaining a specific monitoring lead. In addition, the nurse must use current research in determining which monitoring lead is most appropriate for the patient requiring cardiac monitoring in the critical care environment. The author reviews the current research on continuous bedside monitoring and lead selection, examines why nurses continue to make less than optimal lead selection decisions, and offers recommendations to improve the consistency with which patients are accurately monitored