Why can't nurses intubate? - page 5

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

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    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
    Esme12 and KelRN215 like this.

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  2. 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 ?
    SummitRN likes this.
  3. 0
    At my last jobs, we were permitted to place IO lines. At this one, it's always done by a resident.
  4. 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.
    usalsfyre likes this.
  5. 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.
  6. 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.
  7. 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.
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    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.
    ohiobobcat, delphine22, PMFB-RN, and 1 other like this.
  9. 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.
    SummitRN and PMFB-RN like this.
  10. 0
    I think nurses should be able to. Even if it is only when there isn't a Doc available.


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