can nurses intubate?

Super RT · Nov 30, 2005

I work in a teaching hospital where we get the sick babies (ECMO, MAS, etc) The nurses just don't have the time or the expertise to ru the vent along with all the meds, weighings, baths, feedings, etc. Our nurses raw gasses if they are also drawing labs, but otherwise, the RT's handle this. As far as intubations are concerned, if there is a resident redily available, we will let them try twice. If they can't get it, then the RT intubates. We also handle lots of high risk deliveries and intubate there. The neonatologists are dealing with other issues with the baby. We work with the babies as a team. We are lucky to have the staff so that the baby get a specialist for all major facits of care.

skysurfer · Dec 1, 2005

Hello From Switzerland,

We don´t intubate at our Unit, we dont have RT´s, so the intubation is done by our Physicians. But we perform BGA´s interpret them and do Vent changes. In our post graduate intensive care course, which takes 2 years to graduate, we are well trained do to respiratory care like when to choose the right vent setting or mode. We don´t interpret X-Ray´s, sometimes we do interpret them together with an MD, but only if you´re interested in doing so. So you can but you dont have to......Difficult cases are treated by a RN with special license in intesive care mentioned above,(All RN´s in our Unit have to have this license....) and an MD together. That means that the goals are set together, but the changes and the evaluation then is made by a Nurse......

LilPeanut, MSN, RN, NP · Jan 13, 2006

In my unit, only the docs and NNPs (and theoretically RT) intubate. I'm at a large lvl III nicu w/ ECMO

MegNeoNurse · Jan 17, 2006

I work in an "18" bed Level III NICU. Our unit always has atleast one NNP on at all times. The NNP or resp. therapist will intubate, or an NNP student under the supervision of an NNP. But in a delivery, it is the NNP who does the intubation (if needed, of course.)

kitty29 · Jan 22, 2006

I am a nursing student and I was wondering if nurses can intubate? i have heard that they can, but I thought only doctors could. :uhoh21: Thanks in advance

Our transport nurses do...they are trained to do so as are the RT's.

luvmy2angels · Jan 22, 2006

Girl,
In Alabama not only do we intubate, we "read" x-rays....we never have a doctor in house after they are through making their rounds, we draw our own blood gases, interpret them, and make ventilator and cpap changes based on them!!! I just graduated in May, and I can't believe the stuff we are doing sometimes. I don't intubate and I double-check with more senior nurses before I touch the vent, but still!! We have had some travelers that are working with us now who are in disbelief at all the responsiblity we're given. It's too much. Sometimes we have 2 vents and a cpap...or a HFOV and an isolette..... Then, sometimes you'll have 4 grower-feeders who all eat at the same time, have to be weighed, etc etc. I guess the one thing I should be happy about is if I move to another state (which is a certainty with my Air Force honey!) I will have more reasonable assignments and more physician help.
:)

WOW! That is kinda scary! I hope you get paid like a Dr!! :chuckle

Personally I wouldn't want that responsibility. Not to question any of the nurses abilities (I'm sure you are all wonderful nurses!!), but if I were a patient in that hospital I would want a Dr reading my x-rays etc.

Good luck to ya, sounds like you are getting a lot of great experiences!!:)

BamaGirlRN · Jan 22, 2006

Not to question any of the nurses abilities (I'm sure you are all wonderful nurses!!), but if I were a patient in that hospital I would want a Dr reading my x-rays etc.

In my hospital the radiology docs read the xrays before sending them up, isn't that how it is everwhere, lets hope so. I usually tell the neo if I have to call what the xray says on it (that the rad wrote) and if he has a question about expansion, tube placement then I'll let him know. Every NICU nurse should know how to do this IMO. Why wait to do rounds with the neo in the morning(or afternoon) if you film shows a high tube or 12 ribs, so we always glance at the films when they come up and let then let the neo know if it is something that needs to be corrected ASAP.

fergus51 · Jan 22, 2006

In my hospital the radiology docs read the xrays before sending them up, isn't that how it is everwhere, lets hope so. I usually tell the neo if I have to call what the xray says on it (that the rad wrote) and if he has a question about expansion, tube placement then I'll let him know. Every NICU nurse should know how to do this IMO. Why wait to do rounds with the neo in the morning(or afternoon) if you film shows a high tube or 12 ribs, so we always glance at the films when they come up and let then let the neo know if it is something that needs to be corrected ASAP.

We don't wait for rounds to deal with Xrays. If a baby is getting one, we call the doc when it's done and he reviews it right away. Radiology often has a comment or two, but it's the neos that are the final word. I enjoy looking at Xrays, but I don't think it would be appropriate for me to diagnose. One of my favorite moments was about 2 hours after taking the Xray for a known diaphragmatic hernia patient, the radiologist called the unit and said "Ummm... from the Xray it looks like a diaphragmatic hernia.". It's the only time I've spoken to a radiologist in this facility and wanted to say "Thanks tips":D

I worked with a travel nurse from Alabama and some of her stories were almost unbelievable as far as her patient loads and what responsibilities nurses had.

KK7724 · Feb 28, 2006

How's it going finding a hosptial in SC to work for?

I definitely know which one I want to work for....currently their job posting website does not list any openings for NICU.

I got the Nurse Manager's name, phone number, and she was courtesy-copied on an email I sent to the Nurse Recruiter....I may call her up this week. I'm nervous...still don't feel very proficient at all and certainly not comfy with admits...HFOV (since I've never been assigned one...and only took care of one 5 months ago on orientation once!) I'm keeping my fingers crossed.

KK7724 · Feb 28, 2006

I am pretty sure that each facility has different protocols on who can and cannot intubate. As a NICU nurse for almost 2 years I am glad that I am at a place that encourages the RN's to become more advanced and skilled at what they do. We do have crazy pt ratios at times but I couldn't imagine only having one vent or two nc's, I would be so bored I would think. I like that we can make vent changes(with or without the RT) usually just the IMV sometimes pressures at our discretion, our MD's are just a phone call away for major changes in a patient when we need them. They really only come in at night for admits and codes, which thankfully we haven't had many of lately. If a kiddo is acting stupid and needs an xray or labs they are normally done first then we call the MD with the results and just let them know what we have done and take any new orders from there. It all works out and we have super smart RN's (some NNP but not praticing as so) here in Bama.
BTW War Eagle KK7724

It sounds like maybe we work for the same facility???

tracy6fan · Mar 31, 2006

KK, I think my nurse manager just toured your unit about a month ago. She came back and told me about a unit that nurses did everything you described, and as an 18 year veteran, it gave me the willies.

We treasure our therapists' knowledge of the vents, and even after all these years I'm still learning all the intricacies of how different vent modes and settings work for the lungs.

KK7724 · Apr 1, 2006

I think when I originally replied to the original poster....I was a little stressed with things in our unit. Also....I think you might work in same unit as me BamaGirl and I know your opinion is a lot different from mine???....I wish to clarify a few things.... First...only the experienced nurses will intubate the child if necessary. I won't lie...I have seen countless admissions where the neo is present and he tells the nurse to intubate the kid. If the child is going to have surgery on their eyes for example....the nurse will intubate. I haven't taken NRP yet, but I know that even if I had it, I wouldn't be expected to tube a baby. A lot of times when your baby is doing something bad...a herd of people will rush over and take over most of the time. This is good and bad for the new learner.

Also...about "Reading x-rays". No we don't have to "read" them...for lack of a better word I said "read" at the time. Yes, the radiologist writes his comments on there, but we have to count how many ribs are expanded and make sure the ETT is where it's supposed to be. If not...we are expected to push it in or pull it out a little bit. I will tell you....I cannot tell where PICC lines and UAC's and lines are on the x-rays. I am terrible at this. I am also really bad at looking at the KUB's. I usually will just take mine to the charge nurse and let her look at it and tell what she thinks. Seriously...the radiologist might write: "Questionable NEC? Free air. ETT High or ETT Ok". It's not like he writes a detailed report that comes with the x-ray. He comments on what he sees in the form of "ETT Ok", NEC ?" etc.

Also, we don't have an in-house Neo or resident or NNP. We have a few NNP's in our unit, but they don't function as such. We have to get several opinions, go to the charge nurse, see if anyone else needs a doc and then make the call. Sometimes we wait till 6 a.m. to call for small things we want him/her to know.

Two weeks ago, I had a two-vent assignment. One was a new admit that was a micro premie and on minimal stim. She had issues from the start....hyperglycemia, low BP, needing second dose of Survanta. The other child was a 3 month old active vent that did not receive much sedation all day long! My charge nurse was having to help me a LOT! I was the only person in the room with two vents. Another nurse had two CPAPS....someone overheard me say this and told the nurse who had made the assignment before she left. She said, "It's just two vents!" The evening shift charge nurse sympathized and said the assignment was stupid.

Last week, I was in a room with another nurse who had a two vent assignment as well. So...our assignments are heavy...yes.

We give survanta without a dr. present. I think this is okay? I don't know. Every hospital is different.

We have respiratory therapists...they don't usually tube although some will if the nurse doesn't get it. 1 or 2 of them might adjust the vent....the main ones I work with just hand the blood gas reading to you. I don't really mind the vent settings deal....most of the babies have parameters on their bedside of a range of acceptable pH, CO2, and SaO2.... I know most of the time if they're blowing off too much CO2, to go down on the rate, and when to go up etc.... If I'm confused about a gas, I ask the RT or another nurse and the ultimate--take it to the charge nurse.

Our unit does have a lot of autonomy for nurses and we take really good care of the babies. I do agree that we do a lot of things that most nurses are not expected to do. As you can see from BamaGirl's post, she likes the opportunity to be hands-on and get experience from these things. I think I am just a little bit more timid about it. Also, I realize I will probably have to move around a LOT because of my DH's career and the fact that I'm a new nurse...I just want to know what to expect at other hospitals. Hope I cleared things up a little bit better than before. I hope I didn't make my unit look bad. We all work hard and we could work harder on teamwork....sorry...I'm just a little bit opinonated, although I whole-heartedly admit I'm just a nurse of 10 months....I'm still very very very green!