I have been an RN for 40 years and have been trained in ACLS, PALS and TNCC. My training included endotracheal intubation, and I am proficient at it. I have intubated several patients at the facility at which I work. However, the facility recently instituted a policy that RNs are not allowed to intubate patients. Instead, the RNs are supposed to use a bag valve mask until someone is available to intubate the patient. If I intubate a patient whose life is at stake, am I in trouble? Even if it saves a life?
Nancy Brent replies:
You did not include the contents of the new policy nor did you include why it was changed. Were there competency issues with the RNs who were intubating patients? Was there a change in the law in your state that allows only certain healthcare providers to intubate? These, and other, questions might help explain why the new policy went into effect.
Although you are skilled in intubation, if your institutions policy bars RNs from doing this procedure and you intubate a patient, even saving his or her life, you may face disciplinary action by your employer, including termination. You also may face discipline by the state board of nursing for various reasons (e.g., the employer says you violated policy, intubation is not allowed by RNs under state law or you are practicing medicine rather than nursing because of scope of practice issues).
It might be best to discuss this issue with your employer so you are clear about the ramifications if the policy is not followed. Likewise, reviewing your state nurse practice act and rules, or asking the board for an opinion about intubation and nursing practice in your state also are options.
Clearly, saving a life is a most important consideration anytime a nurse is faced with providing a treatment or procedure he or she might be proficient in but is not allowed to do for whatever reason, in a facility or a state. It is a tough dilemma to face, and if you think a specific legal opinion might be helpful to you, consulting with a nurse attorney or attorney in your state who works with nurses and knows nursing practice would be a good idea.