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 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.
Exactly. Believe it or not, doctors are humans too. They miss stuff too. On a particularly busy day in the ED, they may not listen as closely as they should. Even on a not-so-busy day they may just not hear even an obvious adventitious sound. Respiratory therapy was mentioned in another post. They are only in the ED to work with BiPAP and vent patients. The "run of the mill" SOB--asthma attacks, CHF exacerbation, COPD flare--RT does not listen to the patients lung. The doctor will…that is only one person and stuff can get missed. If the RN does not listen, he or she either admits they didn't listen (bad news in a court of law) or they lie about it (can't imagine doing that in court). I certainly have my shortcomings as a nurse, and I'm sorry if they comes off "holier that someone," but listening with a stethoscope is such a basic thing, I can't imagine not doing it on a pt who is SOB (in addition to some other times).
Boy I thought I was burned out, but this has gone beyond burn out and contempt for your job. Not doing an assessment with a stethoscope? I used to work in ER and I always carried a stethoscope, and yes, I did use it for assessments.
I don't like my job. I don't like bedside nursing. I don't even like many if not most of my patients. But I still have a duty to my patients, and have to make sure they are okay.
I had never really thought about it until this thread, but when I have been in ER I do not remember getting any sort of physical assessment by a nurse, other than vitals. It was vitals, quick history of presenting problem, go on cardiac monitor, labs and/or other tests. The physician did a physical assessment, but never the nurses. I know the emphasis in ER is on focused assessment, not head to toe, so maybe that has something to do with it, but a couple of my visits were "focused" on possible cardiac problems. I don't know what the nursing section of ER chart looks like--maybe physical assessment by nurse is not even listed, or it may vary from ER to ER. But if physical assessment by a nurse is not deemed necessary in ER, why employ nurses? Just use techs, they're a lot cheaper!
Also, if OP's providers have actually shared with her that they just use their stethoscopes to reassure patients, then I want to know where she works, so that I can stay far away!
Just FYI the nurse I shadowed in the ER documented PERRLA in her ED assessment (there was just a box to check) without ever taking out her penlight. So she just assumed because he was totally oriented that everything was good? To her credit, the stroke pt who came in got the full neuro exam using the wall light.
Specializes in Nurse Leader specializing in Labor & Delivery.
Yes, I would listen to lung sounds on my L&D patients. At least once at the beginning of the shift, and then as needed for any kind of status changes, or hourly on MgSO4 patients.
Yes, I would listen to lung sounds on my L&D patients. At least once at the beginning of the shift, and then as needed for any kind of status changes, or hourly on MgSO4 patients.
hmmm interesting.
Do you think all nurses on your unit are doing the same?
Is this how your preceptor taught you?
I've honestly never seen an L&D nurse do this as part of an assessment!
We don't chart anything about lung sounds unless on mag.
I may need to start a post on the OBGYN forum to get more input.
What?!?! You got a free crappy one in nursing school? Dang. We didnt get a free anything. Lol.
Our student nurses' association came into the classroom to sell us new Littmans. That is how they raised money and how most of each new nursing class ended up with the same maroon colored scope.
psu_213, BSN, RN
3,878 Posts
Exactly. Believe it or not, doctors are humans too. They miss stuff too. On a particularly busy day in the ED, they may not listen as closely as they should. Even on a not-so-busy day they may just not hear even an obvious adventitious sound. Respiratory therapy was mentioned in another post. They are only in the ED to work with BiPAP and vent patients. The "run of the mill" SOB--asthma attacks, CHF exacerbation, COPD flare--RT does not listen to the patients lung. The doctor will…that is only one person and stuff can get missed. If the RN does not listen, he or she either admits they didn't listen (bad news in a court of law) or they lie about it (can't imagine doing that in court). I certainly have my shortcomings as a nurse, and I'm sorry if they comes off "holier that someone," but listening with a stethoscope is such a basic thing, I can't imagine not doing it on a pt who is SOB (in addition to some other times).