How often do you use your stethoscope?

[moreoreo]

I am a brand new full time elementary school nurse. Just wondering how often you use your stethoscope and what cases you feel warrant its use. Of course a child having respiratory issues or who says they haven't gone #2 in days would bring me to use it but I have only used it twice in two days despite seeing about 40 children. I am used to doing a full head to toe on hospital patients but I don't want to over- or under-do it in the school setting. Thanks!

[JenTheSchoolRN, BSN, RN]

Depends on the complaint - I typically use mine a hand full of times a week. During the winter, I use it a lot more because it is often when see flare-ups from students with asthma. The staff at my school gets all worried when they see me with it around my neck because they now something "was real today" (their words) as I usually keep it in my desk drawer and take it out when I need it.

I very rarely do full head-to-toe assessments; I do not have the time. I do focused assessments based on complaint; if complaint warrants a deeper exam, sure.

One way I describe school nursing vs hospital nursing thinking is this: In the hospital/acute care, one may start with the worst possible scenario and work one's way down to the less serious. In a school setting, one may start with the less serious and work one's way up, unless a gut feeling or symptom points otherwise. (Example: I had a student experiencing chest discomfort, no other reported symptoms. Mom, who is a cardiac nurse, called me in the morning to let me know about the student's symptoms at home. Mom told me she immediately grabbed her stethoscope and thought cardiac, I immediately asked if the student had a history of GI upset, which she did. We both laughed a bit at what we both thought first. Issue did turn out to be mild reflux.)

Of course, this takes practice. But in a school, we have the benefit of getting to know our patients (on various levels, depending on visit frequency) and what may not be usual for them and therefore be able to pick up on something that isn't usual for them. I can actually guess the complaint on some of my frequent student visitors before they even enter my office :).

Welcome to school nursing!

[Flare, ASN, BSN]

Mine gets used mostly for the asthmatics wanting their inhalers. I also use it a lot for the children coming in with coughs. I will pull it out on occasion for an unwitnessed report of vomiting to listen for increased bowel sounds.

I use it often enough that I keep it at arm's reach, but not right on my desk.

[BeckyESRN]

Mine sits on the ledge above my desk, but gets used rarely. I use it for respiratory complaints mostly. My first year, I had a student with a pacemaker(rate set to 40) and a history of bradycardia, so when she complained, I would do an apical pulse. For my inhaler kiddos, I use it when they c/o SOB, wheezing, ect, but not if it's a use before PE situation. I get the rare request for BP checks on teacher too. It's handy, but not an everyday item. My pen light gets way more use!

[Nurse_JackieVA, BSN, RN]

It's a hard transition when you're coming from the hospital to the school setting. I know when I started I felt like I wasn't using it enough but I started telling myself this isn't the hospital and its a more focused assessment. These are generally healthy kids and let's focus on what they're telling me - shift through and piece together what they are saying then do an assessment - sometimes for the littles its hard for them to verbalize how they're feeling or what exactly hurts.

I only use it for resp issues - especially now and listening to bowel sounds. BP check here and there. I have some cheap ones hanging up next to my desk for BP checks but I break out my hospital one that I keep locked up when I really want to hear breath sounds.

[Eleven011]

Sadly, it doesn't get used alot. I have it at the ready, in a basket by my recovery couch, with my oximeter and manual b/p cuffs. I have an automatic b/p machine too, so don't even use it for that! I use it like the rest have said, for asthma attacks, respiratory complaints, etc.

[ohiobobcat]

I use mine for chest pain complaints (had 2 in here at the same time the other day!), nasty sounding coughs, and asthma complaints. I keep my Littman in my home/work bag, but I bought some NurseMate cheapo stethoscopes to keep in the office and in my emergency bag and I really like them! I use that way more often than I use my Littman. I use my stethoscope 4-5 times per week on average.

I have an automatic BP machine as well, so occasionally I use it for the rare BP that gets checked not in my office.

I listen to abdominal sounds way less often. Maybe 3-4 times a year.

[NutmeggeRN, BSN]

I forget I have it on most days, until someone calls me "Doc"

[KKEGS, MSN, RN]

I listen for lung sounds on a kid who complains about wheezing or feeling short of breath or asks to use their inhaler. I have listened to bowel sounds exactly once on a kid exhibiting potential appendicitis symptoms. I've never listed to heart sounds at school.

Welcome to the crazy, wonderful world of school nursing! This is my first year too after working NICU and pediatric home health. This board has been invaluable!!!

[tamarae1]

Mine gets an almost daily workout. Asthmatics, bronchitis type complaints that I just want to be able to hear, complaints of "chest pain" (old habits of cardiac nursing), and the occasional stomach ache when I'm trying to tell if they're lying or not

[moreoreo]

Super helpful replies, thank you everyone for your input! It's definitely a transition from hospital nursing but we certainly up other aspects of our assessment, being that we are the only health professional who can help them in that moment! I'm excited to join your ranks and thankful for this forum as I certainly creeped all over it while preparing for this position. Thanks again!

[Windchaser22]

Yes to all the above plus don't forget the screenings and staff who come in for a quick check...lots of BP's. Welcome!!