Why can't nurses intubate?

Specialties Emergency

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Paramedics and Doctors intubate, why can't nurses?

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.

Specializes in Nursing Education, CVICU, Float Pool.

I think nurses should be able to. Even if it is only when there isn't a Doc available.

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?

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.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I think nurses should be able to. Even if it is only when there isn't a Doc available.

We can at certain facilities but it takes commitment on the part of the faciltiy to maintain competency. Emergency department have ED MD's available 24/7 for the major majority....there are adjunct airways that can also be used ie: LMA.....that will ventilate the patient until intubation available.

Intubation isn't easy...it takes experience and skill...I don't think it is a skill nurses need to acquire in most instances let other focus on the airway while the nurse focuses on her multiple other duties.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
We can at certain facilities but it takes commitment on the part of the faciltiy to maintain competency. Emergency department have ED MD's available 24/7 for the major majority....there are adjunct airways that can also be used ie: LMA.....that will ventilate the patient until intubation available.

Intubation isn't easy...it takes experience and skill...I don't think it is a skill nurses need to acquire in most instances let other focus on the airway while the nurse focuses on her multiple other duties.

*** I agree. Can nurses intubate? Yes. Should they? Yes. That said not just every staff RN should be intubating people. Nurses can be, and are, trained to intubate but the number is kept low so that those who are trained can get enough intubations to keep their skills up.

I have to do 30 supervised intubations a year and take a class each year to maintain my comptency. Only a handful of nurses can be trained like that in any faciliety.

Esme12 I wanted to point out that the ER is the most common area where we (nurses on our team) have to intubate. Many of the very small rural hospital ERs are not staffed with ER physicians. Often it is a FM or IM physician, or even a PA or NP solo in these little ERs at night. Often those providers are not comfortable intubating and will avoid doing it. Some haven't even been trained to do it.

Specializes in Nursing Education, CVICU, Float Pool.

*** I agree. Can nurses intubate? Yes. Should they? Yes. That said not just every staff RN should be intubating people. Nurses can be, and are, trained to intubate but the number is kept low so that those who are trained can get enough intubations to keep their skills up.

I have to do 30 supervised intubations a year and take a class each year to maintain my comptency. Only a handful of nurses can be trained like that in any faciliety.

Esme12 I wanted to pint out that the ER is the most common area where we (nurses on out team) have to intubate. Many of the very small rural hospital ERs are not staffed with ER physicians. Often it is a FM or IM physician, or even a PA or NP solo in these little ERs at night. Often those providers are not comfortable intubating and will avoid doing it. Some haven't even been trained to do it.

Good point.

I think RNs should be allowed to intubate if they're trained. 20+ years ICU-CCU and ER, both in Level 1 and 2 trauma centers. It's 3 am in ICU, you have a problem with the ET tube, you should be able to replace it. I also understand the liability associated with same. Guess it boils down to where one works. If your anesthesiologist, anesthetist is right down the hall, then call them. I don't see a need for a med-surg staff RN to do it as they lack the frequency in placement. As an RN we put in art lines. If we can put in an art line, we can put in an ET tube. I've seen some RNs who had to call the med student to replace/start an IV if they're in a teaching hospital.

As an RN we put in art lines. If we can put in an art line, we can put in an ET tube. I've seen some RNs who had to call the med student to replace/start an IV if they're in a teaching hospital.

If you miss an art line stick, you may have to monitor the BP or draw labs another way. A delay yes but not necessarily life threatening.

Miss a tube and without a physician around to give you more med orders and manage the equipment to bail the patient out of the consequences, the patient is screwed.

Not every area allows for RSI_ initiated by RNs unless in special protocols such as a code or transport team. Intubating without that ability would be stupid and irresponsible. There is so much more to consider than just putting a tube through the cords and without permanent damage.

Most of us who do intubate have also had extensive training with alternative airways including the BVM, King, LMA, fiber optic scope and even a Cric if necessary. No one who intubates should ever rely on just "tubing". When teaching nurses to intubate, they sometimes get frustrated when they must squeeze a BVM with perfect technique for 15 minutes and review NG/OG.

If you have a problem with an existing ETT, a tube changer is great but not fool proof. This is also not always an emergent thing to do. Just because you can does not mean you should. You can easily fix a leaky pilot balloon and some modern ventilators have adjustments which can be made to compensate for leaks. High PEEPS might be a concern but if you are running ARDS_ protocols, you probably have an Intensive st or Pulmonologist on call.

Nurses *can* intubate... and docs *can't* intubate... all depending on the policies and protocols of the sponsoring institution or agency.

Specializes in CRNA, Finally retired.

If you attempt to intubate someone with a difficult airway (and you missed it because takes some airway experience to separate the difficult airway from the normal) and you make a bloody mess, it's really difficult for anesthesia to get a tube through a bloody swollen mess. Persons who have had any radiation to the next will give you coronary constriction because you only get 1 chance to get that tube in- otherwise you've created a perfect storm.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
If you attempt to intubate someone with a difficult airway (and you missed it because takes some airway experience to separate the difficult airway from the normal) and you make a bloody mess, it's really difficult for anesthesia to get a tube through a bloody swollen mess. Persons who have had any radiation to the next will give you coronary constriction because you only get 1 chance to get that tube in- otherwise you've created a perfect storm.

I don't disagree but it's moot if there simply is no anesthesia provider available. This happens often in my hospital as we only have one provider at night and they are often tied up with emergent OR cases.

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