RNs Intubating???

No RN's at our facilty (~200 bed hospital) intubate. We have Respiratory Therapist Supervisors who do the intubating much of the time, upon doctor orders, or during a code. If needed, RN's may use oral/nasal airways to keep the airway open until intubation is accomplished. We always have a ER doctor in house, if intubation is difficult.

I am a GN. But while reading your post a thought came to mind. Paramedics intubate and they only have one year of training. Yet many people are hesitant to have RN's intubate when they have anywhere from 2-4years of school. I feel it could be done sucessfully with the right competencies and training in place. Kim Rush

KR, The real question is not if RNs CAN intubate, we are all taught intubation in ACLS, PALS, TNCC, NALS, etc. It is really not that hard. You can even take unlicensed people and teach them to do it. Our supervisor is looking into our staff in ICU intubating. The problem is, the frequency that you do it. You may learn it one year and not have a chance to do it for another year. Unless you would go to surgery and practice all the time. The reason EMICTs, EMT-I and Paramedics do it is because they get a lot more practice, in the field. We have an ER doc in our 100 bed hosp all the time and can intubate and we can always bag for a while if there is a problem, and there is a CRNA always on call ( and often in the hospital). So the question is not If we can, it is if we should. Of course, being an ICU nurse, most of us would want the opportunity to do it...the more excitement, the better, but not if it may hurt the patient because of inexperience.

------------------

nurseyperson

Nurseyperson, I couldn't agree more. As a RRT I intubated in critical care and er literally hundreds of times over the years. It is a skill that one must do to keep up. And when you need to intubate you must be confidant in the skills of person doing it.Especially for women, a certain strength is needed in that left arm to stay off the teeth.Hitting the teeth on the dummy during ACLS is one thing;quite another for your facility to pick up the dental bill on our pt's.

Respiratory Therapists are degreed ,have passed a registry examination and have more extensive training in airway management than nurses.

Now, as an RN, I have so many other things to manage, I'm happy tp leave the intubation to the MD'S and RRT's.

There is no doubt that any ICU nurse could be taught to intubate, but without the opportunity to keep those skills up it sounds as if the risks outweigh the benefits.

Do we as critical care nurses need one more thing to manage?

Originally posted by nurseyperson:

KR, The real question is not if RNs CAN intubate, we are all taught intubation in ACLS, PALS, TNCC, NALS, etc. It is really not that hard. You can even take unlicensed people and teach them to do it. Our supervisor is looking into our staff in ICU intubating. The problem is, the frequency that you do it. You may learn it one year and not have a chance to do it for another year. Unless you would go to surgery and practice all the time. The reason EMICTs, EMT-I and Paramedics do it is because they get a lot more practice, in the field. We have an ER doc in our 100 bed hosp all the time and can intubate and we can always bag for a while if there is a problem, and there is a CRNA always on call ( and often in the hospital). So the question is not If we can, it is if we should. Of course, being an ICU nurse, most of us would want the opportunity to do it...the more excitement, the better, but not if it may hurt the patient because of inexperience.

what a clear and appropriate reply.

I am a CCU nurse, and no we are not allowed to intubate. The only people that intubate at our codes are the ER docs. I was a medic for 10 years and have extensive experience intubating but am not allowed to intubate in the hospital. I personally think that we should be trained to intubate because it would give us quick "full control" of the airway (which was drilled in my head as a medic). We use OPAs and bag, but if you don't have someone who actually opens the airway correctly how much O2 is the pt actually getting? Our CCU, ER, and MICU nurses are always head nurses of the code teams and we have a lot of codes, so I think we would be able to keep up with the skill. Plus, if you documented the number of times that someone intubated within a certain time frame, required X numbers of intubations within that time frame, and sent them to the OR for intubations (if they didn't have X number of tubings within that time frame) I think it may be successful. I do think that if a nurse would rather not take the responsibility, he/she shouldn't have to. We have some nurses that hate to go to ACLS training, but I think all ICU nurses should be adequate in ACLS. It just kills me to hear some nurses complain about ACLS. The first time I took it was back in the good old days when they really drilled you. I know that I learned it a lot better back then than what it is taught now. I see them now giving people ACLS cards that only made it through the stations with MUCH coaching during the station. While I don't think it should be as tough as it once was, I do think it should be tougher than it now is.

I have to agree that intubation, while it could save a life, is one more thing to maintain credentialing and competencies on.

As an EMT-Critical Care, I do not actually get that much practice in the field on real patients. My peers at all levels in the field also get very little experience, so we all drag out the mannekin every so often and "tube the head" to keep our skills up. By the way, intubation is being looked at as a possible Basic EMT skill in some areas.

The procedure itself is basically plumbing and pneumatics; insert tube (ET) into another tube (trachea) and add air with oxygen . Any nurse can be trained to do the procedure, but do we want the added liability. We all know that, if something goes wrong, the nurse takes it in the shorts (legally and financially) and the hospital says, "who.... us????? "

KR - you are just down the road from me. I get to Sayre occasionally (Bob's Honda).

I work in CCU and we are not allowed to intubate even if we are ACLS and PALS certified which doesn't make much sense to me either. Our resident on call for code team is the leader of the code and initiates intubation. Sometimes our respiratory therapists do it, if the resident has not responded within the first couple of minutes. Unfortunately, the residents do not always know what they are doing and are asking for guidance from the code team nurses at the same time. I think it would be beneficial to be certified in intubation. I know from experience that in Critical Care, we have patients code everyday and since the airway needs to be cleared first and we are the first ones to respond. It only makes sense that we should be trained in this procedure.

I was able to intubate in one ICU. I was also on a specialty transport team, the nurses on that team were the only nurses who intubated. We utilized protocols for our non-physician transports and yes I did get to intubate outside of the unit a few times. The first stepping stone was having a policy at the facility to allow this skill. Then the training, and finally certification as PHRNs. To keep the skills current we needed 3 intubations each quarter. This could be in the ICU, on trips or in the OR. Once a month we would schedule ourselves for 4 hours in the OR just for this purpose.

I work in a private hospital in South Africa . At night time we hardly ever have a dr. on call . If anything happens to pt. we have to phone the dr. in charge , who often lives up to 15min drive away from the hospital . If a pt. starts dev. resp problems , we as nurses must according to scope of practice "oxygenate the pt to the best of our abbility" .Thus if all we feel we are competent to do is put a mask over the pt's face , then so be it . If , however we have been trained to intubate a pt. (as all nurses who have done basic life support are ) we are compelled to intubate the pt if need be .

I therefore think that if you have the training & there is no-one else , then by all means intubate . You must just be able to justify your own actions later . We are afterall each accountable for our own acts & ommissions .

I have worked in two hospitals where I was allowed to intubate. A lot of states do consider it within nursing scope of practice, however, the ACLS guidelines also call for the most experienced person in that particular skill do the honors. Usually, there is someone around that has more experience with that task than me, so I defer and direct them to the head of the bed whenever possible.

We are taught how to do it in ACLS and PALS because we are a small hospital and if we were to have more than one code (which has happened) someone would have to intubate the pt. But if there is someone more qualified in the room I will be the first one to step back and let them have at it. We always have RT in the building and we have an ER doc so we would most likely never have to do it.