Can Nurses Intubate?

One of the first things nurses learn in school is to assess “The A-B-Cs”—airway, breathing, and circulation. A clear and open airway is critical to your patient’s survival. So, when the airway is compromised, it may be necessary to intubate. 

You may be wondering, can nurses intubate? The answer is, maybe. It depends.

Each state’s Nursing Practice Act governs nursing practice within its borders. Since each board of nursing is different, scopes of practice vary from state to state. 

Another factor to consider is the setting. Even when states allow RNs to intubate, employers may not. 

As you can see, the answer is complex. Let Incredible Health help!

• Can a nurse intubate?
• What types of nurses can intubate?
• What is intubation?
• What is the nurse’s role during intubation?

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Can a nurse intubate?

In short, the answer is yes. Some nurses are trained, and called on, to intubate patients during emergencies. However, due to state practice laws and varying facility policies, most nurses do not perform intubations. 

For example, in Arizona nurses with ACLS training can intubate within their specialty. In other states, only advanced practice registered nurses (APRNs) are allowed to introduce intubation. 

In South Carolina, nurses may intubate in emergency situations as long as their facilities have detailed written policies, procedures, and standing orders for intubation. 

What types of nurses can intubate?

Nurses may be trained to intubate in acute critical care settings. They care for the most serious patients, and there is a high risk they may need to intervene quickly. 

The RNs in critical care settings can complete special training which may qualify them to intubate in certain situations. Types of training and education that may prepare nurses to intubate include:

• ACLS classes
• Advanced training on airway management
• Certifications and credentials in their fields

Here’s a look at the specialized nursing roles where nurses intubate.

Flight nurses

Flight nursing is one of the fields where it is more common for an RN to intubate. 

Flight nurses (FNs) are highly-skilled RNs with advanced training and critical care experience. The FN’s job is to transport critically ill or injured patients between facilities. This is usually because the patient is unstable and requires a higher level of care. 

FNs must be prepared to act quickly when complications arise in the air. For this reason, with proper training they are allowed to perform complex interventions, including:

• Intubation
• Chest tube insertion
• Rapid sequence intubation

ICU nurses

Nurses in the ICU also work with critically ill patients that are vulnerable to neurological injury or blocked airways that can become emergent. Some ICU nurses may intubate, depending on their training, state regulations, and facility policies.

There are typically more rules about the scope of practice for nurses in the ICU compared to other settings. Nurses in intensive care settings are also likely to have resources available such as respiratory therapists and doctors who can perform intubation when needed. Most hospitals limit who can perform intubations because it’s a high-risk procedure.

Neonatal nurse practitioners

Intubations in the NICU are performed for respiratory distress or failure and for certain procedures. NPs in these situations must act fast! 

Neonatal nurse practitioners (NNPs) are specially trained to intubate their tiny patients. They perform many delicate procedures including placing central lines and lumbar punctures. One study found NNPs to be more successful at neonatal intubation than pediatricians.

Nurse anesthetists

Another hospital setting where nurses are responsible for airway management is the surgical suite. Drugs used during anesthesia affect the respiratory system. Patients under anesthesia may not be able to regulate their breathing or breathe on their own. Nurse anesthetists must be able to intubate. 

What is intubation?

Intubation is usually performed in a hospital during an emergency or before surgery.

Intubation is a life-saving procedure that can be performed by a qualified medical professional during an emergency when a patient can’t breathe. The brain must have oxygen from blood circulation or else the patient can suffer brain injury or death.

Intubation involves passing a small tube through a person’s nose or throat, down the windpipe. The tube keeps the airway open so oxygen can reach the lungs. The tube is secured in place with an inflated cuff. 

Procedure

The procedure for intubation typically follows these steps.

1. The patient is positioned supine. The healthcare provider stands at the patient’s head.
2. The patient’s mouth is opened, and a teeth guard may be inserted for protection.
3. Using a laryngoscope, the provider gently guides the tube into the airway.
4. When in place, a small balloon is inflated to hold the tube.
5. The end of the tube coming from the mouth is taped in place, and it may be used to deliver medications or be connected to a ventilator.
6. Proper placement is confirmed by checking breath sounds, a chest x-ray, or capnography.

Following intubation, the nurse will carefully monitor vital signs and document in the patient’s medical record.

Intubation should not take more than five minutes. You can watch an anesthesiologist demonstrate proper intubation procedure on Intubation Tips and Tricks.

Training

Proper training is critical for patient safety and care quality. Nurses who go through intubation training will learn about these important procedural aspects. 

• Proper head placement
• Preoxygenation
• How to use a laryngoscope
• Tube placement

Typically, training courses utilize a blend of simulations or manikins, online lectures and videos, and in-person hands-on skills practice.

Techniques

There are two different techniques for intubation.

• Endotracheal intubation typically happens during emergencies when the patient is sedated or unconscious due to injury. The healthcare provider uses a laryngoscope to guide the ET tube down the patient’s throat.
• Nasotracheal intubation is likely to be performed in a more controlled environment. In this procedure, a tube is fed through the nose to the throat and down to the windpipe.

Both techniques are similar and carry the same risks. In some cases, the tube may go into the esophagus instead of the trachea. This is why proper procedure by a qualified professional is important. 

What is the nurse’s role during intubation?

As mentioned before, some nurses may perform the intubation procedure, depending on the situation, setting, and facility. However, all nurses can participate during intubation. 

During an emergency or a procedure in which a patient must be intubated, nurses will perform general nursing interventions. Such tasks might include the following:

• Collecting patient history and reviewing labs
• Monitoring vital signs (pre-intubation baseline and following procedures)
• Preparing and administering medications including oxygen
• Managing infusions, fluids, and IV lines
• Coordinating with other disciplines (respiratory therapy, physicians, etc)
• Providing patient and family support and education
• Documenting interventions and patient response in the medical record

During an emergency, nurses who are not performing intubation may manage multiple tasks. 

The American Nurses Association produced a helpful video for nurses who assist during intubations: Assisting During Intubation. 

Next steps

Intubation is a life-saving procedure that nurses may play an active role in. 

The major takeaway is that intubation is a high-risk procedure reserved for certain situations. It requires specialized knowledge and skills by a qualified medical professional. 

Even advanced nurses with specialty certifications must stay current on evidence-based practice and care standards. Continuing education courses is a great way to do that. Check out Incredible Health’s free CEU courses online. 

You can check with your state board of nursing to find out more about the scope of practice for RNs in your state. And you can also get advice from other nurses in the field on Incredible Health’s nurse community.

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FAQs

Can RNs intubate?

Answer: In some settings RNs can intubate. Check with the state board of nursing where licensed for clarification. The RN will also be subject to facility and employer policies.

Can a trauma nurse intubate? 

Answer: Yes, some trauma nurses in emergency or critical settings, with appropriate training and certifications may intubate if the facility and state in which they work allow it.

Can nurse practitioners intubate?

Answer: Yes, some nurse practitioners (NPs) can intubate. Certified NPs are considered advanced practice registered nurses (APRNs) because they have specialized training in their practice area. This gives them a wider scope of practice than RNs. The case will depend on the NP’s specialty, the situation, and state and local regulations.