Certified Registered Nurse Anesthetists can intubate in all 50 states, Washington D.C., and Puerto Rico. For every other registered nurse, there is no clean list of states that allow nurses to intubate, because authority depends on your state’s Nurse Practice Act, your clinical role, and your employer’s credentialing. A small number of state Boards of Nursing have issued formal guidance recognizing RN intubation in defined situations, mostly in emergency departments, neonatal resuscitation, and critical care transport. Most states have not spoken directly to the question at all, which leaves the decision to the individual nurse’s judgment within the limits of license, training, and facility policy.
CRNAs Can Intubate Everywhere
Intubation is a core clinical skill for CRNAs and falls squarely within their recognized scope alongside other advanced airway techniques, medication prescribing, and critical care services. The American Association of Nurse Anesthesiology represents more than 69,000 CRNAs and nurse anesthesiology residents practicing across every U.S. state and territory.1American Association of Nurse Anesthesiology. A Guide for RNs/APRNs: Scope of Nurse Anesthesia Practice
What varies state to state for CRNAs is independence, not authority to intubate. Under federal Medicare regulations, hospitals generally must have CRNAs supervised by an operating practitioner or an immediately available anesthesiologist, but a state’s governor can opt out of that requirement by letter to CMS after consulting with the state boards of medicine and nursing.2eCFR. 42 CFR 482.52 – Condition of Participation: Anesthesia Services As of 2026, roughly two dozen states and Washington D.C. have exercised this opt-out, with recent additions including Michigan, Arkansas, Delaware, and Massachusetts. Several other states have replaced physician supervision with collaborative or cooperative practice frameworks. Even in states that still require supervision, CRNAs continue to perform intubation routinely. The requirement shapes the organizational structure around their practice, not the scope of the procedure itself.
Why the Answer Is Different for Other RNs
Nursing is regulated state by state, not federally. Each state legislature enacts a Nurse Practice Act that defines what nurses at each license level can and cannot do, and each State Board of Nursing interprets those laws through licensing decisions and advisory opinions. One board may issue a formal opinion explicitly permitting RN intubation under defined conditions. The neighboring state’s board may be silent, or may prohibit the procedure outright for anyone below the APRN level.
When a Board of Nursing has not addressed a procedure directly, nurses are generally expected to decide whether it falls within their education, training, and the legal boundaries of their license. That gray area is where most of the confusion around RN intubation lives.
Institutional policy adds a second layer. Your employer can always narrow your scope below what state law allows but can never expand it beyond your Nurse Practice Act. A hospital may decide that only physicians and CRNAs intubate in its facility even if the state board would permit a trained RN to do so. So the real question is not just “does my state allow it” but whether state law, facility credentialing, and documented personal competency all point the same direction.
Where Non-CRNA RN Intubation Is Recognized
For RNs who are not CRNAs, intubation sits outside the standard scope of practice in most states. Where it is allowed, it comes with strict conditions: documented training, demonstrated competency, physician involvement, and facility-level authorization. The settings where authority is most often recognized fall into three patterns.
Emergency Departments and Intensive Care Units
Some states authorize RNs to participate in rapid sequence intubation in emergency departments or ICUs. In practice, the RN may administer the induction and paralytic medications while a credentialed practitioner manages the airway, or the RN may perform the intubation itself under direct supervision. Common requirements include a physician or other authorized practitioner at the bedside, a direct order for the medications and the procedure, current ACLS or PALS certification, and documented facility-specific competency.
Nevada’s Board of Nursing has issued practice decisions specifically covering RN participation in rapid sequence intubation. Arizona has advisory opinions recognizing RN airway management within certain specialties. South Carolina permits RN intubation in emergencies if the facility has detailed written policies and standing orders in place. These are examples, not a complete list. If your state board has not published an opinion on intubation, contact the board directly before assuming the procedure is within your authority.
Neonatal Resuscitation
Neonatal intubation is one of the more widely recognized exceptions. Several states allow experienced RNs with appropriate training to intubate neonates in emergency resuscitation or transport situations. Washington State’s Nursing Care Quality Assurance Commission concluded that RNs may perform neonatal intubation in both emergency and elective situations up to their individual scope of practice, based on their education, skills, and knowledge. That same opinion noted the broader national picture: some states allow RN neonatal intubation with special training, some only in emergencies, and others restrict it to advanced practice nurses.3Nursing Care Quality Assurance Commission. NCQAC Advisory Opinion 3.0: Neonatal Intubation and Related Procedures
The expected training pathway typically involves the Neonatal Resuscitation Program or equivalent transport certification. Completing a program alone does not establish competency. Each institution is responsible for determining and documenting the level and frequency of competency required before a nurse takes on neonatal resuscitation responsibilities.3Nursing Care Quality Assurance Commission. NCQAC Advisory Opinion 3.0: Neonatal Intubation and Related Procedures
Flight and Critical Care Transport
Air medical and critical care ground transport is the setting where RN intubation is most practical and most consistently authorized. When a flight team picks up a critically ill patient from a rural hospital, there may be no physician on board. Transport nurses working under medical director protocols and standing orders regularly perform advanced airway management, including endotracheal intubation, as part of their authorized duties.
The Commission on Accreditation of Medical Transport Systems sets national standards for these programs. CAMTS requires critical care transport providers to complete initial intubation training involving at least five live or cadaver intubations and to maintain currency with at least one successful intubation per quarter. Transport services typically require credentials such as the Certified Flight Registered Nurse, which validates knowledge in resuscitation principles and airway management.4DOD Civilian COOL. Certified Flight Registered Nurse (CFRN)
Note the regulatory boundary here. The National EMS Scope of Practice Model, published by NHTSA, places endotracheal intubation at the paramedic level for EMS personnel.5EMS.gov. National EMS Scope of Practice Model 2019 Nurses working in transport roles are typically governed by their Nurse Practice Act and the transport service’s medical director protocols, not the EMS scope model. The interaction between the two varies by state.
What Has to Be in Place Before You Intubate
Three things need to line up before any non-CRNA nurse intubates a patient. First, your state’s Nurse Practice Act or Board of Nursing has to authorize the procedure for your license level, either through statute, a formal advisory opinion, or a defensible reading of your scope given your training. Second, your facility has to credential you for it through its privileging process, which typically involves documented simulation practice, proctored live intubations, and periodic competency reassessment. Third, you have to hold current, documented competency yourself.
Certifications support the second and third pieces but do not substitute for the first. ACLS and PALS cover adult and pediatric emergency airway management and are standard requirements in emergency departments and ICUs where intubation may occur. The Neonatal Resuscitation Program is the expected baseline for nurses performing neonatal intubation. Transport credentials like the CFRN require recertification every four years through re-examination or 100 contact hours of relevant clinical education.4DOD Civilian COOL. Certified Flight Registered Nurse (CFRN) None of them, held alone, authorizes intubation. They demonstrate knowledge; legal authority still comes from your Nurse Practice Act, and practical authority still comes from your employer’s credentialing process.
What Happens If You Intubate Outside Your Scope
Performing intubation without proper legal authority is a scope of practice violation, and state Boards of Nursing treat these seriously. A board that finds a Nurse Practice Act violation can impose discipline ranging from a formal reprimand to fines, probation, license suspension, or revocation.6NCSBN. Discipline Revocation means losing your license entirely, often with a mandatory wait of at least a year before reapplying.
The exposure does not stop at the board. A nurse who performs a procedure outside authorized scope faces heightened malpractice risk. If a patient is harmed during an unauthorized intubation, the nurse may be personally liable even if the clinical decision to intubate was medically appropriate. The argument that someone needed to do it does not reliably protect a nurse whose state law did not authorize the procedure, and malpractice insurers may deny coverage for acts outside the insured nurse’s legal scope.
If any one of the three pieces (law, credentialing, competency) is missing, the safer course is to let someone with clear authority manage the airway and to document your role in supporting the procedure.