Why can't nurses intubate?

[natnat122]

Paramedics and Doctors intubate, why can't nurses?

[BrandonLPN, LPN]

I'll never understand the mindset some people have that equates nursing and paramedics. Maybe they watch too many medical shows? They are two very different disciplines, and two very different jobs.

Being a paramedic is about being a first responder to emergency situations. Being a nurse is about promoting health and alleviating suffering. I'm sorry if that doesn't sound as cool or exciting, but there it is.

The two roles overlap a bit in the ER for obvious reasons, but they are still separate. A paramedic being able to intubate does *not* make him "higher" than a nurse. Like someone said, that's faulty logic. There are lots of things other members of the healthcare team can do that we cannot. There's even more that we can do that they can't. If everybody could do everything, what point would there be in different titles and licensures?

There seems to be a fundamental misunderstanding of what a nurse *is* among students and the general public. I cringe a little when I see so many say they want to become nurses because they want to "save lives". Yes, I suppose we do that sometimes, too. But if your main passion is life saving and emergencies, I think you're missing the point of what being a nurse is about.....

[PMFB-RN, RN]

Nurses CAN and DO intubate. All that's needed is a faciliety compenetcy, appropiate training, and a policy in place allowing them to do so. My hospitals requires that I do 30 supervised intubations a year (in 2011 I got all 30 done in one days in out patient surgery) to maintain my competency (spervised by any CRNA or MDA). In addition we (those RNs who hold intubation privalges) sit through a 2-3 hour class each year taught by one of the CRNAs on new equipment / practices in airway managment. For exampe last year we were trained on the glide scope.

A while back all that training came in handy when I intubated an old farmer with a dead bull laying across his hips/legs in the middle of the night in an unlighted, un heated cattle barn. I had 6 people holding flashlights for me and a terrified sheriff's deputy holding cryc pressure for me while I stood mid-calf deep in cow manure. I love my jobs.

[PMFB-RN, RN]

I'll never understand the mindset some people have that equates nursing and paramedics. Maybe they watch too many medical shows? They are two very different disciplines, and two very different jobs.

Being a paramedic is about being a first responder to emergency situations. Being a nurse is about promoting health and alleviating suffering. I'm sorry if that doesn't sound as cool or exciting, but there it is.

QUOTE]

*** Nurses work in many rolls and enviroments, including as first responders in emergency situations. Our transport crew consists of a transport RN, a paramedic, and an EMT/driver or EMT/ pilot. The RN is the team leader. It is the RN who decides when a patient is stable enough to transport (in small hospital ER to large hospital ICU transfers), weather the scene is safe enough for our intervention (in the case of field calls), it is the RN who decides if a patient gets intubated or not (though we may or may not deligate the actual intubation to the paramedic). It is the RN who decides if we need to divert to a closer medical faciliety due to a change in patient condition enrout.

[PMFB-RN, RN]

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?

*** I know what you mean about MDAs not being thrilled about training paramedics, Lucky for us our hospital's chief CRNA used to be full time on the transport team (and still works casual)when he was an RN and is a big advocate for RNs intubating on the transport team. We can intubate anywhere in the hospital too but those are always supervised by a CRNA, and much less often by an MDA. Our CRNAs provide all the training and seem very happy to allow us to maintain our compentency by supervising us when we intubate in the OR.

[seamang2, BSN, MSN]

In Nevada, the state BON says that nurses may intubate. No hospital policy allows for it because medicare/medicaid will not reimburse for an intubation performed by the nurse. Hence, no nurse intubations in NV. It's all about the $$$'s.

[HazelLPN, LPN]

Advanced practice nurses do tube pts all the time. When I did NICU, it wasn't all that uncommon for the NNP to grab the laryngoscope out of the resident's hands if they were struggling to get the tube in while we have a premie who needs an airway. As far as staff nurses intubating, we have enough to do already! However, I must say that in all of my years in nursing, we have picked up so many functions that only the docs used to do. I remember when nurses never touched the lines. I used to have to call the doc to come draw a gas! Even worse, when I started in nursing I remember setting up for an IV start and assisting the doc put it in. I didn't start my own until the mid/late 1960s. Maybe the day will come when staff nurses do intubate routinely as they are always adding new things for us to do and be responsible for. Now that I'm retired, there are some days that I really miss working in critical care. When I think about having to be responsible for intubating my 28 weeker when he pulls out his tube not realizing that it keeps him alive.....no thank you....any illuisions that I have of working one more day in the unit are completely shattered...give me my rocking chair...and maybe in a few months I'll start to rock!

[NurseKitten, MSN, RN]

All day, every day. But let me say this: while I have literally thousands of intubations...y'all, it's a neat party trick, but knowing how to maintain an airway with chin lifts, jaw thrusts, oral airways, and how to bag someone...THAT'S how you save a life.

[SoldierNurse22, BSN, RN]

When I was in my EMT-B class, the paramedics used to get at nurses by saying things like, "Yeah, you can do x and y and z...but you can't intubate." It was their favorite dig against RNs.

I used to think they had a point, but I have to agree with NurseKitten on this one. It's a cool party trick, but the basics are the basics. And no matter how many skills you have, nothing beats good assessment abilities and basic intervention skills. Those, 9.9 times out of 10, will save a life.

[BrandonLPN, LPN]

*** Nurses work in many rolls and enviroments, including as first responders in emergency situations. Our transport crew consists of a transport RN, a paramedic, and an EMT/driver or EMT/ pilot. The RN is the team leader. It is the RN who decides when a patient is stable enough to transport (in small hospital ER to large hospital ICU transfers), weather the scene is safe enough for our intervention (in the case of field calls), it is the RN who decides if a patient gets intubated or not (though we may or may not deligate the actual intubation to the paramedic). It is the RN who decides if we need to divert to a closer medical faciliety due to a

change in patient condition enrout.

Fair enough, but you have to admit the number of RNs working as first responders is a tiny percentage. I maintain that far too many students get into nursing thinking it's something it isn't. The majority of jobs out there are paperwork and/or bedside care. I still say students who say "I want to be I nurse because I want to save lives" are being naive.

I didn't mean to imply that nurses who *do* work in a first responder capacity aren't practicing "true" nursing, I just think some students will be pretty disappointed to learn the "cool" stuff is few and far between for most nurses.

[SoldierNurse22, BSN, RN]

I still say students who say "I want to be I nurse because I want to save lives" are being naive.

That entirely depends on what they end up doing.

Let's face it--most of the time, when we save lives, it isn't in the TV drama fashion that people think it is. It's a nurse noticing that something isn't right about the pt/lab values/I&O's/etc and alerting the proper people and then advocating the urgency of the situation to those people.

THAT is saving lives, undervalued and unappeciated as it is.

[LadyFree28, BSN, LPN, RN]

Nurses do intubate...It's a part of ACLS and PALS.

I know it depends on the facility, etc. In the Rehab facility I worked for, several residents were knocking out teeth..One snatched the scope out of an experienced nurse who was VERY proficient in intubation and proceeded to knock that patients two front teeth down their throat...how "proficient" was that?? That resident at the next code passed the scope to that proficient nurse. Teeth remained intact. :)

Where I work at now, management of the ET tube is still collaborative, but if you need to advance the tube if it is going to be compromised, then by all means we have the autonomy to do so, after PALS, CC, and ICU training. If you have this, plus hours of management and support, then you are good to go!

[LadyFree28, BSN, LPN, RN]

That entirely depends on what they end up doing.

Let's face it--most of the time, when we save lives, it isn't in the TV drama fashion that people think it is. It's a nurse noticing that something isn't right about the pt/lab values/I&O's/etc and alerting the proper people and then advocating the urgency of the situation to those people.

THAT is saving lives, undervalued and unappeciated as it is.

^ eh, that's relative...those aspects ARE valued, to the families, and the lives and the healthcare team members we save everyday with our skills and constant questioning attitude. If it wasn't, we wouldn't be consistently the most trusted profession...just my two cents. :)

And a lot of people escape reality and love to dabble in fiction...they see nursing as an end all be all to help serve them sometimes, unfortunately...