PURPOSE: To describe Registered Nurse Anesthetists' (RNA's) experiences of the process of extubation of the endotracheal tube in patients undergoing general anesthesia.

DESIGN: A descriptive qualitative design.

METHODS: This study was conducted in two hospitals with 20 RNAs in total. Data were generated from focus group interviews. Content analysis was used to analyze data.

FINDINGS: The RNAs' experiences were described within four categories and eight subcategories. The category To be a step ahead includes assessment and preparation, and To be on my toes, their ability to recognize patterns and build a connection. To use situation awareness relates to their use of experience and feelings, and To be alone in a critical moment, to feeling alone in the team and protecting the patient.

CONCLUSIONS: The RNAs make decisions when to extubate by combining theoretical knowledge, clinical experience, and intuition with the uniqueness of each patient.