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?
Tarotale: I almost cannot believe that you are asking why would we use a stethoscope and what good does it do??? Prime assessment skills tell what is going on with your patient. Sure, you can look at the results of a CXR, but how do you know if the pt is wheezing? The CXR will not tell you that, and perhaps they need a nebulizer treatment!!! How well has that worked for this pt? You can only tell by listening to lung sounds etc. I had an elderly patient recently who was receiving blood at fast rates due to a GI bleed, you better believe I was listening to lung and heart sounds as a warning of him going into CHF. The stethoscope is a basic tool for assessment use and one I proudly wear around my neck and use on each and every patient no matter what their diagnosis, each one gets a head to toe physical assessment from me. Insurance companies may not look kindly on unjustified diagnostic tests being ordered and done on patients who are not having documentation about lung or bowel sounds etc. What other short-cuts are you taking??
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.
Uhh...really a good new nurse. I'd say by completing a head to toe you are just a nurse. That's your job.
asking mundane questions.
Actually those questions can help complete a picture of your patient quite a bit.
In terms of outcomes, of course it serves no use
No use?! You've got to be kidding. I think you need to review the clinical implications of abnormal breathe, heart, and GI sounds.
As I see it has been asked before...what the heck are you charting? If you are not using your stethoscope what other things are you cutting corners on? It's really disheartening to see this and have other nurses also say they don't use it.
The question is asked again.....what do you chart? What happens if there is an emergency or trauma and your stretch is nowhere near you? I don't understand how you can be so lackadaisical about listening to your patients. What happens if someone comes in with SOB and asks "aren't you going to listen to me?" Do you tell them it's not important?
Oops- "steth" not "stretch"- darn autocorrect. Carry on.....
I always carry mine around my neck. I do a full assessment on all my patients Q shift, lung and heart sounds etc., but the most important in a surgical setting is probably bowel sounds. We get lots of GI surgery, we want to know if the bowels are moving and the pt is progressing. We get a lot of bowel obstructions, ileus etc. so it's super important. Fluid balance is also really important so we need to assess lung sounds for fluid overload often. I couldn't live without mine!
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Do you even want to be a nurse? Why would you stop using your stethoscope? You're a nurse. That's part of your job, to use it to listen to lung, bowel & heart sounds. What are you documenting?
It is so important to listen before & after procedures & medications are given. What if the patient gets worse before an xray can be taken or gets worse after the medication is given? But you didn't listen to their lung sounds so you don't know what they sounded like before.
Stethoscopes aren't there to look pretty around your neck like a necklace. They have a purpose. If you don't want to be a nurse, find another career before you get sued.
Yes, I admit to a practice that is not *textbook* but by what you are doing, or not doing, you are really dumbing down the role of RNs. Anyone can follow a doctors order, if you are not using your assessment skills or critical thinking..... Why employ an RN at all? Have you never found an inappropriate order based on your assessment? How would you know to question it? I love the docs I work with, but they are only human. In a fast paced, over crowded environment like most ERs, the importance of 2 healthcare professionals agreeing on the treatment they are implementing based on independent assessments cannot be overstated.
Specializes in LTC, assisted living, med-surg, psych.
I hate to pile on, but.....I don't understand how an experienced nurse can do an assessment without a stethoscope, let alone a new nurse with a lot to learn. Maybe you can get away without one if you're doing a desk job, but certainly not if you're a floor nurse. I ALWAYS wore mine when I worked the floor, and kept it in my office when I was a DON for those times when a nurse needed a second opinion.
It concerns me that the OP is so cavalier about not performing assessments. Yes, I can see not doing a head-to-toe if your patient is a healthy 15-year-old junior varsity football player with a tib/fib fracture, but patients with CHF? COPD? Acute abdomen? Sure, the docs do their own exams, but you can't document a nursing assessment based on theirs.
FWIW, I've been in the ED many times, and the only time I didn't receive even a cursory assessment by a nurse was when I went in for severe depression. (I did have vitals taken and of course they watched me closely, but they didn't listen to my heart or lungs.) Bottom line: a new nurse who is not taking every opportunity to use---and further---their assessment skills is a scary nurse. 'Nuff said.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
I'm "just a psych nurse" we're not considered to be "medical" but I bring my stethoscope to work every day. I don't carry it around my neck, but keep it at work for the times I need it. I use it for admission assessments (lung and bowel sounds) as well as to take BPs. I think it's more accurate than an electronic cuff. Especially when I want to confirm an abnormal reading taken from an electronic cuff.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I'm "just a psych nurse" we're not considered to be "medical" but I bring my stethoscope to work every day. I don't carry it around my neck, but keep it at work for the times I need it. I use it for admission assessments (lung and bowel sounds) as well as to take BPs. I think it's more accurate than an electronic cuff. Especially when I want to confirm an abnormal reading taken from an electronic cuff.
You're not just a "psych nurse". When I worked psych/drug rehab I always brought my stethoscope to work. We had to do a head to toe initial assessment when the teens first got there. If I pretended I didn't listen to their lungs or got a correct b/p, documented as I did & then later they start coming off a drug & we have to call 911. How do I give the paramedics the vitals if I have none to give?
How, exactly, do you determine wheezing via chest x ray? What about response to nebs or diuretics?
Exactly what I was thinking. Do they need more albuterol? I've seen/heard people that look much better after a duoneb, but on auscultation they still have some significant wheezing.
I also had a patient who fell off a bike, had shoulder pain. No SOB, no increase in pain with breathing. Listened to his lungs…nothing on the one side. CT revealed a pretty significant pneumothorax. Yes, the doc listened too, but if he weren't careful about his listening and I didn't listen, the patient may have been discharged with just a ibuprofen, rather that his ultimate transfer to a trauma center with a chest tube. FWIW, he had no significant injury to his shoulder.
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firstinfamily, RN
790 Posts
Tarotale: I almost cannot believe that you are asking why would we use a stethoscope and what good does it do??? Prime assessment skills tell what is going on with your patient. Sure, you can look at the results of a CXR, but how do you know if the pt is wheezing? The CXR will not tell you that, and perhaps they need a nebulizer treatment!!! How well has that worked for this pt? You can only tell by listening to lung sounds etc. I had an elderly patient recently who was receiving blood at fast rates due to a GI bleed, you better believe I was listening to lung and heart sounds as a warning of him going into CHF. The stethoscope is a basic tool for assessment use and one I proudly wear around my neck and use on each and every patient no matter what their diagnosis, each one gets a head to toe physical assessment from me. Insurance companies may not look kindly on unjustified diagnostic tests being ordered and done on patients who are not having documentation about lung or bowel sounds etc. What other short-cuts are you taking??