RNs intubating

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PL198 said:
Everyone always wants to expand and do more and more and more. Well a physician really can't do that obviously as they are the top of the ladder. It's just hilarious how they want to do more and more, yet not have the responsibility of making sure it goes well. They want to intubate, but the moment they f*ck it up, you know you'd hear, " well resident X I saw you walking by going to another room, you should have made sure I didn't mess it up."
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The nurses want responsibility, but they lack accountability. They're just like children.
 
Psai said:
Because if something goes wrong, who is going to be responsible for cleaning up the mess and taking responsibility?
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The intensivist who is supervising them.

Intubating patients is a technical skill. The actual act in the vast majority of patients is relatively straight forward and simple. It isn't something that doctors are particularly good at relative to others because of their training. Like most technical things in medicine, it is more about how many times you have done something and how many times you've watched a really good person do something and how they managed the trickier patients than it is your formal education. At our quatrenary care hospital, PAs/NPs/RTs intubate patients in the SICU, CCU and CVICU. They are all much MUCH better than the non-anesthesia MDs that are in the ICUs or on the code teams. They do more, they see more and they are ALWAYS doing it, day in day out, every day. They don't rotate off service, they don't take long breaks.

Someone made a good argument that this isn't about the technical aspect of intubating people, it is about the THINKING part of it. Knowing who/when/why to intubate is a lot harder than the technical part. But, even that is limited. Yes, there are borderline calls that need to be made that are made better by better educated individuals, but that is always going to be true.

This is no different than saying that Cardiologists shouldn't be allowed to do cardiac caths, balloon pumps, TAVRs, etc. They are much worse technicians than we are and generate significantly more access complications than we do. They are also incapable of managing their own complications, even in an emergency. They can't cut down on vessels, they don't have the training in emergency endovascular maneuvers, etc. Vascular surgeons have to clean up the mess and get compensated less than the original procedure that caused the problem in the first place.

WildcatS11 said:
That's not a good comparison. I think what most people are worried about is less qualified providers trying to perform EMERGENT intubations - not elective, controlled, pre-op intubation. These run of the mill, non-difficult airway pre-op intubations are the easiest procedure performed in the hospital - let the tech's do them for all I care. Honestly, crna's do a hundred of these each month. In the OR, if there is a predicted difficult intubation that a crna is performing, there will be a back up plan - glide scope, anesthesia present, etc. however, the same can not be said for each and every EMERGENT intubation - sure, an RN could throw a tube in a regular person, but what about an adentulous 380 lbs dude with no neck who got half his face blown off from a gun shot? Are they going to be trained in c-Mac, glide scope, LMA's, bougies, cric's?!? If they aren't, then there is no way they should be allowed to attempt emergent intubations - you can't always predict these bad airways in the emergent setting.
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First, glide scopes are easier to use for undertrained people than a standar mac or miller and the number of MDs that know how to and would cric someone is very very low. Sorry, good luck getting a non-surgical practicioner to really feel comfortable doing that. Even in "emergencies" which really are extremely rare (and when they aren't, that facility will have a well staffed code team or trauma team). You have time, you can bag most people for a long ass time. The main question is should someone setup and attempt a standard intubation in the time it takes to get someone more experienced to the bedside. In my mind it is an unequivocal yes.
 
mimelim said:
This is no different than saying that Cardiologists shouldn't be allowed to do cardiac caths, balloon pumps, TAVRs, etc. They are much worse technicians than we are and generate significantly more access complications than we do. They are also incapable of managing their own complications, even in an emergency. They can't cut down on vessels, they don't have the training in emergency endovascular maneuvers, etc. Vascular surgeons have to clean up the mess and get compensated less than the original procedure that caused the problem in the first place.
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Well I've always thought that vascular surgeons should be the only ones to do those procedures and that they've been unjustly taken by cardiologists so yeah
 
mimelim said:
This is no different than saying that Cardiologists shouldn't be allowed to do cardiac caths, balloon pumps, TAVRs, etc. They are much worse technicians than we are and generate significantly more access complications than we do. They are also incapable of managing their own complications, even in an emergency. They can't cut down on vessels, they don't have the training in emergency endovascular maneuvers, etc. Vascular surgeons have to clean up the mess and get compensated less than the original procedure that caused the problem in the first place.
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I agree. If I needed any of those procedures, I would much rather have a vascular surgeon do them.
 
mimelim said:
This is no different than saying that Cardiologists shouldn't be allowed to do cardiac caths, balloon pumps, TAVRs, etc. They are much worse technicians than we are and generate significantly more access complications than we do. They are also incapable of managing their own complications, even in an emergency. They can't cut down on vessels, they don't have the training in emergency endovascular maneuvers, etc. Vascular surgeons have to clean up the mess and get compensated less than the original procedure that caused the problem in the first place.
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Not to derail this thread too much, but how and why did vascular/CT surgeons ever let this happen in the first place? Seems like that turf should have always been firmly in the surgery realm.

I know other surgical specialties are starting to draw firm lines to prevent "interventionalists" from encroaching on their turf too much. Neurosurgery is slowly disenfranchising the interventional neurology & neuro-IR training pathways by incorporating their procedures into standard integrated nsurg residencies across the country. In urology, uro onc fellows learn how to do percutaneous tumor ablations under fluoro (which was originally developed by IR). Maybe they're just learning from the sins of their vascular/CT fathers?
 
WildcatS11 said:
RN's have just never done this. It's a whole new aspect of training that would need to be addressed.
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Also they would need to be doing enough to maintain the skills, even if they did get the training, which would be hard for an RN when there are many other more experienced people doing them in the hospital.
 
repititionition said:
If you think there is any appreciable clinical difference between an NP and an RN, you need to go hang out in a community hospital -- it's a distinction without a difference. The meat of the two bell curves overlaps substantially.
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That's pretty scary when you consider that NPs have prescribing power and independent practice rights in many states.
 
tdram said:
I love how many doctors / med students defend non-physician providers. I wonder how many non-physician providers defend doctors? Haven't met a single one yet. If you have, I'd love to hear about it.
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You should hang around more PA's.
 
tdram said:
Also they would need to be doing enough to maintain the skills, even if they did get the training, which would be hard for an RN when there are many other more experienced people doing them in the hospital.
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I think what is largely being missed here is that it isn't just any RN that would be doing intubations. Usually it is a hand selected group of RNs that are on a specific team that are trained by physicians and intubate on a regular basis. It's not just whatever floor RN feels like intubating tonight- it's a guy or gal that the anesthesia or pulmonary team has personally trained and believes to be competent in the procedure. Usually they are required to maintain a certain number of procedures and recertify their skills on a regular basis under physician supervision.
 
didymus said:
You should hang around more PA's.
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I've had multiple PAs and PA students trying to convince me that their education is pretty much the same as ours, since they take basically the same classes plus or minus a few and do the same rotations, and don't take summers off etc. One PA student told me we're the same because they have more requirements to get in, that's why their schooling is shorter, whereas we have less requirements to get in, but we do more in school.
 
Mad Jack said:
I think what is largely being missed here is that it isn't just any RN that would be doing intubations. Usually it is a hand selected group of RNs that are on a specific team that are trained by physicians and intubate on a regular basis. It's not just whatever floor RN feels like intubating tonight- it's a guy or gal that the anesthesia or pulmonary team has personally trained and believes to be competent in the procedure. Usually they are required to maintain a certain number of procedures and recertify their skills on a regular basis under physician supervision.
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If that's the case, I'm OK with it. As long as it isn't a blanket license for any RN to intubate. It has to be someone that has been trained and is being supervised.
 
tdram said:
If that's the case, I'm OK with it. As long as it isn't a blanket license for any RN to intubate.
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I've never seen a case where it was not a carefully selected team of RNs or RTs intubating with regular skill checks and competency requirements. It's never just some free pass for whatever RN happens to be working the floor at the time to throw in a tube. It's a hand-picked team that has been trained by a physician to operate under a very specific protocol, generally to be carried out under the approval of the current attending physician. It isn't exactly cowboy medicine lol.
 
Mad Jack said:
I've never seen a case where it was not a carefully selected team of RNs or RTs intubating with regular skill checks and competency requirements. It's never just some free pass for whatever RN happens to be working the floor at the time to throw in a tube. It's a hand-picked team that has been trained by a physician to operate under a very specific protocol, generally to be carried out under the approval of the current attending physician. It isn't exactly cowboy medicine lol.
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Yeah, I guess the problem for some of us when we see RNs and other providers doing these procedures is we feel a little jealous because we've been told if we're diligent and go through all the hoops of med school and residency, etc, we'll eventually be allowed to do these things, yet here are other people who didn't have to do that and sort of "jumping the line" and getting to do it witout having to go through the prescribed path... kind of a WTF? You can be an RN with just an associates degree...

The question becomes what exactly am I jumping through these hoops to get permission to do? Seems like everything but surgery can be done by others through shorter paths. I'm getting the same rights as that NP over there but for some reason I have to pay $250k and she only pays $35k..
 
tdram said:
Yeah, I guess the problem for some of us when we see RNs and other providers doing these procedures is we feel a little jealous because we've been told if we're diligent and go through all the hoops of med school and residency, etc, we'll eventually be allowed to do these things, yet here are other people who didn't have to do that and sort of "jumping the line" and getting to do it witout having to go through the prescribed path... kind of a WTF? You can be an RN with just an associates degree...

The question becomes what exactly am I jumping through these hoops to get permission to do? Seems like everything but surgery can be done by others through shorter paths. I'm getting the same rights as that NP over there but for some reason I have to pay $250k and she only pays $35k..
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If you're going to medical school to learn how to intubate someone, you're going for the wrong reasons buddy. I'll let you in on a little secret...the difference between an anesthesiologist and a midlevel is not intubation skill level.
 
calvnandhobbs68 said:
If you're going to medical school to learn how to intubate someone, you're going for the wrong reasons buddy. I'll let you in on a little secret...the difference between an anesthesiologist and a midlevel is not intubation skill level.
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I'm not I was just trying to understand where some people's reacitons came from.
 
tdram said:
I've had multiple PAs and PA students trying to convince me that their education is pretty much the same as ours, since they take basically the same classes plus or minus a few and do the same rotations, and don't take summers off etc. One PA student told me we're the same because they have more requirements to get in, that's why their schooling is shorter, whereas we have less requirements to get in, but we do more in school.
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I find the bolded difficult to believe, but, what the hell do I know--I wasn't there. If that PA made such a statement, s/he is a fool, and an outlier. I think most PA's are pro-physician, and do not have a goal in mind of independent practice, and do not value being the authority. I think most PA's recognize and embrace the limitations in their training, and appreciate working with physicians who act as mentors, and see the PA's as valuable contributors to healthcare delivery, and as allies considering they are trained in the medical--as opposed to the nursing--model.

I guess, as with all things, YMMV.
 
RJGOP said:
The nurses want responsibility, but they lack accountability. They're just like children.
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This thread is making me all the more grateful I'm at a hospital where the doctors and nurses respect each other. Especially this gem of a post about nurses being children. I hope that was sarcasm @RJGOP. Personally, I'm not taking offense because I know my place and training as an RN right now. I do want to practice outside the scope of nursing and that is why I'm applying to medical school. I just hope you don't have that attitude towards the people you perceive as "beneath" you.

That particular RN the original OP mentioned sounds a little haughty. Never once have I heard from any of my coworkers that we wish we could be the ones to intubate. Maybe be able to put in a PICC line late at night when we have crap for veins and a bunch of orders to fill that involve giving 4 antibiotics plus fluids and blood product, which is something a team of RNs already does at our hospital on day shift.

To answer the question should RNs be able to intubate? Only seasoned and competent ones that go through a significant amount of training. If an EMT can intubate in the field with 9 months of training then how is an RN "taking away" that procedure from an understaffed hospital?
 
TriNurse said:
This thread is making me all the more grateful I'm at a hospital where the doctors and nurses respect each other. Especially this gem of a post about nurses being children. I hope that was sarcasm @RJGOP. Personally, I'm not taking offense because I know my place and training as an RN right now. I do want to practice outside the scope of nursing and that is why I'm applying to medical school. I just hope you don't have that attitude towards the people you perceive as "beneath" you.

That particular RN the original OP mentioned sounds a little haughty. Never once have I heard from any of my coworkers that we wish we could be the ones to intubate. Maybe be able to put in a PICC line late at night when we have crap for veins and a bunch of orders to fill that involve giving 4 antibiotics plus fluids and blood product, which is something a team of RNs already does at our hospital on day shift.

To answer the question should RNs be able to intubate? Only seasoned and competent ones that go through a significant amount of training. If an EMT can intubate in the field with 9 months of training then how is an RN "taking away" that procedure from an understaffed hospital?
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I don't feel that nurses are beneath me, however I think many of them (not all) act childish. The reason they get on my nerves sometimes is becaus they pretend they know more than the physicians about everything, and once they are proven wrong- they deny it. Also, they tend to blame the physicians for their mistakes. I do not feel superior to nurses at all, however sometimes they behave childish, and I was referring to the ones who lack accountability for their mistakes.
 
maxxor said:
That's funny, because IR invented the procedure.

http://en.wikipedia.org/wiki/Charles_Dotter
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We get far fewer access problems from IR than from IC or IN. They are better technically and use ultrasound, ministicks, etc. That having been said, they still can't deal with their own complications and what is worse, if one of their complications come in, they don't see the patient, ever. They don't admit their complications to the hospital, they don't treat the complication, they don't even go see the patient (since they are not involved in their care).
 
calvnandhobbs68 said:
If you're going to medical school to learn how to intubate someone, you're going for the wrong reasons buddy. I'll let you in on a little secret...the difference between an anesthesiologist and a midlevel is not intubation skill level.
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Yet he's recognizing something important that most pre-meds overlook: midlevel encroachment. The incremental value of becoming an MD/DO has been so substantially eroded that it is far more LOGICAL (notice no value judgement and leaving room for personal goals) to become a midlevel in this country than it is to become a doctor (and yes -- for clarity, I mean an MD/DO, not a DNP :vamp:).
 
calvnandhobbs68 said:
If you're going to medical school to learn how to intubate someone, you're going for the wrong reasons buddy. I'll let you in on a little secret...the difference between an anesthesiologist and a midlevel is not intubation skill level.
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Then what's the difference between an Anesthesiologist and a crna? Knowing more anesthetic drugs and their side effects?
 
RJGOP said:
I don't feel that nurses are beneath me, however I think many of them (not all) act childish. The reason they get on my nerves sometimes is becaus they pretend they know more than the physicians about everything, and once they are proven wrong- they deny it. Also, they tend to blame the physicians for their mistakes. I do not feel superior to nurses at all, however sometimes they behave childish, and I was referring to the ones who lack accountability for their mistakes.
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That's the thing about people though. Some people suck. There's some nurses that I can't believe passed the NCLEX just like there are some doctors that I'm shocked made it through med school. Lumping all nurses into the same category would be like me thinking all doctors are jerks because one hung up on me.

I was taught to respect the schooling and responsibility that comes with an MD. Yes, I can predict what most of the docs will order based on the presentation/history of a patient after a few years in ICU.

Thinking I could treat a patient better than one of my docs would be a personal problem...not a nurse problem. I don't understand why a nurse would get into a pissing match with a doctor. Different hospitals, different cultures?
 
TriNurse said:
That's the thing about people though. Some people suck. There's some nurses that I can't believe passed the NCLEX just like there are some doctors that I'm shocked made it through med school. Lumping all nurses into the same category would be like me thinking all doctors are jerks because one hung up on me.

I was taught to respect the schooling and responsibility that comes with an MD. Yes, I can predict what most of the docs will order based on the presentation/history of a patient after a few years in ICU.

Thinking I could treat a patient better than one of my docs would be a personal problem...not a nurse problem. I don't understand why a nurse would get into a pissing match with a doctor. Different hospitals, different cultures?
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I feel like a lot of nurses are burned out, overworked, and unhappy with their jobs. Same goes for doctors. These types of issues come out when everyone is stressed and irritated.
 
TriNurse said:
That's the thing about people though. Some people suck. There's some nurses that I can't believe passed the NCLEX just like there are some doctors that I'm shocked made it through med school. Lumping all nurses into the same category would be like me thinking all doctors are jerks because one hung up on me.

I was taught to respect the schooling and responsibility that comes with an MD. Yes, I can predict what most of the docs will order based on the presentation/history of a patient after a few years in ICU.

Thinking I could treat a patient better than one of my docs would be a personal problem...not a nurse problem. I don't understand why a nurse would get into a pissing match with a doctor. Different hospitals, different cultures?
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I probably should of said some nurses lack accountability. It was misleading to just say nurses. Obviously we have two very different perspectives, but I'm sorry if I offended you.
 
RJGOP said:
I probably should of said some nurses lack accountability. It was misleading to just say nurses. Obviously we have two very different perspectives, but I'm sorry if I offended you.
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No worries you didn't. I am secure in the fact I'm a good nurse. I think through every call to a doctor and know when to leave an issue for rounds. I also know my current level of education and am frustrated because I want to know more which is why I am currently applying to med school. It's a shame whichever nurse(s) you were talking about didn't see it as a learning opportunity. Their loss.

The whole debate about procedures and responsibilities traditionally reserved for physicians but being done more and more by mid-levels is interesting and a little scary. I have the option of going the NP route but if I'm going to best care for my patients I want the best training.
 
tdram said:
I've had multiple PAs and PA students trying to convince me that their education is pretty much the same as ours, since they take basically the same classes plus or minus a few and do the same rotations, and don't take summers off etc. One PA student told me we're the same because they have more requirements to get in, that's why their schooling is shorter, whereas we have less requirements to get in, but we do more in school.
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People need a feeling of importance.
 
DermViser said:
Then what's the difference between an Anesthesiologist and a crna? Knowing more anesthetic drugs and their side effects?
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The greater amount of education, as has been mentioned before. I don't get why it's so hard for some of you to realize that procedure competency is mainly dictated by the number of times you've done the procedure under competent supervision. Thus why anesthesiologists are better at intubating than most other physicians. Thus why a CRNA would be better at intubating than you (or me or most people on this board besides the anesthesia residents). They've simply done it more times. Being a physician doesn't just automatically make you better at everything.
 
calvnandhobbs68 said:
The greater amount of education, as has been mentioned before. I don't get why it's so hard for some of you to realize that procedure competency is mainly dictated by the number of times you've done the procedure under competent supervision. Thus why anesthesiologists are better at intubating than most other physicians. Thus why a CRNA would be better at intubating than you (or me or most people on this board besides the anesthesia residents). They've simply done it more times. Being a physician doesn't just automatically make you better at everything.
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Yes but how does that extra education come into play in Anesthesia? Is it the basic science? I'm sure crnas can read this, too:
 
EMDO2018 said:
People need a feeling of importance.
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Yes, in America we teach every kid that they are unique, special, and important just for existing. Then they go into the real world and find out that they actually have to earn that importance and naturally get frustrated.

Not everyone can be the boss.
 
What I mean is, people create their feeling of importance by being delusional and creating an alternate reality. ex. " PAs and MDs are the same"
 
DermViser said:
Yes but how does that extra education come into play in Anesthesia? Is it the basic science? I'm sure crnas can read this, too:
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If we want to rehash the crna vs anesthesiologist argument we can all head over to the anesthesia forum where its been hashed out 100 times. They'd be happy to let you know over there. Of course, we could start making the same argument about any specialty now right? What's the difference between a dermatology PA and you? Let's not pretend that shave and punch biopsies are something mindblowing and we can all assume PAs can read Clinical Dermatology.
 
EMDO2018 said:
What I mean is, people create their feeling of importance by being delusional and creating an alternate reality. ex. " PAs and MDs are the same"
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Yes, that's the defense mechanism they use to reconcile what they were taught by society growing up with the reality of the situation. Their ego can't handle the fact that others are better than them so they create these delusions to protect their ego.

That's what we do in America. We always look for the shortcut. For example, instead of losing weight when you're obese, Americans try to make obesity "normal" (see Fat Acceptance movements).
 
calvnandhobbs68 said:
If we want to rehash the crna vs anesthesiologist argument we can all head over to the anesthesia forum where its been hashed out 100 times. They'd be happy to let you know over there. Of course, we could start making the same argument about any specialty now right? What's the difference between a dermatology PA and you? Let's not pretend that shave and punch biopsies are something mindblowing and we can all assume PAs can read Clinical Dermatology.
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You said it was your education that set you apart, hence I'm asking which part. Is that not your specialty's textbook?
 
tdram said:
Yes, that's the defense mechanism they use to reconcile what they were taught by society growing up with the reality of the situation. Their ego can't handle the fact that others are better than them so they create these delusions to protect their ego.
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Everyone is a special snowflake and everyone gets a participation trophy.
 
calvnandhobbs68 said:
The greater amount of education, as has been mentioned before. I don't get why it's so hard for some of you to realize that procedure competency is mainly dictated by the number of times you've done the procedure under competent supervision. Thus why anesthesiologists are better at intubating than most other physicians. Thus why a CRNA would be better at intubating than you (or me or most people on this board besides the anesthesia residents). They've simply done it more times. Being a physician doesn't just automatically make you better at everything.
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True, a CRNA would definitely be trusted compared to physicians who barely intubate. I mean, you don't need to learn anything basic science related to know how to do an intubation.
 
DermViser said:
Everyone is a special snowflake and everyone gets a participation trophy.
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There was this one obnoxious PA student who kept trying to convince me that her education was just as good as mine, and that we were the same, so I asked her one simple question -- If we're the same, why does your degree have "Assistant" in it. She never brought it up with me again.
 
KnuxNole said:
True, a CRNA would definitely be trusted compared to physicians who barely intubate. I mean, you don't need to learn anything basic science related to know how to do an intubation.
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What exactly do you need to learn basic sciences for?
 
tdram said:
There was this one obnoxious PA student who kept trying to convince me that her education was just as good as mine, and that we were the same, so I asked her one simple question -- If we're the same, why does your degree have "Assistant" in it. She never brought it up with me again.
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I would have pronounced "Assistant" with emphasis on the first 3 letters.
 
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