Can Nurses Intubate?

Can Registered Nurses Perform Intubation?

Assessing airway, breathing, and circulation—often referred to as the "A-B-Cs"—is a fundamental skill taught in nursing school. A patient's survival often depends on maintaining an unobstructed airway, and intubation may become necessary if the airway is compromised. But can registered nurses (RNs) perform intubation? The answer depends on several factors.

Each state’s Nursing Practice Act outlines the roles and responsibilities of nurses, which leads to differences in practice scopes across states. Additionally, healthcare settings can influence whether or not RNs are allowed to perform intubation. Even in states that permit RNs to intubate, individual employers may have policies that restrict this practice. Thus, the question is nuanced and varies based on location and facility guidelines.

In essence, some nurses are indeed trained to intubate, particularly in emergency situations. However, because of state regulations and institutional policies, most nurses do not perform intubations. For example, some states allow nurses with Advanced Cardiac Life Support (ACLS) training to perform intubation within their specialty, while others may limit it to Advanced Practice Registered Nurses (APRNs). In certain regions, nurses may perform intubation only during emergencies, following strict protocols and orders set by their healthcare facilities.

Training for Intubation

Nurses working in acute or critical care often receive specialized training in intubation since they deal with severely ill patients who may need immediate intervention. RNs in these settings can undergo additional education to qualify for intubation in specific situations, including:

• ACLS courses
• Advanced airway management instruction
• Certifications in advanced practice nursing roles

Roles Where Intubation May Be Performed by Nurses

Here are examples of nursing roles where intubation may be part of the job, depending on state law and hospital policies:

• Flight Nurses: In air transport nursing, RNs often perform intubations. These highly trained nurses have critical care expertise and are responsible for transferring critically ill or injured patients between facilities. Due to the instability of these patients, flight nurses need to perform advanced procedures, including:
  • Intubation
  • Chest tube insertion
  • Rapid sequence intubation
• ICU Nurses: Intensive Care Unit (ICU) nurses manage critically ill patients who might require intubation due to airway issues or other urgent health concerns. Depending on the hospital policy and state regulations, some ICU nurses may be authorized to perform intubation, especially in collaboration with respiratory therapists and physicians.
• Neonatal Nurse Practitioners (NNPs): In the Neonatal Intensive Care Unit (NICU), intubation is frequently required to manage respiratory distress or failure in infants. NNPs, who are specifically trained for neonatal care, are often trained in neonatal intubation and perform delicate procedures, including central line placements and lumbar punctures. Research indicates that NNPs tend to have higher success rates in neonatal intubation compared to other specialists.
• Nurse Anesthetists: In surgical settings, Certified Registered Nurse Anesthetists (CRNAs) are responsible for airway management during anesthesia. Since anesthesia can impair a patient’s ability to breathe on their own, intubation is often necessary. CRNAs are trained to manage these procedures, which are critical for maintaining oxygen levels and preventing complications such as brain damage or death. These procedures are typically performed in hospitals during emergencies or before surgeries.

Intubation Procedure

Intubation involves inserting a tube through the nose or mouth into the windpipe to ensure that the airway remains open. The procedure generally follows these steps:

1. Position the patient in a supine position, with the provider at the head.
2. Open the patient’s mouth, using a teeth guard if necessary.
3. Insert the tube with a laryngoscope.
4. Inflate a balloon to secure the tube in place.
5. Tape the tube securely and connect it to a ventilator, or administer medications.
6. Confirm correct placement through breath sounds, chest X-rays, or capnography.

After the intubation, nurses monitor vital signs, document the procedure, and ensure the patient's condition remains stable. Intubation should be completed within a critical time frame (usually within five minutes). Proper training is essential to ensure patient safety and optimal care. Nurses who undergo intubation training learn essential skills, such as head positioning, proper use of a laryngoscope, and techniques for tube placement.

Techniques of Intubation

Two main techniques are used in intubation:

• Endotracheal intubation is performed in emergencies, often when the patient is sedated or unconscious. The tube is guided down the throat using a laryngoscope.
• Nasotracheal intubation is typically done in controlled settings by inserting the tube through the nose to the windpipe.

Both methods carry inherent risks, so only qualified professionals should perform these procedures. While nurses may not always perform intubations, they are critical in the process and often work closely with other healthcare providers during the procedure.

Nurses' Role During Intubation

Regardless of whether they are performing the intubation, nurses are involved in various vital roles:

• Collecting the patient’s medical history and reviewing lab results
• Monitoring the patient’s vital signs before and after intubation
• Administering medications, including oxygen and sedation
• Managing infusions, fluids, and IV lines
• Collaborating with physicians and respiratory therapists
• Educating patients and families about the procedure and care
• Documenting interventions and patient responses

Intubation is a vital, life-saving procedure that requires specialized expertise. Nurses who are trained in these techniques play an essential role in supporting patients and ensuring that the procedure is conducted safely.

For more information about RN practice scopes and continuing education courses, visit your state’s nursing board or healthcare facility guidelines.

If you’re interested in exploring nursing positions where intubation might be part of your duties, check out GoodWork, which connects healthcare professionals with employers in various medical settings.