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Putting nurses in a bad spot.

Posted

I'm extremely frustrated at the moment. Without going into much detail, at my facility, the only thing we are allowed to push for intubation is versed. With that being said, half the time it doesn't work. At night, there is no in house doctor unless you call anesthesia (which half the time they're in the OR anyway) where you can have someone who is able to push succs, dip or whatever. I have seen this issue in multiple hospitals, not just where I'm working now. Why is it ok to put nurses in this situation? I'm not legally allowed to push Diprivan so what the hell do we do? . I feel like something needs to change in the policy in order to make it safe for everyone. Either allow us to do what we need to adequately sedate the patient, or make it mandatory that a physician be present on intubation. I'm so sick of stuff like this. What is your policy for intubation? What are you as the RN allowed to push?

I'm extremely frustrated at the moment. Without going into much detail, at my facility, the only thing we are allowed to push for intubation is versed. With that being said, half the time it doesn't work. At night, there is no in house doctor unless you call anesthesia (which half the time they're in the OR anyway) where you can have someone who is able to push succs, dip or whatever. I have seen this issue in multiple hospitals, not just where I'm working now. Why is it ok to put nurses in this situation? I'm not legally allowed to push Diprivan so what the hell do we do? . I feel like something needs to change in the policy in order to make it safe for everyone. Either allow us to do what we need to adequately sedate the patient, or make it mandatory that a physician be present on intubation. I'm so sick of stuff like this. What is your policy for intubation? What are you as the RN allowed to push?

During an intubation aren't there physicians in the room that can push meds? We often use Ketamine which nurses are not able to push at my facility and one of the docs at the bedside does it.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Who is intubating? Where is the hospitalist? If the patient can't be intubated are you trained on LMA'S?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

You might find the answer in your state's nurse practice and what is legal can vary greatly from one state to another.

Are resp. therapists allowed to intubate in your state without a physician present? I know of a not so great hospital in another state which uses versed and morphine for intubation done by the RT when there is no MD in house at night.

In the state where I am working right now, RTs are not allowed to intubate at all and RNs are not allowed to insert LMAs according to the nurse practice act.

Dodongo, APRN, NP

Has 7 years experience.

What? Seriously? How can they put a constraint like that on the ICU RNs? You should be able to push any sedative or paralytic you need to administer in order to assist the provider performing the intubation - etomidate, succs and propofol are a minimum. Why even have RNs around if all you're allowed to do is to stand there twiddling your thumbs? I can't stand hearing things like this.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

In every state that I have worked, RSI drugs may only be given in the hospital, in the presence of an MD according to the Nurse Practice Act.

There are sometimes exceptions for nurses on flight teams, though I have no first hand experience as Critical Care transport nurse and maybe someone else can explain that more thoroughly.

Would you be able to lead me to where I can find this information, regarding the nurse practice act and RSI?

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

Yes, google RSI and your state and nurse practice act.

For safety, these meds, which cause deep anesthesia and paralysis, can only be given by the RN, in the presence of an MD capable of advanced airway management.

Dodongo, APRN, NP

Has 7 years experience.

The language of most state practice acts concerning this is as follows:

"It is not within the scope of practice for an RN who is not A CRNA to administer medications classified as anesthetics such as ketamine, Propofol, etomidate, sodium thiopental, methohexital, nitrous oxide and neuromuscular blocking agents(paralytics), except under the following circumstances:1) The patient is intubated and ventilated in the acute care setting 2) In an emergency setting for Rapid Sequence Intubation (RSI) in the presence of a physician or advance practice RN credentialed in emergency airway management and cardiovascular support."

They further specify that the RN should be ACLS certified, with proper monitoring equipment, etc. I have never participated in a RSI without at least etomidate or propofol on board. Unless of course the patient was arresting and sedation wasn't needed in the first place.

Edited by Dodongo
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Dodongo, APRN, NP

Has 7 years experience.

I guess one more thing though - RNs in my state are able to perform conscious sedation or procedural sedation. We are required to use ETCO2 monitoring, etc.

It is ridiculous. I think it's just a way to lessen Liability on the Hospital. I'm not sure, but if there's doctor in the room, what difference does it make who pushes it???

calivianya, BSN, RN

Specializes in ICU.

We absolutely cannot push propofol, even with a MD in the room, but we can push etomidate/succs/fentanyl/versed. Go figure.

whofan, ADN, BSN, RN

Specializes in ICU. Has 16 years experience.

I can't believe that you don't have and MD there to intubate. The hospital I work for will not allow RTs to intubate, but we are a teaching hospital and we have dedicated ICU docs no matter what.

essT

Specializes in NICU. Has 5 years experience.

In my old unit, we were limited to RTs to intubate and versed push for sedation prior. No MDs in the unit on night shift. Anesthesia would get called stat if RT couldn't get it; hopefully the patient wouldn't code before they got there.

I'm glad to no longer be working there.

CrazziiRN913, ADN, BSN

Specializes in Electrophysiology, Medical-Surgical ICU. Has 9 years experience.

in the ICU in which I work we can push prop, succs, and etomidate only in the presence of the MD performing intubation. Only MD's perform intubations at my facility. But we can bolus prop off the iv pump if they have a drip running.

We can push and manage paralytics (Roc/Succ), short-acting anesthetics (Etomidate) and sedatives (Versed etc) but not Propofol.

MDs/NPs intubate. RTs are allowed to intubate in my state but I rarely see it happen. One of our RTs intubated with the doc present once in a non-complicated intubation due to hypercapnic resp failure. We probably didn't need sedatives lol....