I carried my stethoscope when I first started my job on the floor. I was being the "good new nurse" and did head-toe assx, check for PERRLA on a regardless of patient's neurostatus, checked for 4 points pulses, auscultated for breath sounds, APETM, etc etc, then I stopped using stethoscope completely for quite long time.
Especially at the ER, I feel that stethoscope was almost of no use. When I was on ER transition, I listened to breath sounds but soon recognized that it was almost waste of time mainly because almost everyone gets chest xray. But I started carrying stethoscope again recently and this is why. I feel that when I actually listen to the patients' lungs and breath sounds, it seems that patients trust me more, they like it more than me just coming in, hooking them up to monitor and asking mundane questions. That is actually the biggest reason I use my stethoscope now. In terms of outcomes, of course it serves no use because doc will order xray and know if there's effusion, atelectasis, or pneumo, but one, I like to be able to depend on skills instead of imaging tools to know what's going on, and two, patients react positively to that. I see that this is why docs put stethoscopes on patients "just as act" even though I know for sure he/she's not listening, but somehow that probably assures the patient.
Anyways, that's been my experience with stethoscopes. Do you carry yours and use them, do you think it actually matters? I don't but I use them for above reasons. What do you do?
I work ICU. Yes I use it to do my assessments every 4 hr + prn. I set it down in my work bag & just pick it up when I need it. I've left it around occasionally and it makes it's way to the lost stethoscope drawer...never been stolen in over 15 years. Guess I work in an honest work environment.
As for other areas I work: ER & day surgery. In ER: if it's applicable then I use it, if not then no (which is most of the time). For example: SOB, listen to heart & lungs, but skip the belly unless it's symptomatic. For a broken leg on a young patient with no medical history, skip stethoscope auscultation generally. In day surgery: super basic auscultation of heart, lungs, abdomen with every patient but then it's beyond the "requirement" of the unit & a more focused assessment of what the surgical problem is.
The issue I see is if you didn't assess it, don't chart it! I see the doctors doing it all the time! Either they go in without a stethoscope and chart auscultation or they just document what I told them my assessment is. There are maybe less than 25% of the doctors at my place that actually perform a complete physical assessment, which is what they chart. Many will do a focused assessment though. My favorite is when they document assessments without even entering the patient room.
I do carry mine and use it however...in the ED where I work I think a nurse could easily get by without one. A patient comes in SOB, the med student, resident, and sometimes attending physician listens. A patient gets a neb, those are administered and charted on by RT. ET tube placed, the med student and docs are again listening. Plus the patients are all getting CXR's. They want to order fluids on a CHF'er the doc does a bedside ultrasound to make sure they can handle the fluid and of course everyone listens.
I am sure if I didn't use my stethoscope on a patient there would be 5 other people who did but I like to be in the loop.
Who cares if the doctors are listening? If you're going to chart it, you need to listen too. You have your own license. That means you don't just take other people's word for things.
Dozens of times I've had patients with no bowel sounds that the fellow charged as present x4. I watched a fellow do their assessment, then listened to the patient's heart and he was oviciously tachy and irregular. The fellow acted like I was nuts and blew me off when I asked for an EKG. So I went to the attending and boy did the fellow look like an idiot when the EKG showed rapid afib with a rate of 170.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
I do carry mine and use it however...in the ED where I work I think a nurse could easily get by without one. A patient comes in SOB, the med student, resident, and sometimes attending physician listens. A patient gets a neb, those are administered and charted on by RT. ET tube placed, the med student and docs are again listening. Plus the patients are all getting CXR's. They want to order fluids on a CHF'er the doc does a bedside ultrasound to make sure they can handle the fluid and of course everyone listens.
I am sure if I didn't use my stethoscope on a patient there would be 5 other people who did but I like to be in the loop.
Nope. I have had ER docs miss wheezing on me. My sats were good, my CXR was clear, EKG was normal, so there was nothing wrong. Except I couldn't breathe and was later diagnosed as having asthma. A nurse heard the wheezing and got me the breathing tx. And 10 days worth of prednisone. BTW: This was a teaching hospital. And quite frankly, I don't trust most first year residents.
I have seen a lot missed by docs. We are responsible for our patients. Not listening because "well others will catch it" is irresponsible at best.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I do carry mine and use it however...in the ED where I work I think a nurse could easily get by without one. A patient comes in SOB, the med student, resident, and sometimes attending physician listens. A patient gets a neb, those are administered and charted on by RT. ET tube placed, the med student and docs are again listening. Plus the patients are all getting CXR's. They want to order fluids on a CHF'er the doc does a bedside ultrasound to make sure they can handle the fluid and of course everyone listens.
I am sure if I didn't use my stethoscope on a patient there would be 5 other people who did but I like to be in the loop.
Does it really matter if the med students, residents, fellows, and attending listen....do they document the nursing assessment?
Is this a joke? How do you listen for lung sounds, heart sounds, bowel sounds without a stethoscope? A cardiac monitor can't hear a murmur. A chest xray can't hear wheezing. If your post-op patient perfs his bowel and needs emergency surgery, how are you going to explain why you didn't listen to his bowel sounds for the hours that he was sitting in the ER? If the automatic BP cuff gives you a reading of 70/30 or 200/140, you don't want to check a manual?
When I worked in the hospital, I carried my stethoscope around my neck. Now, as a home health nurse, I carry it in my bag. And, yes, what I hear matters. If I hear crackles in my patient's lungs, I send him in and report my findings to the MD. If it's in a baby who's had feeding difficulties, perhaps this is indicative of aspiration and by me assessing his lungs and charting my findings, the process towards getting him on thickened or enteral feeds is expedited. It's going to take 14 yr old Mom a while longer than a licensed nurse to notice that something is wrong.
I have patients with complex congenital anomalies- hypoplastic left heart syndrome, tetralogy of fallot, esophageal atresia, congenital diaphragmatic hernia, gastroschisis, etc. This kids require in depth cardiac, respiratory and GI assessments, respectively and ausculation is an important component of the assessment.
Who cares if the doctors are listening? If you're going to chart it, you need to listen too. You have your own license. That means you don't just take other people's word for things.
Dozens of times I've had patients with no bowel sounds that the fellow charged as present x4. I watched a fellow do their assessment, then listened to the patient's heart and he was oviciously tachy and irregular. The fellow acted like I was nuts and blew me off when I asked for an EKG. So I went to the attending and boy did the fellow look like an idiot when the EKG showed rapid afib with a rate of 170.
I am not saying I agree with the OP but nowhere did they ever say they would chart what they didn't do. Charting in the emergency department is different than on units. You could easily get by not charting or listening to lung sounds if you wanted to.
Like I said, I prefer to do the task and chart it but it is not something a nurse would get fired or disciplined for not doing on a patient if it was charted by respiratory therapy or one of the many providers.
Specializes in OR, Nursing Professional Development.
I haven't brought my stethoscope with me to work ever; it's been in my home office since finishing nursing school. However, I work in the OR, and anesthesia is constantly assessing breath sounds, ETCO2, and everything else- I don't really get the chance to do it. If I needed one, we have a disposable hanging on the back of each anesthesia machine (disposed of if actually used on a patient), plus our MDAs love to teach and will let anyone listen through their scope if they hear something interesting.
Nope. I have had ER docs miss wheezing on me. My sats were good, my CXR was clear, EKG was normal, so there was nothing wrong. Except I couldn't breathe and was later diagnosed as having asthma. A nurse heard the wheezing and got me the breathing tx. And 10 days worth of prednisone. BTW: This was a teaching hospital. And quite frankly, I don't trust most first year residents.
I have seen a lot missed by docs. We are responsible for our patients. Not listening because "well others will catch it" is irresponsible at best.
As I said, I always have my stethoscope available and use it when applicable. I am simply saying for the most part one could get by without. Most of the docs I work with are great, the best nurses and doctors can miss something time to time. We are all human.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I am not saying I agree with the OP but nowhere did they ever say they would chart what they didn't do. Charting in the emergency department is different than on units. You could easily get by not charting or listening to lung sounds or bowel sounds. Like I said, I prefer to do the task and chart it but it is not something a nurse would get fired or disciplined for not doing on a patient if it was charted by respiratory therapy or one of the many providers.
I am a ER nurse and I couldn't disagree with you more. Just because another discipline documents lung sounds doesn't exclude you (not you you...the collective you) from your assessment and observations. What if they are wrong and the patient deteriorates and dies. When the family sues and the chart is looked at it will appear the you (not you you) the nurse did not assess and therfore outside of the standard of care that "another reasonable and prudent nurse" would do and held liable.
I'm pretty shocked that there are nurses who admit to not carrying/using a stethoscope.
I work on a med surg floor and use my stethoscope to auscultate lung/heart/bowel sounds on each of my patients at least once a shift. I get many COPD/CHF patients and its imperative to check lung sounds before/after treatment(s). How else do you know they are effective? What if your patient is nonverbal? I have been the first to recognize silent aspiration pneumonia on a non verbal patient.
We get a lot of bowel surgery, colon resection, colectomy, colostomy placement, SBO, ect... Very important to correctly document bowel sounds and quality. A post surgical bowel obstruction isn't always preventable, but sluggish or slow to return bowel sounds are a clue.
What about documenting apical pulse before dig? Or in general when you need to check apical.
Do you inject air to check for NGT/G-tube placement?
There are many other uses I have for my stethoscope daily. I couldn't imagine leaving to go to work I without it.
Edited to add another reason: manual blood pressure. If my patient is suddenly hypo/hypertensive I am going to confirm with a manual.
Caffeine_IV
1,198 Posts
I carry mine at beginning of shift when I'm doing assessments then I put it down.