Endotracheal intubation is a procedure where a flexible tube is placed into the trachea, or windpipe, to secure the patient’s airway and facilitate mechanical breathing. The common question of whether a nurse can perform this procedure does not have a simple yes or no answer. The answer depends entirely on the nurse’s level of advanced education, specialized certification, and the specific laws governing their practice environment. For the vast majority of Registered Nurses (RNs), intubation falls outside their general scope of practice, but for others, it is a routine, core function of their job.
Intubation and the Standard Registered Nurse Role
The physical act of placing an endotracheal tube is generally not authorized for the standard Registered Nurse (RN), even those working in high-acuity settings like the Intensive Care Unit (ICU) or Emergency Department (ED). This prohibition exists because intubation is considered an advanced medical procedure that carries inherent risks, such as esophageal intubation or injury to the vocal cords, requiring specialized, high-volume skill maintenance. State Nurse Practice Acts and institutional policies draw a clear line between the general RN role and that of advanced practice providers.
The regulatory framework across the United States typically reserves the procedure for providers with credentialing beyond the basic RN license, which includes physicians and certain advanced practice nurses. Even when a state’s Board of Nursing may allow for intubation under specific emergency protocols, many hospital policies still restrict the procedure to physicians or other credentialed specialists. Therefore, the standard RN’s expertise is focused on recognizing the need for intubation, preparing the patient, and managing the process, not performing the insertion itself.
Specialized Nursing Roles Authorized to Intubate
A distinct group of nurses is fully authorized and routinely expected to perform endotracheal intubation as a fundamental part of their practice: the Certified Registered Nurse Anesthetist (CRNA). CRNAs are highly educated Advanced Practice Registered Nurses (APRNs) who specialize in anesthesia and pain management. Airway management, including intubation, is a core competency they learn and maintain throughout their doctoral-level education and clinical practice.
CRNAs perform intubations across all 50 states, often independently, for planned surgical procedures and emergent airway needs. Their extensive training allows them to utilize various advanced techniques, such as Rapid Sequence Intubation (RSI) for emergency cases or fiber-optic intubation for difficult airways. Research shows that CRNAs maintain first-attempt success rates for intubation that are comparable to physician anesthesiologists, demonstrating their high level of expertise.
Other specialized nursing roles also include intubation within their scope, primarily due to the need for immediate, autonomous action in isolated environments. Critical Care Flight and Transport Nurses, for example, frequently operate under specific protocols that permit them to intubate in the field or during transport. Securing an unstable airway quickly in a confined helicopter or ambulance is paramount to patient safety during transport. Additionally, certain Advanced Practice Registered Nurses, such as Neonatal Nurse Practitioners (NNPs), are specifically trained and authorized to intubate critically ill neonates in the Neonatal Intensive Care Unit (NICU).
The Staff Nurse’s Critical Role During Intubation
While the standard staff nurse does not perform the direct laryngoscopy and tube placement, their hands-on duties are necessary for a safe and successful outcome. Prior to the procedure, the nurse prepares the patient by ensuring proper positioning, typically in the “sniffing” position, and pre-oxygenating them using a non-rebreather mask or bag-valve mask to build an oxygen reserve.
The nurse must also ensure that all necessary equipment is immediately available and functional, including:
- The laryngoscope.
- Various sized endotracheal tubes (ETT).
- A stylet.
- Suction apparatus.
During a rapid sequence intubation, the nurse administers the medications, which typically include a sedative agent like etomidate or propofol followed immediately by a neuromuscular blocking agent (paralytic) such as succinylcholine or rocuronium. This precise, sequenced administration is done under the order of the provider but is physically carried out by the nurse. Throughout the procedure, the nurse is the primary monitor, continuously tracking the patient’s vital signs, especially the oxygen saturation (SpO2) and heart rate.
The nurse serves as the patient’s voice, alerting the team if the SpO2 begins to drop below acceptable limits. Immediately after the tube is placed, the nurse assists with confirming correct tracheal placement. Confirmation is done by connecting a device to detect end-tidal carbon dioxide (capnography) and by auscultating the patient’s lung sounds bilaterally. Once placement is confirmed, the nurse secures the tube and initiates continuous sedation drips to ensure the patient remains comfortable and the tube is not accidentally dislodged.