Administration of Etomidate During Rapid Sequence Intubation

In December 2003, the Board responded to an opinion request on the role of registered nurses in the administration of Etomidate during rapid sequence intubation (RSI).  An opinion was issued and further revised in August 2004 as follows.

The administration of medications, such as Etomidate, Diprivan Injection, and neuromuscular blocker agents for rapid sequence intubation (RSI) is within the scope of registered nursing practice when:

• The administration of the medication is performed under the direct supervision/presence of the physician, or advanced registered nurse practitioner designated nurse anesthetist, who is performing the intubation.
  
  
• The nurse is educationally prepared and currently clinically competent to perform the act in a safe, competent manner.  Documentation of the nurse’s educational preparation and demonstrated clinical competence is maintained.
  
  
• The monitoring of the patient is according to accepted standards of practice for RSI and is performed according to the facility’s established, written policies and procedures. 

It is within the scope of registered nursing practice for a registered nurse, qualified by education and clinical competency, to administer medications such as Etomidate, Diprivan Injection, and neuromuscular blocker agents, as prescribed, during RSI in aero-medical settings independent of on-site medical supervision.