I currently work in a very small community hospital - no house doc, no peds, no 24-hour anesthesia, etc. It appears that in our hospital there is a push for nurses to intubate neonates when needed. For instance - stat c/section and personnel as follows: MD performing section, OR scrub and circulating nurse, CRNA, and 2 OB nurses trained in NRP. On two recent occassions, the OB nurses intubated/attempted to intubate. I have been an OB nurse for many years. Although I have been NRP certified, I always thought that the actual intubation was out of my scope of practice as an RN. In the past, the CRNA has always briefly stepped over and intubated. The idea of what could go wrong during intubation scares me to death - especially considering the fact that my only experience with intubating is during the NRP course every 2 years. For those of you who work in small hospitals, what is your experience on this subject? If you are intubating, are you comfortable with it? Thanks so much for any input!
Sep 1, '12
If you dont have regular experience actually intubating newborns, then no. If you had a meconium aspiration you will need to intubate and suction two or three times in rapid succession. I worked ad a NICU nurse who intubated. It is a skill you need hands on training and regular use. Even if its allowed by your board of nursing, if you have no clinical experience doing it then you will never justify to a courtroom why you did it. It would be outside your scope of practice due to inexperience and improper training. Chances are you can do it without any problems, but if you perforated the esophagus or failef to intubate (and it ended in death or brain damage) then it will be your fault. Just because a hospital says do it, doesnt mean you are legally protected. Just my opinion. If your hospital wants to have OB nurses intubating then they need a legitimate hands on intubateion course witha yearly number of intubations required to maintain competency.
Sep 1, '12
When I worked in a tiny hospital where we rarely had a peds doc in house, neonatology was not even an option, and we didn't have CRNPs, we relied on the CRNAs to entubate the babies. We were told, however, (because the CRNAs were not always present) that if push came to shove, to intubate based on our NALS training, because that was a skill we check off. The hospital decided that since this was part of our training, if we were the only available option it was better for us to try than to sit and watch the baby die. Thank God I was never faced with it because the CRNA would arrive of the pediatrician might eventually wander over.
Now I work in a large regional facility with full-time NICU coverage, so it's okay. And I've noticed that the last two renewals I did for NRP we weren't required to intubate.
Which brings me to my next question, what is the difference between NALS and NRP, and why the switch?