A registered nurse in California cannot independently intubate a patient. The procedure sits outside the general RN scope of practice set by the Nursing Practice Act, and the question of whether an RN can intubate in California is answered the same way across almost every clinical setting: the tube goes in through the hands of a physician, a Certified Registered Nurse Anesthetist, a nurse practitioner acting under a standardized procedure, or a respiratory therapist. The RN’s role is to prepare, assist, and monitor.
Why the General RN Scope Does Not Include Intubation
Business and Professions Code Section 2725 defines what registered nurses in California are licensed to do. It covers direct and indirect patient care, administering medications, and carrying out treatments ordered by a physician or other licensed practitioner.1California Legislative Information. California Code Business and Professions Code 2725 Intubation is not in that definition. Inserting an endotracheal tube is treated as a medical intervention, not a nursing one, and it falls outside baseline RN licensure.
What an RN can do during an intubation is extensive. You prepare the laryngoscope and tube, draw up and administer sedation or paralytics as ordered, position the patient, monitor oxygenation during the attempt, and confirm placement afterward. All of that is squarely nursing work. Placing the tube itself is not.
The Board of Registered Nursing reinforces the line in its conscious sedation guidance: an RN managing a sedated patient must make sure backup personnel skilled in airway management and emergency intubation are available if things go wrong.2Board of Registered Nursing. Conscious Sedation/Moderate Sedation The guidance assumes the person who would intubate is somebody other than the RN at the bedside.
When an RN Might Still End Up Intubating
Clinical reality sometimes outruns scope-of-practice rules. If a patient’s airway is failing and no physician, CRNA, or authorized NP is present, an RN may be directed to perform or assist with intubation under emergency protocols or a direct verbal order from a physician communicating remotely. These situations are rare and rest on the principle that immediate life-saving action takes priority when the alternative is death.
Doing it once in a true emergency does not grant you ongoing authority to intubate. The scope boundary snaps back the moment the crisis is over. Facilities that anticipate these scenarios should have emergency airway management protocols that spell out how to handle them, including documentation and post-event review.
Good Samaritan Protection Will Not Cover You in the Hospital
California’s Good Samaritan statute, Health and Safety Code Section 1799.102, protects people who render emergency care in good faith and without compensation at the scene of an emergency. It explicitly excludes hospital emergency departments and other places where medical care is usually offered.3California Legislative Information. California Health and Safety Code 1799.102 An RN who intubates a hospitalized patient cannot claim Good Samaritan immunity. Even outside clinical settings, the protection does not reach gross negligence or willful misconduct, and it generally does not apply when the nurse already has a duty to treat the patient or is being paid to care for them.
The Nursing Roles That Can Intubate
Three nursing-related pathways actually authorize the procedure in California: the CRNA role, the NP role under a standardized procedure, and, with important limits, the newer categories of NP created by AB 890.
Certified Registered Nurse Anesthetists
CRNAs are the one group of nurses for whom intubation is an everyday skill. Business and Professions Code Section 2826.5 authorizes a nurse anesthetist to provide anesthesia services, defined broadly to include preoperative, intraoperative, and postoperative care as well as emergency, critical care, and resuscitation services.4California Legislative Information. California Business and Professions Code Division 2 Chapter 6 Article 7 – Nurse Anesthetists5California Legislative Information. California Code Business and Professions Code 2826 Airway management, including endotracheal intubation, is part of that. A CRNA needs a physician, dentist, or podiatrist to order anesthesia services for the patient; once that order exists, the CRNA selects the approach, adjusts it during the procedure, and manages the airway throughout.
Nurse Practitioners Working Under a Standardized Procedure
Traditionally, California NPs had no scope beyond the general RN scope and relied entirely on standardized procedures for authorization to perform medical functions like intubation.6Board of Registered Nursing. General Information: Nurse Practitioner Practice That remains the primary route by which NPs intubate in most California hospitals.
A standardized procedure is a written protocol developed jointly by nursing, medicine, and administration at the facility. For intubation it specifies which NPs are authorized, what training and competency they must demonstrate, which clinical situations the procedure covers, what supervision or physician contact is required, and how the event is documented. The Board of Registered Nursing requires each standardized procedure to address a defined set of elements and to be reviewed periodically.7Board of Registered Nursing. An Explanation of Standardized Procedure Requirements for Nurse Practitioner Practice An NP intubating without one at the facility level is exposed, and so is the hospital.
What AB 890 Did and Did Not Change
AB 890, signed in 2020, created two new NP categories. A “103 NP” can practice without standardized procedures within a group setting that includes at least one physician. A “104 NP” can practice without standardized procedures outside those group settings, but the Board of Registered Nursing has not yet begun certifying 104 NPs and is expected to start in 2026.8California Board of Registered Nursing. Assembly Bill 890
Section 2837.103 lists the functions these NPs can perform without standardized procedures: advanced assessments, ordering and interpreting diagnostics, establishing diagnoses, and prescribing and administering therapeutic measures.9California Legislative Information. California Code BPC 2837.103 Intubation is not named. Whether “therapeutic measures” stretches to include it in emergency or critical care is a question facilities will need to resolve through their own counsel. The safer assumption is that intubation still requires a standardized procedure or a direct physician order even for a 103 or 104 NP.
Qualifying as a 103 NP requires a master’s or doctoral nursing degree, national board certification, and at least 4,600 hours of supervised transition-to-practice experience in California. A 104 NP must meet those requirements and then practice as a 103 NP in good standing for at least three additional years.8California Board of Registered Nursing. Assembly Bill 890
What Happens if an RN Intubates Without Authorization
Performing a procedure outside your scope creates exposure on three fronts: your license, civil liability, and insurance coverage.
Under Business and Professions Code Section 2761, the Board of Registered Nursing can discipline an RN for unprofessional conduct, which includes incompetence or gross negligence in nursing functions. Violating any provision of the Nursing Practice Act is independently actionable, and performing a procedure outside your scope falls within that category. The Board can also pursue discipline for conduct that amounts to practicing medicine without a license.10California Legislative Information. California Code BPC 2761 Penalties run from a formal reprimand or mandatory remedial education at one end to license restriction, suspension, and ultimately revocation at the other.
Beyond the Board, an RN who harms a patient while performing an unauthorized procedure faces civil malpractice liability. Professional liability policies may deny coverage for acts performed outside the insured’s recognized scope, leaving the nurse personally responsible for any judgment or settlement. The employing hospital can face institutional liability as well, which is why facilities tend to enforce scope boundaries firmly.
If You Want Intubation in Your Practice
The route forward is an advanced practice role, not stretched interpretation of the RN scope. CRNA programs are the most direct path to making intubation part of daily practice. For NPs in emergency or critical care, pushing for a well-written standardized procedure at your facility is the practical step that creates the legal authority to perform the procedure when the clinical need arises. Until one of those is in place, your role at the bedside during an intubation is to prepare, medicate, position, and monitor.