Why can't nurses intubate?

Specialties Emergency

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Paramedics and Doctors intubate, why can't nurses?

Specializes in PACU, ED.
We had a nurse get fired at my job for trying to intubate a patient. It did not happen while I was there, but one of my coworkers told me about it later. RT was unsuccessful, the patient was desatting, the nurse pushed RT aside and intubated the patient... and the nurse lost her job. It's a scary world when we have to make the decision to let people die to save our jobs...

In today's world we have to know our scope of practice and hospital policies and procedures. In the Army, part of my medic training included making an emergency surgical airway. However, I would never attempt one on someone who was not a blood relative that I loved more than my license. Even if I saved a person's life I would lose my job and livelihood.

We had a nurse get fired at my job for trying to intubate a patient. It did not happen while I was there, but one of my coworkers told me about it later. RT was unsuccessful, the patient was desatting, the nurse pushed RT aside and intubated the patient... and the nurse lost her job. It's a scary world when we have to make the decision to let people die to save our jobs...

Probably this nurse was fired for violence against another employee. At no time should violence against a co-worker EVER be tolerated even if you are superior to them. I don't where those of you who agreed it was okay to push an RT get the idea it is okay to push anyone on the job.

You push me while I am intubating and I will have you in handcuffs as soon as I can call 911. I hope the RT pressed charges.

This nurse showed she could not handle stressful situations and didn't know the first thing about intubation. Even when the best of the best is intubating, a patient might decrease their pulse ox number. The best of the best might even miss a tube. But, you do NOT push them. You assist them with bagging, repositioning and maybe get a nasal cannula in place for the next attempt.

There have been many times when I wanted to push nurses out of the way after they tried for the 10th time to start an IV start in the ER. But, instead of resorting to pushing someone, I will offer my assistance even though I am not an employee. It is frustrating as hell to watch nurses fiddle with IVs on a patient needing resuscitation when I could probably place it or at least have the ability to do an IO. But I respect their turf. When I see a doctor or RT struggling with a tube in the ER, I will offer my assistance. 9 times out of 10 these professionals will allow me to help and even intubate if necessary.

Specializes in ICU, PICC Nurse, Nursing Supervisor.

Right!!!!!

No thanks!
Specializes in Emergency/Trauma/Critical Care Nursing.
Probably this nurse was fired for violence against another employee. At no time should violence against a co-worker EVER be tolerated even if you are superior to them. I don't where those of you who agreed it was okay to push an RT get the idea it is okay to push anyone on the job.

You push me while I am intubating and I will have you in handcuffs as soon as I can call 911. I hope the RT pressed charges.

This nurse showed she could not handle stressful situations and didn't know the first thing about intubation. Even when the best of the best is intubating, a patient might decrease their pulse ox number. The best of the best might even miss a tube. But, you do NOT push them. You assist them with bagging, repositioning and maybe get a nasal cannula in place for the next attempt.

There have been many times when I wanted to push nurses out of the way after they tried for the 10th time to start an IV start in the ER. But, instead of resorting to pushing someone, I will offer my assistance even though I am not an employee. It is frustrating as hell to watch nurses fiddle with IVs on a patient needing resuscitation when I could probably place it or at least have the ability to do an IO. But I respect their turf. When I see a doctor or RT struggling with a tube in the ER, I will offer my assistance. 9 times out of 10 these professionals will allow me to help and even intubate if necessary.

I agree with most of what you are saying but if you have a person requiring intubation, what is the point if having the nasal cannula "in place for the next attempt" ? Did you mean ambu bag?

Not all doctors should intubate. If they have the training and practice that's fine but whoever intubates should be someone who practices and is proficient with that skill. Consider the death of a famous pop star who hired a cardiologist to manage anesthesia. If a hospitalist has the experience and practice to be proficient then sure, he should intubate. If not then he should not let ego compromise good patient care.

I was uncertain if the other person was not confusing hospitalist with PA although a PA can also intubate if properly trained.

I am also going to echo that no nurse is going to physically push me while I am intubating. If she was there to assist then she was clearly not doing her job to keep the RT informed and say time to pull out and get the SpO2_ back up. We do this with patience all time when a transport nurse who are getting their first intubations. I may say take a break and let me do the intubation after 3 attempts but I will not push anyone unless it is to get out of harm's way. Even the Anesthesia doctors need to be told to stop or occasionally they too need to step back, reassess and go with a different blade or method. The one assisting should be keeping things under control during the reassessment and changing of plans.

Nasal cannula oxygenation at 8 - 15 liters is commonly used by Paramedics and sometimes in the ER. We use a flow inflating bag for intubation but we have also used a nasal cannula for oxygenation. A non re breather mask is not always tolerated well for pre oxygenation nor is it high flow. The nasal cannula can be left in place during the actual intubation. This agaon is all part of what you need to learn rather than just the act of intubation itself.

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I'll never understand the mindset some people have that equates nursing and paramedics. Maybe they watch too many medical shows? They are two very different disciplines, and two very different jobs.

Being a paramedic is about being a first responder to emergency situations. Being a nurse is about promoting health and alleviating suffering. I'm sorry if that doesn't sound as cool or exciting, but there it is.

QUOTE]

*** Nurses work in many rolls and enviroments, including as first responders in emergency situations. Our transport crew consists of a transport RN, a paramedic, and an EMT/driver or EMT/ pilot. The RN is the team leader. It is the RN who decides when a patient is stable enough to transport (in small hospital ER to large hospital ICU transfers), weather the scene is safe enough for our intervention (in the case of field calls), it is the RN who decides if a patient gets intubated or not (though we may or may not deligate the actual intubation to the paramedic). It is the RN who decides if we need to divert to a closer medical faciliety due to a change in patient condition enrout.

PMFB-RN

I'm confused about your role? It sounds like your the RN on a transport team is that correct? However it sounds like your referencing 911 calls talking about oil fields and things? How are you responding to 911's....can you clarify? Inter facility transfers are a different animal from 911's.

Sometime a service will just be a transfer service that uses paramedics and EMT's. Other times a service is just 911's with no inter facility transfers. Other service combine both and designate trucks for each.

Your comment about nurses calling all the shots on a truck varies significantly by service. Also usually the only time an RN is on a truck (ambulance) is on some kind of inter facility transfer in which case it's a transfer not a 911 call. Being that it's their pt from the hospital of course they call the shots on a transfer b/c it's not a 911 call. My only comment on this is that paramedics get really focused training on intubation. Kind of like 12 leads, nursing school skims over 12 leads and airway management but in paramedic school you spend 3-4 semesters on that stuff. You have to know RSI meds inside out, and do skill checkoffs on crics/intubations/retrograde intubations, etc. Analyzing capno waveforms, not just knowing the numbers. You eat breathe and sleep that stuff throughout paramedic school. Nurses have to know a little about everything paramedics have to know a lot about one thing 'emergencies'.

I meant to quote PMFB-RN not BrandonLPN

Specializes in MICU, SICU, CICU.
I know in my state it is not in the nurse's scope of practice.

I was surprised to read in my state's nurse practice act that placing an LMA is outside of the RN scope of practice. They teach it in a skill station in ACLS and PALS so I had no idea. I have never had to insert an LMA as an ICU nurse and I had no idea it could be a board reportable mistake.

Specializes in CICU.

I have no desire to intubate. I generally have WAY MORE than enough to do during a code, or when dealing with a crashing patient.

We are trained on the kings to back up our docs in our tiny rural ER. LOVE them and the middle ground they offer.

The level of proficiency required to maintain the skill is high and honestly if the MD has taken 5 stabs at an intubation then airway is a disaster. Just leave it to the CRNA or Anesthesiologist and let the pull out their toys.

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Intubation takes A LOT of practice to become proficient at... if every nurse, doctor, and paramedic could intubate there would be far less ability for people to get better at it through practice, thus more missed tubes and bad outcomes for patients!

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