nurses not using stethoscopes

[akint19]

new grad here, noticed ALL the nurses on my unit (med surg) do not use their stethoscopes...and just compare their notes to the previous shift notes..... i just bought a new stethoscope and hung it around my neck and the nurse told me to leave it in my bag. so how am i supposed to do assessments???? patient hasnt pooped in 3 days but do you think any of the nurses would pull out their stethoscopes to listen to bowel sounds??..... im still on orientation and i feel like this hospital is making me crazy... i still do my full assessments regardless!

[operations]

As a student, it does get confusing when you go to clinical and see the nurses skipping the different assessments. Granted, if you ask they will give you rationale. But for the inexperienced nurse who doesn't know when they aren't necessary, it does get confusing. And some nurses like the nuero example above don't know the difference between skipping cause unecessary and straight up cutting corners/negligence. It can be stressful to know which habits are the ones to pick up.

[JKL33]

I agree with Sour Lemon. It probably is a corner being cut.

The nurses are likely taking cues from doctors for who basic assessment skills are in decline.

In my unit, if a doctor has questions about a patient's pulmonary function, they are more likely to pull up the daily x-ray and latest blood gas than they are to use their stethescope.

Interesting take. There are plenty of RNs from whom poor-practice cues can be taken.

As for the docs, maybe the lawyers taught them that; not that it's any excuse if they are fraudulently billing assessments, but it seems pretty likely that having listened to someone's lungs doesn't help them much these days in the face of whatever allegations come their way.

As for me I use my stethoscope on anyone who is even mildly ill, perform the appropriate assessments, and chart only what I assessed.

[DTWriter]

Hmm...

OP-

Do you think it is a good idea to work on this med/surg unit for long? Maybe consider applying to other jobs in the meantime?

Easier said than done to go against an unit's culture. In your case, you should in terms of using a stethoscope, but be prepared when you do. Honestly, if anyone reacts negatively to you using a stethoscope, that is just sad~

[dream'n, BSN, RN]

In my experience, all through your career you will see unsafe and unethical time-cutting things being done by nurses and doctors around you. These employees usually are 'management's favorite' at first and you'll hear how quick they are, how their time management skills are excellent, and how they never get overtime. BUT they do eventually get caught and then they pay the price. And they will have absolutely no defense for their actions. Do what you know is right, don't let the bad ones influence your patient care. Stand strong

[TriciaJ, RN]

In my experience all through your career you will see unsafe and unethical time-cutting things being done by nurses and doctors around you. These employees usually are 'management's favorite' at first and you'll hear how quick they are, how their time management skills are excellent, and how they never get overtime. BUT they do eventually get caught and then they pay the price. And they will have absolutely no defense for their actions. Do what you know is right, don't let the bad ones influence your patient care. Stand strong[/quote']

Exactly. They can only skate so long. When the jig is up, it's usually spectacular and painful to watch.

[Sour Lemon]

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.

You'd be surprised, then. The workload at my first job as a new graduate was overwhelming, even to nurses with 20 years of experience. Very few nurses assessed their patients, even in a focused manner. Once I accidentally charted "wheezing" on a patient and the patient "wheezed" for weeks until he happened to be assigned to me again. We had a urology patient unable to void for two days before someone noticed, and it was the urologist. We even had a patient who'd had a stroke with all the obvious signs and symptoms. After about three shifts, a nurse who'd previously had that patient wondered why the patient could no longer speak clearly and wasn't walking anymore.

I cut corners all the time, too, just not with assessment.

I do believe focused assessment is appropriate in many cases, though.

[OliverElio87, BSN, RN]

I work as a PCT, and also a nursing student, and the hospital I work at some units do not do their initial assessment. I was so astonished. Whenever I am a sitter at these floors, the only time you will see the nurse come in is 2 hours after the shift starts to give meds. No head-to-toe or focused assessment whatsoever. I was sitting once and the nurse comes in to give meds and I noticed the patient had unilateral pupil dilation (anisocoria). The nurse didn't even notice until she was about to leave and I said "I think you should look at the patients eyes" and she goes "they didn't tell me that in report".

However, the hospital where I do my clinicals they do the initial assessment at the start of every shift. That's why I was so surprised when I started at this other hospital as a PCT.

[NuGuyNurse2b]

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.

LOL I think you're the only honest poster here. A head to toe assessment on a floor where you are getting something like 1:7 or 1:8 is going to leave you behind on med passes, telephone calls, and dealing with all the other stuff happening. Admission? Yup, head to toe. Came from nursing home? regardless of what they came in for, I'm checking for pressure ulcers. Everybody gets a minimum of lungs, bowel and heart sounds. but I am not checking for pressure ulcers on an 18 yr old athlete who came in for a torn ligament and if the prior nurses are charting there's no skin breakdown, I don't chart that I assessed it because there's no reason for me to do so.

[HeySis, BSN, RN]

Our stethoscopes are at each bay, get used on that patient only (by one nurse) and then cleaned before the next patient comes through.

I work PACU, and I listen to every single patients lung sounds... and never listen for BS, because most patient not having them is a normal finding after surgery, so why waste my time. But I DO NOT chart that I listened to them either.

My assessments are very focused, and not head to toe. For example, all patients get airway, cognition, pain and surgical site assessments (along with VS, Aldrete and Namdu), after that it varies depending on the surgery.

Learning what needs to assessed is hard for new nurses, but in my opinion, it's why they still have nursing students write out long care plans in school (which frustrates most students, because they don't have to do that in the real world. The computer generates the care plans based on problems you check off.) But when you have spent several semesters writing care plans for specific diagnosis, then you are training yourself on what your focuses should be. Pt taking opioids, bet all of your care plans delt with possible constipation (assessment and treatment). Pt had injury to extremity, your care plans included a neuromotor and perfusion assessment (sensation, movement, CRT, pulse...). Diabetics get BG checked.

So although you are no longer writing out those care plans, you are still looking at the patients active lists of diagnosis and make sure you are covering the bases for that patient.

[JKL33]

LOL I think you're the only honest poster here.

Nah. I do appreciate A&O's honesty, but s/he isn't the only one.

I use my stethoscope on a lot of patients mostly because there are a lot in my patient population (ED) whom I want to "know" that lungs are WNL...not just assume. Fever, chest pain, trauma, allergic reaction/rash/itching, any breathing difficulty/cough, edema, upper abd pain, etc., etc., etc.!! It's important because most of the time in the ED, there IS no prior assessment. I take seriously the opportunity to quickly get an accurate idea of what is (or isn't) going on.

But I don't do everything all the time, and I don't chart what I didn't do.

[momto5RN]

You are absolutely right to do an assessment on all your patients. I remember during my preceptorship in nursing school, my preceptor laughed in my face when I asked her if she listens to lung sounds post respiratory treatment. Her response was, I only did that as a new nurse. I also noticed this during my first nursing job a few years back. Even had a nurse tell me to "cut corners." I just don't get it.....

[NurseSpeedy, ADN, LPN, RN]

I would like to tell you that this is only an issue with RNs. Unfortunately, during my orientation as a new NP most of the NPs & MDs training me never utilized a stethoscope. However, all charted physical assessments. I was absolutely astonished.

As a nurse, I know what to expect when I go into a doctor's office for a physical. With recent insurance changes causing me to change my PCP I've yet to find one that does not do just focused problem assessments, even for a new patient physical.

The EOB shows that a physical was charged. With experience working in insurance fraud prevention, I'm pretty sure my "exam" or lack there of, was fabricated and documented. Scary what healthcare has become.

I will never forget the doctor at a hospital that we had to page to come back and suggest that he re-evaluate the patient that he had just charted on stating that they were doing well and possible discharge tomorrow. The patient was in a body bag awaiting the morge transport. I guess he meant their forever home?