advanced airway use

Altra, BSN, RN · Dec 12, 2011

I agree that it will depend on scope of practice and facillity policy.
I do have a piggyback question. Here in MO, EMTs can use and are trained on the use of a Combitube. If a nurse was also an EMT and had a Combitube available used said Combitube on a patient, would they be covered under the scope of practice for an EMT, even if working as a nurse. Not a likely situation to occur, especially in an ED, but a curiousity question. thanks.

Facility policy. Remember, an institution is free to limit the scope of practice outlined by a licensing authority, but it cannot expand it.

Trauma Columnist · Dec 12, 2011

Nope, not covered one2gofst.

I'm in IL. I'm a prehospital RN (its a real license) and am a volunteer on my rural fire dept. In that capacity I place King tubes.

I'm also an APN. In that capacity (provided I've been credentialled) I can place an ETT, run a code, place central lines and anything else that I've been credentialled in and is included in my collaborative agreement.

It all depends on the role where you are.

Now that said, even pre-hospital, I'm held to the standard of an APN for assessment expectations.

Editorial Team / Moderator · Dec 12, 2011

Not a likely situation to occur, especially in an ED, but a curiousity question. thanks.

Nope ... in Virginia I was a paramedic and an ED RN. I could do paramedic things outside my ED doors, but once inside the ED doors, those paramedic things weren't in my nursing scope. Kinda frustrating when a patient has an awesome EJ, and the doc can't hit it but you know you could have ... LOL

Esme12, ASN, BSN, RN · Dec 13, 2011

Ok thanks! I know its way outside my scope of practice for now. Do you happen to know NJ policy for those situations. I know the emphasis is on BVM ventilation and good CPR, but I am curious as to what is allowed.

YOu are restricted by the policies that govern the position you are acting (being paid for) for that shift.

If the hospital you are working in allows specially trained nurses to intubate and trains them on advanced airways then yes....you can use them. Example, As a trauma flight nurse and paramedic, when acting in that role, I acted as both a medic and a nurse. I intubated, started EJ's, etc. I also worked part time in a local ED that was my forever home where I was not allowed to do those things by policy of the hospital it didn't matter that I could and I was a medic as well....the medics of the department could intubate..I could not, I was working as an RN and that was not allowed by the RN's in that facility in the ED. I have also worked at facilities that did not have in house coverage at all times and anesthesia was 30 min away and a select few were trained in advanced airways to be used in the event the ED MD was busy.

You need to be more concerned with basic nursing skill in school and leave the advanced airway policies and practice to the more experienced. When you graduate you will be a new grad as will be expected to act within the restrictions placed on you by policy. I suppose there may have a situation arise in a mass casualty situation and you are the only one to save this persons life (like the tragedy that hit Joplin Mo hospital) but othet than that there should always be someone with the responsibility to be the advances airway provider. In a nursing home you'l have an ambu and you call 911....they don't even have a LMA/combitube in the building. YOu need to Practice within the scope of you job description. :)

akulahawkRN, ADN, RN, EMT-P · Dec 13, 2011

Out here in California, generally speaking, the facility doors are the point where things change for prehospital and hospital staff. Outside those doors, a Paramedic can do a LOT of things where the RN is typically restricted to basic interventions. Inside those doors, a Paramedic can do just basic EMT stuff and the RN (and above) providers run the show. It's not really all that confusing for people that are licensed as one or the other. It's when you have both licenses that things get interesting and you must be VERY aware of the role you're in at the moment and maintain that awareness at all times.

Also, generally speaking, facilities don't want to hire one person to fill 2 separate roles simultaneously. Part of that comes from the role confusion problem, but also from the issue of liability if something goes wrong and it involves a skill, procedure, whatever that is in BOTH scopes of practice. How do you settle which license to go after? One? Both? How about for those where ONE covers that... do you go after the OTHER license for something done out of scope?

It's just too confusing. Know your present role's scope of practice and stick to it while you're on the clock.

jedi88 · Dec 13, 2011

Just to play devil's advocate here but if you are trained to do something and don't, doesn't that open you up to possible litigation? The patient or family can say you could have done more to save them but did not.

FlyingScot, RN · Dec 14, 2011

It's a good question and the answer is generally "no". You must act within your scope of practice. That might not stop someone from trying to sue you but would severely limit their chance of being successful.