I think that it is great that you want to learn new things and even if you CANNOT do the procedure, you may get some benefit from knowing how it is done.
Knowledge is a great thing. Knowing what to do with the knowledge is essential.
I want to caution you that even if you take a "certification" class - you should not plan on actually doing the skill without:
1. Checking with your state BON for RN scope of practice confirmation. Some states are more explicit than others and most have practice restrictions. RN's that do these skills always will operate under MD authorization (generally written protocols) and will have very exacting verifications of competencies.
AND
2. Written confirmation from your employer that you (as an RN, in-house) can actually do these skills even with a physician order. I will bet that the facility in which you work will have restrictions in who can do these procedures and they will be fairly detailed.
Nurses that work in the transport environments are the ONLY RN's (not advanced practice nurses) that I am aware that do these skills. Most paramedics are competent in airway management, but it is a rare paramedic that can actually do chest tubes - I have only encountered a couple in 17 years (one flight and one that practiced in a remote setting). My MD medical director (under whose license I am extended the privilege of being allowed to perform these and other procedures - even as a paramedic my practice is regulated in the same manner) has very comprehensive requirements that I have to meet to in order to be allowed to perform "advanced" skills (initial class, cadaver time, OR insertions under direct MD supervision, monthly/quarterly competencies and his "blessing" after assuring that I am going to be deliberate, prudent and accountable!)
Generally, needle decompression works well as a temporary (and life saving!) procedure in advance of a chest tube (for tension pneumothorax) and is taught in TNCC classes for RN's. Check
www.ena.org - Choose from the left menu the CATNII/ENPC/TNCC and you can locate courses by state with contact information. The ASTNA (
www.astna.org) does a course for transport nurses that teaches some advanced skills called TNATC, but none of these classes authorize you to do the procedure.
As for intubation, it used to be taught in ACLS classes though it is not required for course completion - you may still generally get basic instruction in this manner. More advanced classes are offered at some EMS/Trauma seminars in airway management, your local EMS folks may have some info they could share. Intubation is also a critical skill and when it is not done successfully it is going to kill a patient that may otherwise, have had an airway that could be managed in a more basic manner (BVM ventilation). Airway management can be complex for the very experienced provider, so even if you acquire the knowledge/skill -- I will still caution you in actual clinical practice decisions.
"Missed intubations" have disastrous outcomes (for the patient, your liability and the MD that you practice under), so proceed with caution here. Being good at intubation takes a while - I've done a few hundred as a medic, but few as an RN. The reason I am good at it as an RN is my prior paramedic practice - so, I will caution an RN new to the skill that you need extensive preparation and another experienced provider by your side to rescue you (and the patient) if you are unable to intubate. That is just one reason that 2 folks are on the helicopter! There are also many other ways to "manage" a patients airway, so to be good at "airway" you must be good at these too.
Not trying to be a downer, learning new things is worth it, just don't take performing lifesaving skills lightly. There are as many risks as potential benefits and a "certification" class is just a start.
Practice SAFE!
Would you like to comment?
