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.
Specializes in Mental health, substance abuse, geriatrics, PCU.
58 minutes ago, CKPM2RN said:
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.
You have a point, cross trained staff are common and yet often limited to whatever role they're filling at the time. I knew a couple RT's that were also RN's that got in some sticky situations at times. When I was an LPN in the hospital, on certain floors LPN's were permitted to administer certain IVP medications that they could NOT administer on other floors even though an RN could, made no sense and was a headache. I think sadly, the limitations on staying in our designated role are mainly driven by legalities and desire to avoid lawsuits. It would be nice if the laws were supportive of clinicians working to their full potential, but as a previous poster said "stay in your lane."
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.
Sorry, I may have taken your comment out of context. No offense intended.
like you I was trained to intubate but unlike you I have never done it for real. Always plenty of medical staff around. In an absolute emergency then yes, I would have done it, albeit reluctantly, because saving someones life was more important. As an RN (in the UK) intubation is definitely not a nursing skill unless you are like me from ED or an anaesthetics Nurse Practitioner.
As for paramedics, what can I say...
Actually the ones I have known have mostly (vast majority) been good at their jobs and I have had many a beer with them over the years.
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.
Administration needs to straighten this person out.
It is not so much that initials matter when it comes to intubations. It is experience. On the floors of a hospital (pre-COVID) airway management was an infrequent, high-stakes practice. When you have a procedure that is infrequently used, you want it limited to a small number of people to avoid skill dilution. Think about the IV guy/gal on your unit. Typically, whoever does a procedure more frequently, will be more capable. The case of a hospital in BFE with no one around to intubate is a different story and doesn't warrant training nurses in nursing school to intubate. Most new grads can't even insert foleys in females with good success rates. This is definitely a case where I do not think the medical profession is trying to keep the nurse down. I was a paramedic before becoming a nurse. I'm now in anesthesia school and I have been in clinical for 3 months with 30 or so successful intubations. I have had every resource available and I still have been humbled by difficult airways and had to have a more experienced provider intubate. These have been with stable patients in ideal conditions. I say all this to tell you that you really don't want this responsibility in the hospital.
Mask ventilation is a more valuable skill than intubating for a bedside nurse. Most cannot do that either, because they never do it. See what I mean?
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.
Your story PERFECTLY illustrates the tenet it is much better to know when NOT to attempt than to try and stir up the mud in clear waters (bleeding). Friable, post radiated airway tissue doesn't like being tickled with implements...you nailed that exactly!
Mask ventilation is a more valuable skill than intubating for a bedside nurse. Most cannot do that either, because they never do it. See what I mean?
YES! Years ago, I was on bedside report with the team where the night nurse reported 'kussmaul' breathing with pauses...uh-huh. I lifted the patients chin to sniffing position, and golly-gee...air movement, regular, unlabored. This was before OSA was a thing...LOL
Your story PERFECTLY illustrates the tenet it is much better to know when NOT to attempt than to try and stir up the mud in clear waters (bleeding). Friable, post radiated airway tissue doesn't like being tickled with implements...you nailed that exactly!
Thank you. And you have to be expert to intubate someone while lying on your belly on the floor:)
Especially when COVID-19 is running rampant, hospitalists should be doing much more ventilator management and nurses should be doing way more intubation.
COVID-19 Patients should be intubated by people that do it multiple times on a DAILY basis.
They desaturate so fast that you don't have a lot of time for multiple attempts.
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TheMoonisMyLantern, ADN, LPN, RN
923 Posts
You have a point, cross trained staff are common and yet often limited to whatever role they're filling at the time. I knew a couple RT's that were also RN's that got in some sticky situations at times. When I was an LPN in the hospital, on certain floors LPN's were permitted to administer certain IVP medications that they could NOT administer on other floors even though an RN could, made no sense and was a headache. I think sadly, the limitations on staying in our designated role are mainly driven by legalities and desire to avoid lawsuits. It would be nice if the laws were supportive of clinicians working to their full potential, but as a previous poster said "stay in your lane."