When I was in high school, I worked at an animal sanctuary/wildlife park. They wanted me to be a vet tech, so I was going to a vet tech program at the community college during my senior year in high school. That program wasn't even 2 years, so I was working as an active vet tech at the aforementioned wildlife park before I was even 19 – and I had some degree of exposure to the vet field as early as 14 years old, from being in the volunteer program at that park.
While I was working there after my vet tech licensure, I got the opportunity to do all sorts of intubations (yes intubation is within a vet techs scope). I got to tube all sorts of animals ranging from large mammals to small reptiles & birds. It's definitely a perishable skill, but it isn't super difficult. I had double digits successful intubations before I got to medic school. Aside from that fact, paramedics can intubate (and I completed medic school & my first 2 years of nursing school together while working part time).
I don't understand why intubation isn't a nursing skill. Nursing school is 4 years, there's plenty of unnecessary nursing theory fluff that could be replaced by clinical skills like intubation. If nurses can manage a ventilator (which is 100x harder than intubation), or titrate critical care meds, we should 100% having intubation included in our education and scope of practice. Especially when COVID-19 is running rampant, hospitalists should be doing much more ventilator management and nurses should be doing way more intubation.
I have been in situations where the Respiratory Therapist had to intubate due to lack of physician presence. And while they are the experts when it comes to the lungs, I think nurses could swing it as well. I worked at one rural hospital that trained nurses to establish IO access on the floor in case of emergencies and that came in handy a couple of times while I was there.
My practice area is operating room, so I've assisted on thousands of intubations. The fudge factor for IO insertion is much less than that for sucessful intubation. It depends on why you need to intubate the patient. If you can maintain an airway and Sat with ambu, nasal or oral airway, keep doing that. The problem with pushing an RT or RN up to the head to intubate when you CAN'T maintain the airway is that the patient would present a higher degree of difficulty to an experienced provider, nevermind someone who is playing off the bench. Having seen the BEST of the best providers sweating on difficult airways, I would hesitate to rush to intubate as an RN, having seen what I've seen. Like starting an IV, sometimes it's better to look at a situation and realize there are better people for the job than you.
And, having said that, situational exceptions may occur. IF I was in the middle of no where, AND, there was no upper level provider, AND I had adequate materials to do an intubation (crash cart, Glide scope, Eschmann, Rhino kit, etc.) would I attempt intubation IF THERE WAS NO OTHER capable provider? Maybe, maybe not. I've seen intubation shitshows where the parade of residents 'attempts' swelled the airway so bad, the staff anes. doc had nothing to work with....do I wanna be THAT provider? If the airway can be maintained without invasive monkey shines, stay in your lane.
I performed over 500 intubations before graduating CRNA school, and after that there were still plenty of airways that would give me pause or require extra help and consideration. Special situations like limited mouth opening or deranged anatomy/physiology aside, even a normal airway on a 300lb + patient you have about 10 seconds before they start desaturating.
You miss an IV and you get to start again. You miss an airway and that could be someone's life. Why take on that responsibility as an RN?
Specializes in Mental health, substance abuse, geriatrics, PCU.
Well, you guys presented some pretty good arguments as to why staff RN's don't really need or should learn to intubate. It is of course much more difficult to intubate versus putting in IV or an IO. I've just seen some sticky situations where patient needed to be tubed, hospitalist wouldn't do it, ER doc wasn't responding to the code went MIA for a while and here we are in limbo trying to address the other problems going on with the patient while hoping that someone with proper skill can intubate our poor patient. In those situations I think it would be handy to have somebody as back up. But as you guys have said, it takes many intubations for a person to become skilled at it, and that's simply going to be hard to achieve that level of training even with a handful of nurses in a facility.
Sigh, nevermind, I'll go back to pills and IV's and let you boys do the airway ?
I performed over 500 intubations before graduating CRNA school, and after that there were still plenty of airways that would give me pause or require extra help and consideration. Special situations like limited mouth opening or deranged anatomy/physiology aside, even a normal airway on a 300lb + patient you have about 10 seconds before they start desaturating.
You miss an IV and you get to start again. You miss an airway and that could be someone's life. Why take on that responsibility as an RN?
You guys are the only nurses that should be allowed to do it. Period.
Well, you guys presented some pretty good arguments as to why staff RN's don't really need or should learn to intubate. It is of course much more difficult to intubate versus putting in IV or an IO. I've just seen some sticky situations where patient needed to be tubed, hospitalist wouldn't do it, ER doc wasn't responding to the code went MIA for a while and here we are in limbo trying to address the other problems going on with the patient while hoping that someone with proper skill can intubate our poor patient. In those situations I think it would be handy to have somebody as back up. But as you guys have said, it takes many intubations for a person to become skilled at it, and that's simply going to be hard to achieve that level of training even with a handful of nurses in a facility.
Sigh, nevermind, I'll go back to pills and IV's and let you boys do the airway ?
55 minutes ago, Crystal-Wings said:
You guys are the only nurses that should be allowed to do it. Period.
6 hours ago, TheMoonisMyLantern said:
Well, you guys presented some pretty good arguments as to why staff RN's don't really need or should learn to intubate. It is of course much more difficult to intubate versus putting in IV or an IO. I've just seen some sticky situations where patient needed to be tubed, hospitalist wouldn't do it, ER doc wasn't responding to the code went MIA for a while and here we are in limbo trying to address the other problems going on with the patient while hoping that someone with proper skill can intubate our poor patient. In those situations I think it would be handy to have somebody as back up. But as you guys have said, it takes many intubations for a person to become skilled at it, and that's simply going to be hard to achieve that level of training even with a handful of nurses in a facility.
Sigh, nevermind, I'll go back to pills and IV's and let you boys do the airway ?
Why aren't anesthesia (they get paid for every intubation out of the OR) or respiratory therapy present for codes? At least the pool is being decreased so that the most skilled folks are present. Are you in a very rural facility? When I worked in hooterville and no one else was around, the ER doc would run upstairs to the codes.
Why aren't anesthesia (they get paid for every intubation out of the OR) or respiratory therapy present for codes? At least the pool is being decreased so that the most skilled folks are present. Are you in a very rural facility? When I worked in hooterville and no one else was around, the ER doc would run upstairs to the codes.
agreed. If already coding RT can intubate, as they don't need meds at that point and all you need is the physical act of intubating. Someone circling the drain requires much more consideration with someone that has the legal authority to make independent decisions (ED doc, ICU providers, anesthesia).
agreed. If already coding RT can intubate, as they don't need meds at that point and all you need is the physical act of intubating. Someone circling the drain requires much more consideration with someone that has the legal authority to make independent decisions (ED doc, ICU providers, anesthesia).
Yes. Once I called to intubate a patient who was on the floor and had well-healed radical neck dissection that was so well done that it was difficult to detect under the circumstances. She was easy to bag and I knew I was only going to get 1 chance because of the bleeding I would create, so took a quick look, couldn't see anything so decided to just bag her until her surgeon could come and do a trach. It ended up that we had to wait several hours and it worked out but it could have been catastrophic if someone didn't realize that this was not a normal airway decided to keep attempting to re-intubate her. I've attended many hairy intubations that require someone educated and experienced enough to know what can go horribly wrong. There's a lot of outlier airways.
Specializes in Mental health, substance abuse, geriatrics, PCU.
23 hours ago, subee said:
Why aren't anesthesia (they get paid for every intubation out of the OR) or respiratory therapy present for codes? At least the pool is being decreased so that the most skilled folks are present. Are you in a very rural facility? When I worked in hooterville and no one else was around, the ER doc would run upstairs to the codes.
Yes, it was a VERY rural hospital, the ER doc was supposed to do intubations if the hospitalist wasn't present. However, depending on the ER doc they could be resistant to coming to the floor/unit to do so.
This is in the realm of our RT brothers and sisters. They did this where I previously worked. Where I am now, this is within the domain of the CRNAs. They are always on call at our critical access hospital.
So, just for arguments sake: As a 22 year plus field paramedic, I've done a hundred plus intubations. As an RN, it is now out of my scope. Discuss. (I was pre-glidescope, I had to always have successful laryngoscopy before, but have been using glidescope for the past two years).
Why? You have seen the replies from experienced RN's.
Yes.
Discussion over.
Hey Grumpy, I think my comment came across wrong. I didn't mean that I think that I should be doing intubations now, I'm actually very happy to no longer have that responsibility! I meant for the discussion to be more about cross-trained personnel, of which there are many. I see that it wasn't a very clear comment and I apologize for the confusion. I also think that a lot of paramedics are painted with the same brush...cavalier, arrogant, etc. That is not most of us, they are the squeaky wheels.
The crux of the discussion was meant to be the direct laryngoscopy v. glidescope, and how this may be considered. They are worlds apart while being the same process.
11blade, RN
51 Posts
My practice area is operating room, so I've assisted on thousands of intubations. The fudge factor for IO insertion is much less than that for sucessful intubation. It depends on why you need to intubate the patient. If you can maintain an airway and Sat with ambu, nasal or oral airway, keep doing that. The problem with pushing an RT or RN up to the head to intubate when you CAN'T maintain the airway is that the patient would present a higher degree of difficulty to an experienced provider, nevermind someone who is playing off the bench. Having seen the BEST of the best providers sweating on difficult airways, I would hesitate to rush to intubate as an RN, having seen what I've seen. Like starting an IV, sometimes it's better to look at a situation and realize there are better people for the job than you.
And, having said that, situational exceptions may occur. IF I was in the middle of no where, AND, there was no upper level provider, AND I had adequate materials to do an intubation (crash cart, Glide scope, Eschmann, Rhino kit, etc.) would I attempt intubation IF THERE WAS NO OTHER capable provider? Maybe, maybe not. I've seen intubation shitshows where the parade of residents 'attempts' swelled the airway so bad, the staff anes. doc had nothing to work with....do I wanna be THAT provider? If the airway can be maintained without invasive monkey shines, stay in your lane.