Why can't nurses intubate?

sserrn, BSN · Feb 21, 2013

Yes, all the time

KentuckyNurseKim · Feb 21, 2013

I do enough work for the docs. I'd rather not add to that list, thank you.

KelRN215, BSN, RN · Feb 21, 2013

Paramedics and Doctors intubate, why can't nurses?

This is a faulty argument. Paramedics, doctors and nurses are all separate professions. Why not say "Doctors can prescribe medication and perform surgery, so why can't nurses?"

libran1984, ASN, RN · Feb 21, 2013

Nurses in my ER intubate! I've only ever seen an RN intubate once. She was in charge of the shock rooms, had time (and 28 years experience) and she just straight up did it. My jaw just hit the floor when I found out. The doctor passed by and she nonchalantly told him, "by the way..."

like wow. Major props to her. Her charting was impeccable and she put in all the order sets in place with the Doctor's permission prior in case of change of condition.

My ER let's the RN intubate as well as the Medics and PA's. Ta da!

azhiker96, BSN, RN · Feb 21, 2013

My last hospital would let a nurse intubate if he/she had been trained and did a certain number each year to maintain proficiency. Nobody that I knew was certified nor did they want to be. We had enough docs wondering around who could do the odd emergency intubation when needed. By the time we got the cart dragged over and opened we'd have someone with an MD badge who could take responsibility for the airway.

portland medic · Feb 21, 2013

Thought I would chime in here. I am in my second quarter of a BSN program, and have been a paramedic for thirteen years. I've probably done about 150-200 intubations in my career. Nurses can intubate. I live in Portland, and our flight nurses who work on the helicopter intubate. It just depends on where they work.

The thing about intubation is that it is a major skill that has enormous potential to cause adverse events. Perforating a trachea, cracking a tooth and causing an airway obstruction, or causing laryngospasm are just some of the potential scenarios when you intubate. It is a skill where you want clinicians with very recent experience that keep their skills sharp doing it. In the county I work in, we have too many damned paramedics, and not enough tubes to go around, causing us to go to the OR to try and keep our skills up. We compete with residents, and have to convince anesthesiologists who don't like paramedics to let us practice on their patient. It can be a challenge to keep our skills up.

I think this is the main reason nurses don't routinely intubate. Hospitals would rather keep fewer clinicians performing them so as to keep their skills sharp. It is well documented in the literature that providers who get regular intubations, be they anesthesia providers or paramedics, have greater success rates. It's the same thing with IV's. How good would ED nurses be at starting IV's if techs, phlebotomists, and CNA's did them too?

tewdles, RN · Feb 21, 2013

Many nurses work in environments where they intubate all sort of things, including trachea's.

subee, MSN, CRNA · Feb 21, 2013

I'm a CRNA and intubate every day. I didn't become good at it by doing a few here and there. The skill set one needs to recognize a difficult intubation and be prepared for it, separates the slick from the bad. Only people who are experienced should be intubating awake patients (not induced with general anesthesia) because when the intubation fails, one is left with a bloody mess for the next attempt. Of course I understand that in some places anesthesia is not around but I don't want to be a patient in those places because I know I am a difficult intubation! And the argument that doctors do it doesn't hold water. With MD behind your name, in some places you can to ANYTHING (liposuction, anyone?). The good docs know what damage they can do attempting to do something they haven't done since internship.

FlyingScot, RN · Feb 21, 2013

Nurses in my ER intubate! I've only ever seen an RN intubate once. She was in charge of the shock rooms, had time (and 28 years experience) and she just straight up did it. My jaw just hit the floor when I found out. The doctor passed by and she nonchalantly told him, "by the way..."
like wow. Major props to her. Her charting was impeccable and she put in all the order sets in place with the Doctor's permission prior in case of change of condition.

Um, while I don't doubt her experience and assessment skills and I'm ALL for autonomy and critical thinking she sounds a bit like a loose cannon. :nailbiting:

DoeRN · Feb 21, 2013

Do CRNA's even intubate on a regular basis? pardon me if that's an ignorant question.

Actually at my old facility yes they do. They were part of the anesthesia team and if they were assigned to be on the code team too then they showed up at codes and intubated the patient.

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Music in My Heart · Feb 21, 2013

Nurses *can* intubate, if they're trained and they're covered by protocol.

Flight nurses intubate and one of the local hospitals has specially trained nurses who intubate in the NICU.

natnat122 · Feb 21, 2013

This is a faulty argument. Paramedics, doctors and nurses are all separate professions. Why not say "Doctors can prescribe medication and perform surgery, so why can't nurses?"

Touche! Good point.