Why can't nurses intubate? - pg.4 | allnurses

Why can't nurses intubate? - page 4

Paramedics and Doctors intubate, why can't nurses?... Read More

  1. Visit  Skayda profile page
    #39 0
    Everytime I hear the word intubate I think of that Grey's Anatomy episode where "TUBEing" a patient is explained; "totally unnecessary breast exam". So very bad! Lol! And yeah, wouldn't want to have to do the legit thing, intubating, either were I nurse! As if nurses didn't have enough to be scared ******** of going wrong!
  2. Visit  Bringonthenight profile page
    #40 2
    Quote from Skayda
    Everytime I hear the word intubate I think of that Grey's Anatomy episode where "TUBEing" a patient is explained; "totally unnecessary breast exam". So very bad! Lol! And yeah, wouldn't want to have to do the legit thing, intubating, either were I nurse! As if nurses didn't have enough to be scared ******** of going wrong!
    That was ER
  3. Visit  UK_RN_AJ profile page
    #41 1
    Nurses can preform endotracheal intubatation in the UK within certain roles, such as resuscitation officers, critical care practitioners and other specialties. Advanced airway management depends alot on the hospital as well as the roles allowed within a said trust. For example in standard UK Basic life support you are more than competent to places an OP airway and a NP airway as a nurse. If you complete the advanced life support (much like us ACLS in the us and canada) we can preform LMA airways if needed. Then you need to take futhur courses, have in house training and alot of years experience to preform intubation for that hospital if you job role needs you do to do this. Many hospitals will not allow you to do this even if you have been doing it for years and have the skill.

    A lot of the time it comes down to senior doctors saying that this is a doctors role and doctors should be the ones to preform it. On a personal note I feel that a large majority of senior emergency department, ITU, and acute care nurse's who wish to learn this should be allowed to preform this skill within there role if they are competent and if no doctor is available to do this. I have attended several "codes" where a definitive airway could potentially have prevented complications. I have no problems if a doctor is there to preform this skill instead of a nurse as by the many people noted above I have many other things to preform, but why should my patient wait to receive a definitive airway if a doctor is not present??

    A question for all. Within you roles as nurses are you allowed to preform interosseous access in an emergency situation ? what other roles as nurses do you feel you should be allowed to preform in a emergency situation ?
  4. Visit  ♪♫ in my ♥ profile page
    #42 0
    At my last jobs, we were permitted to place IO lines. At this one, it's always done by a resident.
  5. Visit  CodeteamB profile page
    #43 1
    We can place IOs, but so can the residents, new attendings and paramedics so there are a lot of people who want to do it to relatively few opportunities.
  6. Visit  PMFB-RN profile page
    #44 0
    but why should my patient wait to receive a definitive airway if a doctor is not present??

    A question for all. Within you roles as nurses are you allowed to preform interosseous access in an emergency situation ? what other roles as nurses do you feel you should be allowed to preform in a emergency situation ?[/QUOTE]

    *** Yes RNs certainly can place IOs, In my hospital Rapid responce nurses, ICU RNs and ER RNs are trained to place interosseous. Physicians are NOT allowed to place them until they have been through the class and training provided by the rapid response team.
  7. Visit  PMFB-RN profile page
    #45 0
    Quote from ♪♫ in my ♥
    At my last jobs, we were permitted to place IO lines. At this one, it's always done by a resident.
    Nobody in my hospital, including physicans, is allowed to place an IO until they have been trained and checked off by one of the full time rapid response nurses. We (the RRT RNs) teach a class 3 or 4 times a year to new ICU & ER RNs, residents, interns and new attendings. In my experience very few physicians even care to be trained or want to place them.
    We can also place art lines and PICCs and there is a plan to train us to place IJ central lines with ultrasound. We have plenty of residents but few of them are very good at it and the idea is that the RRT RN would get a lot of practice (like with art lines currently) and could be back up to residents on nights and weekends.
  8. Visit  akulahawkRN profile page
    #46 0
    Personally, I don't think it is really that big of an issue that nurses don't intubate very often. Generally speaking, no new grad nurse that I know of exits their program knowing how to perform endotracheal intubation. Generally speaking, new grad paramedics do know how to do that.

    I am not comparing nurses and paramedics directly. Their jobs are very different. Yes, they have a skill set that occasionally overlaps. But the focus of what they do is very very different.

    Personally, I don't have an issue with nurses learning how to intubate. I just don't think that the vast majority of nurses need to know how to do it because that can lead to very serious skill dilution. Skill dilution, especially of endotracheal intubation, is a very serious problem with field providers. With nurses, in the intubation role, you would have to have a relatively few number of nurses to avoid that problem. If you have a fairly active surgery center that you could get some certain number of live intubations, it should be a relatively easy thing to cycle say 50 nurses through every year and they would be able to get that number of intubations. Now imagine the problem you would have if every nurse in the facility was allowed to intubate and had to get a certain minimum number every year. That certain minimum number would have to be literally in the low single digits, at best. That does not lead to good proficiency.

    As far as other airways are concerned, I am a fan of the LMA (and a couple other defices) and placement is relatively easy with that airway adjunct. On a crash cart, in an adult setting, I think I would be much more comfortable with having the LMA or a King Tube available. The reason being is that those devices are very easy to place and don't require a whole lot of ongoing training to maintain proficiency.

    In the end, it's a skill, and like all skills (even surgery), it can be taught... and can perish. In the end, this really isn't about whether or not nurses should be able to intubate... I just don't see the need to include that particular skill in the basic education of nurses. If a nurse wants to do it by all means, go for it! The system is already in place for nurses to learn how.
  9. Visit  LearningByMistakes profile page
    #47 4
    Let there be NO mistake, taking and getting an ACLS &/or PALS card does NOT mean that you can intubate. Why anyone would think they can, is still beyond me. As an ACLS & PALS Instructor for well over 20 years, I will tell you that you are mistaken, if you think they mean that you can intubate. This is one, of many, reasons that the cards now are for course completion only.
  10. Visit  TraumaSurfer profile page
    #48 2
    Almost every state allows RNs the ability to intubate if their job requires it. Only one or two states say an RN can not intubate even if the job was to require it. Examples of when an RN's job requires him or her to intubate would be Flight, CCT and L&D. The RRT should be able to back up the physician in smaller hospitals. There simply are not enough RNs in smaller hospitals to take care of other patients, push meds and be at the head of the bed maintaining an airway. Getting the practice would also be challenging. Most Paramedics do not get enough practice. Many are coming out of schools without performing any intubations on a patient. RRTs around here must get 15 intubations in adults and 20 in children/neo before they can perform an intubation without a preceptor and must do 12 per year for each age group to maintain competency. RRTs are a much smaller group. How difficult do you think it might be to get 60 - 200 RNs competent and to maintain competency? Who is going to do their patients, tasks and assessments while they are tied for an hour with an intubation? No, the PALS and ACLS teaches you nothing about performing intubation correctly nor does it give you a license to do anything which it teach you. In most states a Paramedic can not give the meds necessary for RSI. Only RNs can do this. For this reason, RN/Paramedic or RN/RN teams are used for flight and CCT.
  11. Visit  PatMac10,RN profile page
    #49 0
    I think nurses should be able to. Even if it is only when there isn't a Doc available.
  12. Visit  Jory profile page
    #50 3
    Quote from natnat122
    Paramedics and Doctors intubate, why can't nurses?
    If you were the patient, would you want to be intubated by someone that does it all the time or by someone that may do it one or twice a month?
  13. Visit  TraumaSurfer profile page
    #51 3
    Quote from PatMac10,SN
    I think nurses should be able to. Even if it is only when there isn't a Doc available.
    How many times will you be able to intubate? How will you maintain proficiency? How often will the doctor not be available? If this is an ER without a doctor being available I think the state and Federal agencies should be made aware for possible penalties. How much will you leaving your patients to intubate affect other nurses? Who will push the medications if you are intubating? Can the RTs at your hospital give all the medications AND set up the ventilator while you are at the head of the bed which might be for awhile if you are not able to get enough intubations to maintain proficiency? What about the liability? If you are not able to maintain proficiency and botch up the airway badly or even cause death, neither the BON nor the legal eagles will be kind if you can not demonstrate you were able to maintain an adequate skill level. Just recertifying every 2 years in ACLS or PALS is a joke and demonstrates nothing. Just saying "they can why can't we" is not good enough as a defense. Even Paramedics have felt the pain of losing a skill like intubation. Too much emphasis is placed on a skill without embracing the responsibility which goes with it. There are several EMS departments which will not allow Paramedics to intubate children. There are also EMS departments which will not allow Paramedics to do ETI and supraglottic devices or BVM are the only options. If one does not get the experience through many, many intubations, you will suck at it. Ask any CRNA how many intubations they must do to be really good and not do more harm to a patient. Just wearing a Paramedic patch or RN pin does not automatically make you proficient at a skill.

close