nurses not using stethoscopes

JayHanig · Sep 7, 2017

The only place I ever used a stethoscope consistently was in the ICUs. Working in orthopedics, my priorities changed. 1) Were they breathing? 2) Were they bleeding? 3) Were there pulses where there needed to be? Did they hurt?

They hadn't pooped in three days? So what? Hardly anybody poops on an orthopedic unit in the first three days. They just have to poop before they're discharged. What do I care about bowel sounds? I already know it's probably opioid related, combined with less intake than normal. The question is: does their belly hurt as a result? Then I listen.

The most obvious reason for carrying a stethoscope is breath sounds. Frankly, if you can't hear a juicy cough or a wheeze from across the room you need to make your rounds with a service dog. If I don't hear anything abnormal when I'm just standing there and the patient is in no distress, who am I impressing with my careful auscultation? If I hear something juicy, is it a crackle or a rhonchi? I reach for my stehtoscope. If it goes away when they clear their throat or with a good cough, it's not a crackle. So unless I see distress or hear something abnormal, I'm not reaching for my stethoscope. I always have it in one of the pockets of my cargo scrubs, but I seldom need to use it.

All of that being said, it really depends on your patient. If you work on a cardiac floor, listen. If you work in critical care, listen. If you have a reason, listen. But if you work on a floor like the one I spent so many years on, save it for when it's actually required. You've got too much ground to cover and not enough time to waste any.

I fully expect to be jumped on by some of the folks here but I'm nothing these days if not honest. I can't be fired any more so I no longer have a reason to keep quiet. Trust me, I'm hardly the only one.

I never lost a patient to exsanguination, never had one's bowel rupture, and never had one lose a limb due to lack of perfusion. I wasn't cheap with the pain meds either.

Glycerine82, LPN · Sep 7, 2017

Im the only one that wears mine around the neck at my job, too. (LTC) I don't really get it, but I just do what I want and ignore the nurses who think its not important to listen to lung sounds or bowel sounds. Not only that, but I'd totally lose it if I didn't wear it.

Just do you, forget about what other people are doing. That's probably the best thing I ever did for myself as a new grad.

Glycerine82, LPN · Sep 7, 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.

How do they do manual blood pressures? Please don't tell me they always trust the machine.

Glycerine82, LPN · Sep 7, 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.

Hey now! You won't find a pressure sore on ANY of my folks, except the one who just came back from the unit. He has a stage 4 on his sacrum, tunneling and draining copious amounts of purulent fluid. I know what you're saying though, it's just that not all SNFs give bad patient care. :)

Susie2310 · Sep 7, 2017

To NuGuyNurse2b:

According to your post above that I replied to, you are justifying not listening to patients lungs routinely: "Someone who isn't in for respiratory issues isn't likely to develop one." It sounds as though you work on med-surg, and there are very good reasons to listen to patients lung sounds on med-surg. As already mentioned on this thread, patients very often have multiple co-morbidities, and with heart, lung, and kidney problems, can easily develop fluid overload and congestive heart failure/pulmonary edema when receiving IV fluids and blood transfusions. Another poster mentioned how important it is to listen to the lungs of a patient who is post-operative. The mere act of lying in bed predisposes patients to respiratory problems, and simply being hospitalized predisposes patients to respiratory infections. We are talking about basic good nursing care, not utopic, idealized nursing care. How long does it take to listen to lung sounds? Apical pulse? Heart sounds? Bowel sounds? You have not succeeded in rationalizing substandard nursing care, and neither have the other posters on this thread who have tried to make a case for these practices being acceptable.

jaderook01, BSN, RN · Sep 7, 2017

I work on a pulmonary floor. I always use my stethoscope unless the patient is in isolation. If there is no isolation stethoscope, I will put one in the room. I never rely on someone else's charting of lung sounds, because I have found myself disagreeing with what other people chart as rhoncii, wheezing, or whatever (especially respiratory therapists). Sometimes they happen to be in the room with me when I'm doing my assessment and our assessments don't always match. Other times, if I beat them to charting, some will just carry over my assessment. I've watched doctors make a show of using a stethoscope to pacify patients (not long enough to hear jack)-and- I've even read notes where they have claimed to have talked to me regarding patients (conversations that never occurred- but that's another story).

Sour Lemon · Sep 7, 2017

Hey now! You won't find a pressure sore on ANY of my folks, except the one who just came back from the unit. He has a stage 4 on his sacrum, tunneling and draining copious amounts of purulent fluid. I know what you're saying though, it's just that not all SNFs give bad patient care. :)

Even when everything is done correctly, some patients will still develop pressure ulcers. It's not always an indication of poor care.

painreliever · Sep 7, 2017

When I was a new grad, many years ago, I would often follow a nurse from the previous shift that I had noticed did no assessments on her patients other than vital signs. However, when I would read her notes, she always had an assessment documented. BBS were always CTA. I pondered what to do initially, but ultimately decided to go ahead and chart my assessments, even though they were often vastly different from hers. I kept waiting for a supervisor to take note, but none did. I didn't want to say anything because I was new to the profession and she had twenty years experience. I assumed because of her experience, she would notice if something alarming was going on and would act accordingly. After eight months on med-surg, I took a permanent position in a specialty unit. I would continue through the years to give her report periodically. She never wrote down anything I said. I discussed her lack of note taking and assessments with nurses in her area. They all said she was a good nurse with experience who would notice if there were a problem. Well, long time later, I heard she was fired. When asking for details, I learned she had charted a patient was not having any issues when they actually were. The patient was in a very dire situation and ultimately passed away. When her documentation was reviewed in total, it was finally noted she had done no assessments and was documenting falsely. I can state that you are accountable in every sutuation in which you have provided care and have documented it. Only you can protect your license. I would never skip a portion of my assessment for any reason, least of all peer pressure. You can set an example. Perhaps others will confront you, which will give you an opportunity to remind them of the great risk they are taking with their license and their patient's lives.

Susie2310 · Sep 7, 2017

When I was a new grad, many years ago, I would often follow a nurse from the previous shift that I had noticed did no assessments on her patients other than vital signs. However, when I would read her notes, she always had an assessment documented. BBS were always CTA. I pondered what to do initially, but ultimately decided to go ahead and chart my assessments, even though they were often vastly different from hers. I kept waiting for a supervisor to take note, but none did. I didn't want to say anything because I was new to the profession and she had twenty years experience. I assumed because of her experience, she would notice if something alarming was going on and would act accordingly. After eight months on med-surg, I took a permanent position in a specialty unit. I would continue through the years to give her report periodically. She never wrote down anything I said. I discussed her lack of note taking and assessments with nurses in her area. They all said she was a good nurse with experience who would notice if there were a problem. Well, long time later, I heard she was fired. When asking for details, I learned she had charted a patient was not having any issues when they actually were. The patient was in a very dire situation and ultimately passed away. When her documentation was reviewed in total, it was finally noted she had done no assessments and was documenting falsely. I can state that you are accountable in every sutuation in which you have provided care and have documented it. Only you can protect your license. I would never skip a portion of my assessment for any reason, least of all peer pressure. You can set an example. Perhaps others will confront you, which will give you an opportunity to remind them of the great risk they are taking with their license and their patient's lives.

Great post, and your points about accountability and protecting your license are so true.

suzil · Sep 10, 2017

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!

Continue to do your full assessments as you were taught! Those nurses that tell you that are pure lazy. Do not listen to them. Learn and keep the good habits. Trust me, what you learn now will be your foundation as your grow. I would stay there the minimum time you need to, then move on. That is not good nursing! Trust me there are much better places to learn from.

suzil · Sep 10, 2017

Everyone here here is playing the worst case scenarios and that is simply not realistic. The next time you visit the ER for chest pain, see if your nurse is focusing on checking your skin for pressure ulcers. That's the point I'm making. If you can't understand that, it has nothing to do with my credentials as a nurse or not. And for the record, I am.

The thing is those "head to toe" assessments do not take that long to perform. I call nurses that refuse or try to justify NOT doing them just plain lazy. There is no darn reason not to do them. Worse case scenario? Dude, I've been a nurse way longer than you and have worked every single specialty except Labor and Delivery. Yes, the worst case can happen EVERY WHERE AT ANY TIME! I'm sorry but you are scary and frightening with your lack of care and attitude. BTW, yes I also worked the ER and we WERE EXPECTED TO CHECK THEIR SKIN TOO! If we sent a patient to the floor and we had not assessed their skin and there was ANY kind of problem, we got written up. The problem is none of these assessments take that long! Why are you so bothered by doing them?

suzil · Sep 10, 2017

by HeySis

#32

10

Sep 5 by 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.

Written by SUZIL:

I have always bought and used my own stethoscope. Even working PACU. No nurse I have worked with has come in without their own stethoscope. We assess head to toe even in PACU. We chart what we assess. Our charting also is formulated for a head to toe. I just can't imagine sharing a stethoscope. I want the best to auscultate the heart and lungs.