matt033174

Thanks for all of the input. We have decided after looking at everything that we will not proceed. It will just require to much CE and followup. Just wouldn't be benificial. Thanks for everyones help.

I've been an ED nurse for 12 years and I can't think of a single field of nursing where you do not need to keep learning. Thinks change in medicine all of the time. I have been in medicine for only a short time and have seen medicines come and goprocedures go into common practice that were cutting edge when I started. You have to grom consently. I agree with the sacker job or maybe a nice factory. Same thing day in day out, and the good thing is almost no one dies on you.

Now I am confused. Was this quote form the above web site in agreement or disagreement of my quote. Because when I do a little search I see Physicians and even Dentist that used anesthesia before the end of the 19th century. So a nurse did challenge what was being done because they knew they could do a better job. I also see that some of those nurses went on to develop new techniques and even teach inters, residents and even doctors how to preform thos techniques. Just a thought. I appreciate what you say though Mike. I appreciate what you do and thank you for sharing your experence.

First off I am a Guy not a Girl. Second I wasn't wondering who had the bigest set or who has seen the worst stuff. I asked for thoughts on the subject. I am glad for everyones thoughts. Mike I agree that this is not something to take lightly. I have been in a rural ED for 12 years as a RN. I have seen first hand what happens when someone thinks they know what they are doing with an airway and doesn't. I've seen doctors staight out of residency who puke and pee their pants during there first 2 car MVC with 4 dead and 4 critical. And while I respect you statistics and do not dispute them, I have seen situations where our basic EMS crews bring in 2 or 3 critical patients that need airways controled within minutes of each other. If my RN's with years of experence do nothing but hold the doctors hand whil he intubates they will still be more prepared with continued training. And if the need arises they can intubate. I don't think you understand rural america. You asked if the poster had been in the military. Have you ever worked in a rural hospital in the heartland with only one doctor to call and no way to evac a patient other than a helicopter 42 minutes flight time away when its clean skys and the nearest hospital 1 hour drive by groung EMS with basics and intermediates to transfer. I'm not saying RN's should intubate but some time back someone asked the question can RN's work in surgery and administer anesthesia. You have your position today because someone challenged norms. Lets not say all the reasons this will not work and look at how do we make it work. It's easy to say it's the doctors fault he should be better, its admins fault they should find beter doctors, its not my fault I'm the nurse. What I want to do is what nurses have done or years and that is encourage the growth of my carier and provide the tbest care I can. I'm sorry if this sounds like a flame it is not ment to be. I work with army nurses who have been on the ground in Iraq. My father was a lifer and I have all the respect and appreciation for what you do. Just give us guys fighting in the rural settings a little respect back.

This wouldn't be someone who never did it anyway. This would be continued training that included working with a CRNA for several months on intubation. Then they would have to perform X number with that CRNA to show competency. They would then need to be observed in ED situations X number of times. Then they would have to intubate X number of patients a year to retain privileges. You can't tell me this is any different than a Family practice or IM doctor who hasn't touched a blade in several months or years trying to intubate. What I propose is not putting a patient in danger or at risk.

13 times was a bit of a exaggeration. The more we look the more we don't really think we want to do it. By the way what is PH-RN.

Thanks for your thoughts. The more we get into it the more we really don't want to get into it.

See I'm not sure you could really include RSI or induction drugs in. Just seems like there are so many thoughts on what you use. I don't think we would include this as something our RN's could do. What we are really looking at is last resource situation. No one can get patient smith intubated after 13 tries, Sally RN you try. This would never be a Sally patient smith needs a tube get after it.

Sorry above was responds

well here is the deal though. We only have a total of 8 doctors at our hospital. We have 1 surgeon and 1 CRNA on call. We look at a mass casualty situation the surgeon and CRNA will be in cases most likely so that knocks out the most qualified intubator. Then you have to look at minors that will be the majority of patients you are going to need 2 or 3 docs seeing them at a off site minor care to keep congestion out of the ED. So that leaves you with 1 ED doc and 2 or 3 family practice docs. And when I talk about the ED doc we are not talking about Board Certified 10-20 year ED vets. Many times we have Moonlighting 3 year residents and family pactice docs. You must understad we are the only hospital in our state within 80 miles in three directions and 35-40 in the other. We serve a very poor county in Oklahoma. Majority of our patients in the ED are Medicaid. We usally do with what we have because we can't pay out the money ED certified docs want. We still see alot of trauma though. Agricultural accidents, ATV, motorcycle injuries, good old fashion MVC, Shottings, Stabbings, you name it. What we want to use the nurse for is another resource. We don't want to just simply say its the docs fault he can't intubate. We can say that all we want but if the patient dies because of an unsecure airway, we still loose. We don't intend to have every nurse doing it. We have several old army medic or old RN's who let para medic lapse. To say they can't do it is nuts. They've tubed more people than most doc outside of OR or the ED. And to say you can't make someone competent to do it even with training is crazy. Intubation is no more complicated a procedure to someone who understands the technique than anything else we do. And if you have ever BVM'd someone for any period of time before you intubate you increase there risk of death secondary to aspiration. Any critcal care class will tell you control of the airway is always the priority. BVM is not control. I simple ask the question " Do any of your hospitals allow RN's to intubate, and if so what competency do they require"

I can't speak to a big ED, but in mine (rural oklahoma, 4 trauma beds, 6 exam/minor beds) we work as a team. You kinda rotate through who gets the next trauma or emergent patient, seeing non-emergent, and triage patients. We don't really assign who gets what though. At the most though we have three RNs and at the least we have one. Everybody really helps with everybody.

Welcome to the family. Start looking at your critical care classes. ACLS, PALS, TNCC, ENPC. They will clear up alot. And I agree quiet kids are dead kids. Find a good person in your ED to mentor you. And keep every text, flyer, hand put you ever get in classes. They will come in handy sometime. I like mosby "ECG's made easy" for rhythms. And ENA is a wonderful resource. Join the ENA and you get the emergency nurses journal from them which I think is a wonderful resource.

I had one guy who told me in triage he had a bee sting on his arm and he had an allergie to them. When asked how long ago ut had happen thinking at the most a hour, he told me 3 days earlier. Needles to say you couldn't find the sting on his arm I also had our local PD bring a DUI in one night not for an ETOH level but because she had eaten the cherry scented toliet cleaner brick in the PD bathroom. That was nice. But at least for a drunk she had pleasent breath.

I've only been married for 9 years but I agree with you. You need to help her with the stress anyway you can. Show her how pround you are and how much you love her. My wife knows if I come home and talk about anything other than maybe the nurses I work with that something is bothering me. I agree with whoever said it is not one trauma that does it. It's all of the little stuff that adds up. I know my wife had a hard time with it the first time I said she really couldn't understand. I told her until she had told a momma her baby was dead or a daddy that his beautiful 16 yr old princess was dead she couldn't understand. Now she knows that and encourages me to talk to one of my nurse friends or even sometimes sends one my way. All you can do is be supportive and talk. And just remember not everybody was ment to be a ED nurse

after speaking to the obn intubation doesn't seem to be forbidden. competency must be determined though. i just want to get a feel of what other hospitals and nurses think. i don't think it is something any nurse should do but i don't feel it should exclude all nurses. in relation to sutures, depending on the wound and area it is located there can be many problems. now i also understand intubation is not without risk. but one thing does distingish the two. one is very emergent and the other usualy is not. the cases we would use a rn in would be very rare and only in those cases where there is no other option. we would also most likely limit it to those who are cen or setting for the cen soon. they would also likly need to do competency with one of our crnas. thanks for your thoughts