nurses not using stethoscopes

akint19 · Sep 4, 2017

Thank you everyone for the advice!

akint19 · Sep 4, 2017

Nope - there's no stethoscopes on the unit at all (even disposable ones). We have an isolation room but no stethoscope inside. The only time I saw a stethoscope was in the doctor's pocket but nurses do not carry one at all.

TriciaJ, RN · Sep 5, 2017

When someone is finally caught falsifying charting (like charting assessments that were never done) make sure that someone isn't you. "Following unit culture" will not save you.

Here.I.Stand, BSN, RN · Sep 5, 2017

I don't carry mine just because I'm too lazy to Sani-wipe it every time I leave a pt room, but our pts do have the disposable ones in the rooms. If your unit is overwhelmed, it would seem assessments are NOT the corner to cut. :wideyed:

NunNurseCat · Sep 5, 2017

Ridiculous how people can do that and keep a clear conscience. From techs to docs some people are simply unscrupulous.

I'm sure we've all seen pretty scary things in charts that indicate the person charting has either confused the patient with someone else, or has not looked at the patient.

By the way...confirm what you hear in report too, because report is kinda like playing a game of telephone. If you ever doubt anything you hear, then confirm it for yourself. Honest mistakes do happen.

RNNPICU, BSN, RN · Sep 5, 2017

From the OPs other post, I can surmise that it's a "survival" issue. The wrong corners are being cut by nurses who don't have time to do much of what they're "required" to do.

Gotcha. Thanks. In that case, the only thing I can say to the OP is to own your assessments. You can only chart what you see, hear feel, smell, etc. It is not possible to determine if bowel sounds are absent if you don't listen. L

Apples&Oranges · Sep 5, 2017

Real life? If I have a 35 yo addict in for an acute OD, who is a walkie talkie, yapping on her phone and spending most of her time scheming to leave the unit to go shoot up, I'm not too worried about assessing her lungs. Or bowel sounds. Same with the 50 yo CVA who is yelling at Trump on C-Span. His lungs are good, not gonna fight with him.

If Heather is 32 and was admitted with bilat PEs, is pregnant at ALL, or is 75 and post op bowel resection sepsis, any sort of HF, COPD, MS and not moving except with a cattle prod...yep, I'm listening.

I don't do a "FULL" or "head to toe" assessment on every patient. I just don't check between the toes of my 55 yo fully independent, working full time till this morning General Contractor dude who got hit in the head with a 4x2. If you are from a SNF, however, I'm looking under your scrotum, lifting your heels, checking behind your ears, and taking pics of the (almost) inevitable pressure injuries.

It's admirable that you want to be a thorough nurse - please do so. But also learn to choose your battles. While a full head to toe assessment is ideal, it is not necessary for EVERY patient. Nursing is assessment, and part of that is assessing what really needs to be assessed.

Wuzzie · Sep 5, 2017

Real life? If I have a 35 yo addict in for an acute OD, who is a walkie talkie, yapping on her phone and spending most of her time scheming to leave the unit to go shoot up, I'm not too worried about assessing her lungs. Or bowel sounds. Same with the 50 yo CVA who is yelling at Trump on C-Span. His lungs are good, not gonna fight with him.
If Heather is 32 and was admitted with bilat PEs, is pregnant at ALL, or is 75 and post op bowel resection sepsis, any sort of HF, COPD, MS and not moving except with a cattle prod...yep, I'm listening.
I don't do a "FULL" or "head to toe" assessment on every patient. I just don't check between the toes of my 55 yo fully independent, working full time till this morning General Contractor dude who got hit in the head with a 4x2. If you are from a SNF, however, I'm looking under your scrotum, lifting your heels, checking behind your ears, and taking pics of the (almost) inevitable pressure injuries.
It's admirable that you want to be a thorough nurse - please do so. But also learn to choose your battles. While a full head to toe assessment is ideal, it is not necessary for EVERY patient. Nursing is assessment, and part of that is assessing what really needs to be assessed.

But do you document an assessment that you DID NOT do?

Apples&Oranges · Sep 5, 2017

Good question, Wuzzie. I DO NOT. I have no problem charting WNL for respiratory if the patient is pacing the room, breathing just fine. It seems to be a thing on my unit to report and chart "diminished" and I hear that as code for "I didn't listen." Per my training, diminished is a normal finding in adults, so I dont report or chart it. I literally say, respiratory seems fine. I chart WNL unless I have reason t believe otherwise.

All of my pts are on cardiac monitors, so I can chart NSR, or ST or SB w/ BBB, freq PVC or whatever. I don't need to listen for heart tones on the tweaker who won't stand still long enough for me to check her HR or pulses without biting me. I have been bitten, spit on, peed on and had my crotch grabbed more times than I like to admit. Not the hill I'm trying to die on. If you are tripping hard enough to forget about the monitor, I'll just chart from the screen, thanks :-)

ETA - I see where you're coming from, though. Very, very occasionally I will chart "unable to assess." Usually, though, I feel that I can assess the resp, integumentary and neurologic systems without following the EPIC checklist.

Wuzzie · Sep 5, 2017

Good question, Wuzzie. I DO NOT. I have no problem charting WNL for respiratory if the patient is pacing the room, breathing just fine. It seems to be a thing on my unit to report and chart "diminished" and I hear that as code for "I didn't listen." Per my training, diminished is a normal finding in adults, so I dont report or chart it. I literally say, respiratory seems fine. I chart WNL unless I have reason t believe otherwise.
All of my pts are on cardiac monitors, so I can chart NSR, or ST or SB w/ BBB, freq PVC or whatever. I don't need to listen for heart tones on the tweaker who won't stand still long enough for me to check her HR or pulses without biting me. I have been bitten, spit on, peed on and had my crotch grabbed more times than I like to admit. Not the hill I'm trying to die on. If you are tripping hard enough to forget about the monitor, I'll just chart from the screen, thanks :-)

I agree with you. I don't see a problem with doing more focused exams rather than full head to toes after the initial one on certain patients. If the patient is awake and screaming for a turkey sammich I'll document what I see...just like you do. But people who document assessments that aren't actually being done are committing fraud.

Apples&Oranges · Sep 5, 2017

Wuzzie, I am a neuro nurse at heart and by training- it makes me CRAZY when nurses copy my pupillary charting (pupils 2mm, brisk, etc) and when I insist on doing a bedside (on stroke pts) and I'm like, "OK, where's your penlight" Um, no penlight, no badgelight, no flashlight in the room. They look at me like a deer in the headlights (so to speak.) "So how did you assess the pupil response that you charted?"

Crickets.....

Sorry, dude, I'm gonna call you out on that. If you didn't assess it, tell me, I'm not going to report you, for the love of Pete, I'm not that guy. But don't lie to me. Especially on a stroke patient. That's, like, a big deal. Just saying....

sevensonnets · Sep 5, 2017

How could the OP possibly be in every room during every assessment and looking over the shoulder of every nurse charting every assessment to know that every nurse simply dittos the previous shift's assessment? A med surg unit without any stethoscopes whatsoever seems very unlikely to me.