Do you as an RN insert nasopharyngeal or oral pharyngeal airway adjuncts?

[42pines]

Simple question: When for one of various reasons, a non-responsive person with no gag reflex needs airway resuscitation and a head-tilt is inappropriate or inadequate do you as an RN have the right within your scope of practice to use these airway adjuncts?

This is a scope of practice question, and I've been all through my state scope of practice data and run into the question (in their algorithm): " Is this practice within an accepted standard of care which would be provided by a reasonable and prudent nurse with similar education and experience?"

If so, what sort of training did you receive, do you have certification, and how often must you renew said certification?

Thanks

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The rest of the story for those interested. I'm on Occ Health Nurse in Industry. I have taken the EMT-A National Registry Course, and have passed the practical exam the results of which are now registered with my state. I have yet to take the computerized answer/question exam and prefer to do so in November when I have plenty of free time to bone up on the questions/answers. Upon completion then I would use such adjuncts not as an RN but rather as an EMT-B. However I hold the view that I am an RN who is trained in these procedures to an adequate degree and have proof of proficiency.

A co-nurse where I work essentially says: "no, you can't" unless you are fully EMT-A. I respectfully disagree and would prefer to use an adjunct and save a person's life rather than sit back and say: Oh well, the bag-valve mask doesn't work and the adjunct airways would make it work, but I'm not allowed to use them so good-bye patient--see you in your next life.

The state of MA has an algorithm for determining scope of practice and I'm wondering how many RNs (Not LPN's or APN's) get trained and occasionally use these adjuncts when necessary. If some do, then "is this practice within an accepted standard of care...(see above)" becomes a yes. If so, even in the absence of the EMT-A certification the algorithm leads me to believe that it would be within allowed Scope of Practice with my level of training.

[Esme12, ASN, BSN, RN]

If by Nasopharyngeal airway you mean a nasal trumpet or simple oral airwaythe answer is yes. If however you are talking about advanced airway adjuncts like the LMA or an EOA the answer is..NO.....unless you are covered by hospital policy to utilize these devices the answer is ....you may NOT utilize these devices.

Nurses can be "trained" or "certified" to prove competence to be able to utilize these devices and can be covered by hospital policy to perform these tasks. HOwever.....If you perform this procedure and you aren't covered as an RN at that facility be prepared to lose your job. I understand that you are trained to perform these other tasks as an EMT-Advanced.....and if someone is going to really die if you don't is a decision only you can answer but you aren't covered, you can be fired and sued and have your license at risk for practicing outside your scope of practice.

I have been both, A RN and a Paramedic for trauma flight.......and essentially your are bound by the rules as a nurse when you are employed as a nurse and bound by the rule and regs of a EMT when employed as a EMT. I would get to use both as a trauma flight nurse because that was my job description. Now if you are a nurse and there is a natural disaster and a state of emergency is declared your EMS skills can be utilized under these conditions.

As an EMT-A you are to function ONLY under the direct supervision of your medical control.

Now considering that you have not received your certification from the state....you may not utilize these skills until certified. It's like saying.....I graduated nursing school and passed my practicum....I can be a nurse until I decide to take the NCLEX. The answer is no you can't.

Now, if you place of employment want to make up a certification/competency packet with Q/A quality and proof of instruction that they approve that you are competent in this skill then yes you may. It is within the RN scope of practice with proof of competency and policy allowing this procedure.

[42pines]

Oops...I took the EMT-A course... the low level one.

The top two...your trumpet and simple oral airway are what I'm talking about.

That's about what I expected and yes I understand that even if EMT certified, that one must work under medical control.

But I cannot see why my medical director cannot choose to accept my level and certificate of passing the practical EMT-B exam which does these airways as adequate training and if he chooses to accept that and writes standing orders it seems to me that then I'd be ok using them as within my scope of practice as long as I followed my standing orders.

In fact, after becoming Certified by passing the computerized knowlege test this really does not offer anything further as I would still be practicing under standing orders of my medical director. It seems that it is the practical hands on exam that is proof of competency.

I'll run the question by the proper person in the MA BON to make sure.

Thanks

[Esme12, ASN, BSN, RN]

Oral airway and the nasal trumpet are your scope of practice as

both a nurse and EMT-B. They are basic airway adjuncts. Being a nurse alone allows you to utilize these to maintain a patent airway when available for use.

[Murse901, MSN, RN]

There is no reason for you to not be allowed to use basic airway devices, no matter what your specialty is. I would have a hard time believing that this would ever be outside of any nurse's scope of practice.

[FlyingScot, RN]

But I cannot see why my medical director cannot choose to accept my level and certificate of passing the practical EMT-B exam which does these airways as adequate training and if he chooses to accept that and writes standing orders it seems to me that then I'd be ok using them as within my scope of practice as long as I followed my standing orders.

In fact, after becoming Certified by passing the computerized knowlege test this really does not offer anything further as I would still be practicing under standing orders of my medical director. It seems that it is the practical hands on exam that is proof of competency

It may seem that way to you but it doesn't matter what you think. Legally, if you have not taken the certification test your are not allowed to practice as an EMT-A, B or EMT-P. The practial only covers a small portion of the education you received. It is absolutely NOT an indicator of competency for the entire course.

[Altra, BSN, RN]

No prohibition on use of these devices, including the King and LMA, by my state's NPA. And they are covered under nursing policies where I have worked.

[sapphire18]

In terms of OPA and NPA, the use of both of those devices are within a nurse's scope of practice (in both my current and former state of practice) unless contraindicated or a doctor's order to not use one and/or the other on a specific patient.

They are also both included as part of ACLS guidelines.

No idea what EMT-A/B/C/XYZs can or cannot do.

[42pines]

Thank you all for the helpful answers.

FlyingScot, I get your point, but I'll add that it does matter what I think. Analysis of Scope of Practice requires thought and analysis. I suppose here you are saying that it is not my thought process that makes it legal, which is obviously true, but interestingly if you go to MA BON website there is no long list of things within the Scope of Practice, what you find is an algorithm that requires--yes, thought. Try it. The thought process does not make it legal but does give the RN the mechanism to define legality.

You comment that since I have not taken the final test I am definitively not allowed to practice as an EMT-A, and I agree. Yet once I have finished and am certified I am still not allowed to act as an EMT-A because I'm working not as an EMT. At my place of employment I work as an RN. Even when I am National Board EMT-A certified I can only work "as" an EMT within the framework of being an EMT.

The practical covers a small portion of the education of an EMT-A, yet I'll add this: The practical covers the entire indication of comptency for the use of these airways. The non-hands on portion of the use of these adjunct airways is miniscule compared to the hands-on portion. For procedures I still argue that it's the hands-on competency tests that prove competency. For me in the capacity of an RN, the computerized general knowledge test adds little or nothing to the competency of the use of these adjunct airways.

Having used the comments here, what I've decided is that as long as my medical director defines that my having completed the practical is an indicator of competency than it appears to me (Oh my, I'm thinking again) using MA's BON algorithm that this is within my scope of practice as long as all other conditions are met such as Standing Orders.

I will follow up with a request to the MA BON and will update this when I hear a reply.

[GitanoRN, BSN, MSN, RN]

during the time that i worked in the red-zone trauma center facility we nurses got to use this devices pretty frequently, specially on full moon weekends. needless to say, we were certified and covered under the the facility therefore, this practice was within our scope of nursing. wishing you the very best always....aloha~

[Esme12, ASN, BSN, RN]

.

Having used the comments here, what I've decided is that as long as my medical director defines that my having completed the practical is an indicator of competency than it appears to me (Oh my, I'm thinking again) using MA's BON algorithm that this is within my scope of practice as long as all other conditions are met such as Standing Orders.

I will follow up with a request to the MA BON and will update this when I hear a reply.

Just being a nurse enable you to to utilize these airways NPA and OPA per MA Nurse Practice Act....I'm from MA. The EMT-B/A is like an intense inservice for you. Is your boss non-nursing? Because making you take the EMT course is OK for first responder if you are Occ Health industry...it's always good to know that stuff but your RN license covers first responder skills completely.

[FlyingScot, RN]

Thank you all for the helpful answers.

FlyingScot, I get your point, but I'll add that it does matter what I think. Analysis of Scope of Practice requires thought and analysis. I suppose here you are saying that it is not my thought process that makes it legal, which is obviously true, but interestingly if you go to MA BON website there is no long list of things within the Scope of Practice, what you find is an algorithm that requires--yes, thought. Try it. The thought process does not make it legal but does give the RN the mechanism to define legality.

You comment that since I have not taken the final test I am definitively not allowed to practice as an EMT-A, and I agree. Yet once I have finished and am certified I am still not allowed to act as an EMT-A because I'm working not as an EMT. At my place of employment I work as an RN. Even when I am National Board EMT-A certified I can only work "as" an EMT within the framework of being an EMT.

The practical covers a small portion of the education of an EMT-A, yet I'll add this: The practical covers the entire indication of comptency for the use of these airways. The non-hands on portion of the use of these adjunct airways is miniscule compared to the hands-on portion. For procedures I still argue that it's the hands-on competency tests that prove competency. For me in the capacity of an RN, the computerized general knowledge test adds little or nothing to the competency of the use of these adjunct airways.

Having used the comments here, what I've decided is that as long as my medical director defines that my having completed the practical is an indicator of competency than it appears to me (Oh my, I'm thinking again) using MA's BON algorithm that this is within my scope of practice as long as all other conditions are met such as Standing Orders.

I will follow up with a request to the MA BON and will update this when I hear a reply.

Did you actually tell me to try thinking? You don't even know me and you're implying that I don't grasp the concept of the thought process?! Arrogance will get you nowhere in this world and especially not in the nursing world. As it stands your EMT whatever you've got has absolutely no bearing whatsoever on your practice as a nurse. It is strictly your hospital's policy regardless of what the BON says. If RN's aren't allowed to insert adjunct airways at your facility (which I rather doubt they can't) you still can't insert adjunct airways at your facility. They are not going to make a special policy just for you no matter how right you think you are. Sure the medical director can say it's okay but you can guarantee if something goes wrong he's going to hang you out to dry. Go ahead and risk it. You mght find yourself with plenty of time to think your oh so super smart thoughts when youare sitting at home.