nurses not using stethoscopes - page 7

new grad here, noticed ALL the nurses on my unit (med surg) do not use their stethoscopes...and just compare their notes to the previous shift notes..... i just bought a new stethoscope and hung it... Read More

  1. by   brownbook
    Being mildly hard of hearing from a childhood illness I never was much good with a stethoscope. The hearing loss was never a big problem and I honestly didn't think of it in relation to my assessment skills as a nurse. I could never do a good lung and bowel assessment in 2- 3 minutes!

    Maybe more nursing students need to admit, "actually I can't hear a thing" (slight exaggeration), after a 5 minute assessment of a healthy young talking, eating, pooping, classmate. I felt too stupid to admit this. Maybe nursing schools should ask about student's hearing. Advise that more expensive stethoscopes may be needed if they are having trouble hearing with a stethoscope. Then a 2 - 3 minute assessment would be realistic.
    Last edit by brownbook on Sep 12
  2. by   Ellie G
    It is actually illegal to chart an assessment you have not done. The patient's chart is a legal documentation of the care provided and the assessments made. By charting heart, lung, and bowel sounds you are stating what your assessment revealed. You know what is right and that's what you should do. Heaven help these other nurses if they had to defend their actions in court. I know it goes on because I have had patients ask me why I was listening To their chest. I was a patient for two days and in that time only one nurse actually did a full assessment. You use that stethoscope. Never mind what the others think.
  3. by   Neats
    I use my stethoscope when I am working direct patient care. Often times I need to close my eyes to listen better...(not sure if this is age or just concentration). The one thing I do not do is place my scope around my neck. I keep it in my pocket. If you see me around and do not see a scope it maybe in one of my cargo pockets. My initial encounter with a patient is to obtain the vitals first because I want a baseline. I rely on aids to get the BP thereafter, if it is the same I ask them to get it again. With certain medication I always obtain the vitals myself no delegation. I cannot imagine licensed professionals playing "follow the leader" when it comes to vital signs. One cannot assume this is not being completed.
  4. by   Ellie G
    Quote from Sour Lemon
    You'd be surprised, then. The workload at my first job as a new graduate was overwhelming, even to nurses with 20 years of experience. Very few nurses assessed their patients, even in a focused manner. Once I accidentally charted "wheezing" on a patient and the patient "wheezed" for weeks until he happened to be assigned to me again. We had a urology patient unable to void for two days before someone noticed, and it was the urologist. We even had a patient who'd had a stroke with all the obvious signs and symptoms. After about three shifts, a nurse who'd previously had that patient wondered why the patient could no longer speak clearly and wasn't walking anymore.
    I cut corners all the time, too, just not with assessment.
    I do believe focused assessment is appropriate in many cases, though.

    Those examples are horrifying to me. Wow
  5. by   amzyRN
    Every nurse should have a stethoscope. However, I don't listen to breath sounds on every patient someone mentioned above, it is not necessary to list to breath sounds on a healthy patient admitted for something totally different than a cardiovascular issue. Example 21 year old patient, post appy, using their IS, sats 99 on room air. I'd breifly listen to bowel sounds and check the incision but that's it. Id mark WNL in cardiovascular and respiratory, circulation. Knowing when to listen is also important.
  6. by   Susie2310
    Quote from amzyRN
    Every nurse should have a stethoscope. However, I don't listen to breath sounds on every patient someone mentioned above, it is not necessary to list to breath sounds on a healthy patient admitted for something totally different than a cardiovascular issue. Example 21 year old patient, post appy, using their IS, sats 99 on room air. I'd breifly listen to bowel sounds and check the incision but that's it. Id mark WNL in cardiovascular and respiratory, circulation. Knowing when to listen is also important.
    Just because a patient is young and healthy (as far as you know) isn't a good rationale for not listening to their heart and lungs postoperatively. Young patients can have complications of surgery, and can have breathing problems or contract respiratory infections, and can get overloaded with fluid too. That WNL that you chart for cardiac and respiratory function should mean that as part of your assessment you have assessed their cardiac and respiratory function by listening to their heart and lungs. If the patient did go on to develop complications postoperatively you haven't actually listened to their heart and lungs, and anyone reading your assessment to check on the patient's condition during the time you cared for the patient would likely conclude that by checking WNL you actually HAD auscultated the patient's heart and lungs.
  7. by   Ellie G
    I find a short assessment helps the patient feel like you are looking out for them. It gives them confidence in your ability to keep them safe. It makes them feel like you know what you're doing. You can also do some teaching while you're doing it. Remember the Miss America contestant and the ladies on The View wondering why she had a "doctor's stethoscope" That was a big brouhaha and all of these indignant nurses insisting that it was an important part of their nursing duties to use that stethoscope. Of course, the assessment will vary according to the patient population and acuity but I would simply never chart anything I hadn't personally assessed and I sure as heck wouldn't want to be missing something 30 seconds with a stethoscope might have caught. I was charge on a floor when a 4 days post op lap chole who came in for N/V threw a PE. It was caught very early by a nurse with a stethoscope who I'm quite sure never expected a respiratory event. The patient seemed anxious but never complained of any respiratory issue. What if that nurse had said "oh she's here for N/V" and focused assessment on only that? Listening to those lungs for all of 30 seconds could quite possibly have saved that woman's life.
  8. by   akint19
    first of all thanks so much to everyone who commented.

    and to answer this comment...by Miss.LeoRN and sevensonnets

    negative.

    It's more of when I was with different preceptors and observing how they are doing SINCE I AM STILL ON ORIENTATION, I had noticed none of them pulled out a stethoscope even on admission patients. It's the doctors who check with their stethoscopes and nurses have admitted that their stethoscopes are at HOME.
    Last edit by akint19 on Sep 13 : Reason: ..
  9. by   JKL33
    Quote from Susie2310
    anyone reading your assessment to check on the patient's condition during the time you cared for the patient would likely conclude that by checking WNL you actually HAD auscultated the patient's heart and lungs.
    Actually "WNL" should be defined within the EMR for each body system/area in which that notation is an option. The only way "WNL" can ever hold up legally is if it is clearly defined.

    And, right or wrong, WNL Respiratory may mean something like "rate and rhythm normal for age, even and unlabored" as defined within the EMR for that particular section.

    I would do a CV assessment on a post-op patient. However I've given more clear-cut examples where focused assessments are more appropriate earlier in the thread.
  10. by   Jory
    You are doing it right and if you are taking your own assignments, you practice the way you feel comfortable. Your co-workers are lazy.

    Caution: Don't wear the stethoscope around your neck while in a patient's room. If you get a patient that grabs the ends, you cannot break free. Major safety hazard.
  11. by   Becareful
    I noticed the lack of stethoscope usage as well. Keep using yours and don't lower your standard of care.
  12. by   Ellie G
    Quote from Jory
    You are doing it right and if you are taking your own assignments, you practice the way you feel comfortable. Your co-workers are lazy.

    Caution: Don't wear the stethoscope around your neck while in a patient's room. If you get a patient that grabs the ends, you cannot break free. Major safety hazard.
    I had a patient attempt to strangle me with mine. She had dementia but it was scary as heck. Still had it around my neck afterwards though. In ICU I felt like I needed it handy.
  13. by   Akay1717
    Yes!! Always be the exception! Be extraordinary. Be different and always strive to do the right thing for your patients. Don't conform but transform. You have to answer to yourself at the end of the day, make that person be someone you love and respect.

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