ACLS and Advanced Airways

Nurses General Nursing

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

So, every single ACLS class I've been to always does advanced airways - oral, nasal, LMA and intubations, and you have to do a dummy intubation. A friend of mine recently went to an ACLS class - mind you, new grad, never worked in a hospital, was given an ACLS card from someone who sat with her while she did some computer questions (ACLS and BLS in under a few hours...). Seems HIGHLY suspect to me.

She said that advanced airways were not discussed (neither was mono/biphasic machines, voltage, etc...) and when I asked her about it, she called the guy back was told that she doesnt need to learn the aiways because its "not her job". She was also told that "you don't need to learn voltage for defibbing, mono/biphasic stuff because its "written on the machines." ....

EEKKK!

This freaks me out for a few reasons - #1, in what world is a beginner ACLS class a simple computer program discussed over a couple hours?? ESPECIALLY for someone who has *zero* experience in anything acute. and #2, has anyone ever heard of an ACLS class NOT covering advanced airways and defibrillator settings??

She is much more cavalier about it because she is working doing 1:1 hospice home care for patients who need tube feeds, etc... and says she isnt worried about it because she isn't going to use it.... but to me, (and maybe i'm off-base, I don't know), if you are going to be ACLS certified, you should be ACLS capable... It almost feels like an affront to me. I worked *HARD* to be competent, and I KNOW my ACLS protocols, airways, defib settings... I say I am ACLS certified and I know if you hand me a crashing patient, I can handle it. Having someone hold the same certification as I do, who doesn't "need to know" it - drives me INSANE. I feel like its not safe, and I also slightly feel like she didn't work hard enough to have EARNED it. How you can be "certified" in ACLS and NOT be on top of it??? She couldn't even pronounce Amiodorone when we talked about her class the next day... Frankly, its scary to me!

Ideas? Comments?

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Specializes in cardiac, ICU, education.
has anyone ever heard of an ACLS class NOT covering advanced airways and defibrillator settings??

Um, No. The intubation/airways and defib instruction is kind of the point, otherwise it would just be BLS.

Did you see her card from the class? This sounds like just another scheme. Hopefully she will never have to perform ACLS, but if she is an RN, she is responsible for her actions. If she knowingly took this class and needs the skills, I would be fearful for her that she would be held liable.

Most of all, I fear for her potential ACLS patients.

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Specializes in emergency, neuroscience and neurosurg..

As an ACLS Instructor this is worse than scary. What organization is her certification through? It does not really matter if "she will never use it" or if "it's not her job" She will be held liable and accountable for the knowledge implied with holding the certification card. Not only that, the instructor can also be held liable in a court of law. By signing the card the instructor is verifying that the student has met all the criteria and is competent in ACLS. The entire scenario is gives me nightmares.

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While we are on the subject, can someone please tell me where the best place to take ACLS class? I am a new Grad, haven't found employment yet. However my CPR certification is about to run out and would like to take this class before I find employment anyway. Where is the best place for me to go?

I did take CPR at my local community College where I took nursing course, but not enrolled anymore and not sure they offer ACLS.

Any advice?

Thanks,

Bea

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Specializes in Emergency, Internal Medicine, Sports Med.

Is there any possibility this person might have somewhat "embelished" the truth to you, to make themselves appear more qualified? There is just NO WAY this was actually an ACLS class. If it was, it surely was not run by anyone accredited. ACLS is all about drugs & electricity. I understand why you'd feel nervous working with her.

Is it possible you can raise your concerns with your educator/manager in private (assuming this is your coworker?) I mean, I can only imagine if a code is called and someone asks "1mg epi"...... "1 mg wha?" I think it's only fair, speaking in terms of patient safety. If you observed this nurse directly putting patients at risk in another sense, would you say something?

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.
Is there any possibility this person might have somewhat "embelished" the truth to you, to make themselves appear more qualified? There is just NO WAY this was actually an ACLS class. If it was, it surely was not run by anyone accredited. ACLS is all about drugs & electricity. I understand why you'd feel nervous working with her.

Is it possible you can raise your concerns with your educator/manager in private (assuming this is your coworker?) I mean, I can only imagine if a code is called and someone asks "1mg epi"...... "1 mg wha?" I think it's only fair, speaking in terms of patient safety. If you observed this nurse directly putting patients at risk in another sense, would you say something?

No no, she isn't a coworker. She is just an old friend that decided to go to nursing school a few years ago and being unable to find a hospital job, started working registry shifts immediately out of school (no orientation, no more education past nursing school) and is working doing in home 1:1 care with children and 1:1 home hospice. I'm extremely loud about people putting patients in danger - and I work in an ICU where everyone is ALCS, TNCC, etc... I've been really questioning her and trying to push her, but she just calls the same guy back who did the class and says "my friend said I should have learned intubation and...?" The instructor (of course) defends himself saying "You don't need that. You will never use that... etc...etc..." She said it wasn't so much a "class" as much as they looked at things on a computer and he would explain things, she would tell him what she knew and they'd just move on.

She isn't terribly concerned about it. Its more ME that is concerned. Granted, she isn't working in an environment where she is going to actually be handed a crash cart, but simply having the certification and saying that she is "ACLS certified" scares me a lot.

And to answer another question, she doesn't know what organization her certification went through. She went to this guy because her agency recommended him.

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Specializes in Emergency, Internal Medicine, Sports Med.
No no, she isn't a coworker. She is just an old friend that decided to go to nursing school a few years ago and being unable to find a hospital job, started working registry shifts immediately out of school (no orientation, no more education past nursing school) and is working doing in home 1:1 care with children and 1:1 home hospice. I'm extremely loud about people putting patients in danger - and I work in an ICU where everyone is ALCS, TNCC, etc... I've been really questioning her and trying to push her, but she just calls the same guy back who did the class and says "my friend said I should have learned intubation and...?" The instructor (of course) defends himself saying "You don't need that. You will never use that... etc...etc..." She said it wasn't so much a "class" as much as they looked at things on a computer and he would explain things, she would tell him what she knew and they'd just move on.

She isn't terribly concerned about it. Its more ME that is concerned. Granted, she isn't working in an environment where she is going to actually be handed a crash cart, but simply having the certification and saying that she is "ACLS certified" scares me a lot.

And to answer another question, she doesn't know what organization her certification went through. She went to this guy because her agency recommended him.

This is what concerns me. Its not so much that she obviously went to a complete scammer of an ACLS "instructor", but that she received counsel from an experienced nurse, and is still not concerned about it. It bugs me when people- even basic CPR holders- have the ticket, but have no clue how to actually perform the skill- and don't seem to care about their lack of knowledge, somehow thinking that they will never be in this position. What also bothers me is she has no idea what the company was who qualified her. She might be an excellent person and friend, but her passivity in terms of her knowledge, accountability, and responsibility scares me.

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Specializes in Med-Surg, Cardiac.

In our area all the paramedics have to have ACLS. A lot of the hospitals here teach ACLS both for their ICU folks and for the medics. You could ask the paramedics where they take it or go to local hospital websites and check there under something like continuing medical education or prehospital education.

When I first read this post I was upset. The ACLS standards have gotten a lot easier than they were in the 80s and I thought they'd eroded further, but it does sound like this instructor's just a scammer.

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Specializes in CEN, CPEN, RN-BC.

we had to take an online ACLS PREtest before the real class. Aside from that, scary!

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Specializes in ICU.

Our ACLS is on a computer. We run scenarios and have to pass each one. It is very frustrating to say the least when you can't pass the megacode. We do not speak of intubations, lma's ect. Only once in the past 10 years have I worked for an employer that used an ACLS company that required intubation on a dummy.

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ACLS is not designed to teach anyone how to intubate nor does it certify anyone to intubate.

As ACLS is designed now, it puts most of the responsibility on you and is just designed to refresh, review or go over pertinent information. The material should have been studied by whatever means prior to class. PALS and ACLS are no longer the gold standard nor to they measure one's actual ability.

Advanced airway is also no longer emphasized in ACLS and in BLS it is compressions or C-A-B.

No longer is getting a tube in right away a priority. However, I would hope everyone working in whatever part of the hospital has some BVM experience.

Even field Paramedics are getting away from doing endotracheal intubation. It there is an airway, it is a King tube which will be quickly replaced with an ETT in the ED.

For ACLS procedures and meds, the hospital (or whatever employer) bears the responsibility of making sure their employees are competent. In fact many hospitals now do their own training and mega codes instead of requiring an ACLS card during CODE and RRT meetings.

It is also difficult to teach every differment monitor and defibrillator that a hospital could have. Again, this should be the responsibilty of the hospital. We have 4 different machines in our hospital that I know of and some use the same pads and some don't. Some have similar settings but not alwasy the same. No longer will you always find the old 200, 300, 360 for shocks. AEDs are also placed or that mode is emphasized. Check your floor's/unit's P&P and get an inservice. Do not rely on being taught something about your equipment in ACLS.

With all the variations in technology and even the choice of medications one hospital might prefer, it is difficult at best to teach or be taught ACLS for the needs of all students. Algorithms can be memorized to get a card with or without a classroom.

CPR should also be done inhouse. Too often info is shared as to who is the easiest agency to get a card from. Unfortunately some EMS agencies do no believe hospital workers do CPR and will let them slide through a class. We hear this when we do a mock code and we get "they didn't make us do that in class".

I actually found the mega codes I've done on a computer to be rather challenging and even a little entertaining with the attitudes they manage to add to the scenario from the different players. My hospital also does not always follow standard guidelines since we do some of the research for the next changes in the future of resuscitation.

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I just recently took ACLS and decided to do the 2 day class instead of the renewal class. We did airways, practiced on the dummy, etc. and the instructor watched each of us practice, but there was no official check off for airways.

In my experience in ICU at a large metropolitan hospital, I've never seen or heard of any nurse ever being in the position to have to put in an airway. No way I feel competent to do so after taking ACLS and I don't know any nurses who would feel competent either without significant practice and experience on a real patient. In our hospital, there is so much immediate support in the event of a code, I just cannot see the need for nurses to devote very much time to airways in ACLS. It may be much different in rural environments or small hospitals which don't have rapid response teams ready to go in a heartbeat in the event of a code. Personally, I much preferred the mega code practices, as that is how it really works in my hospital environment. Knowing the drugs, doses, EKG rhythms, shock protocols for the various arrhythmias, various roles of the team, etc., is much more relevant for my own practice. If we spent two entire days doing airway practice, I'd walk out more proficient than I am today, but in a month it would be gone again. I don't think anyone who doesn't get frequent practice has any business putting in airways, imo.

All that said, it still sounds like the RN described in the OP took a really crummy ACLS class. I much prefer real instructors with the pressure of quick questions, real time EKG identification requirements, etc. as done in our megacode practice over any kind of computer simulation any day.

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