nurses not using stethoscopes

JKL33 · Sep 10, 2017

BTW, yes I also worked the ER and we WERE EXPECTED TO CHECK THEIR SKIN TOO!

Yes, some places expect you to do a full head-to-toe assessment on every ED patient. Do you know why that is? Do you know why your employer may want you to listen to the bowel sounds of someone who limps in with a rolled ankle, or auscultate the heart sounds of someone who is there for a mosquito bite?

It isn't because the worst case can happen every where at any time...

I'm an advocate of the "appropriate" assessment as opposed to "a full assessment." In fact I think an carefully-considered, appropriate assessment is a full assessment (in that everything reasonable to consider has been considered), but a full head-to-toe assessment may not always be appropriate.

If you know the answer to my questions above, then you will also understand why a full head-to-toe assessment can actually be done for mostly unethical reasons, as opposed to honestly needing to do a full head-to-toe assessment because a patient's condition warrants it.

That's getting a little off-topic as far as people who "never" use a stethoscope, though. :)

suzil · Sep 10, 2017

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.

That is just scary. Good learning for you on what not to do. Follow what you learn at the clinicals. The assessments at the beginning of the start of each shift is the norm.

suzil · Sep 10, 2017

In *my* example, the patient was not a post op. You are talking about a completely different scenario to counter what I'm saying. If your patient is a post op and you are not assessing them, even I can admit that that is dangerous. But that was not the case I was making and I think you know that. OP is looking through her Utopia lenses just like everybody else here being judgmental when we all know there are corners that are cut in order to do our jobs efficiently and avoid the scour of overtime management from upper management. And I even said I wouldn't chart on something I didn't assess, so maybe you need to re-read my post again.

You are cherry-picking. All patients deserve the best of care. Unless you are a true genuine psychic you don't know who is going to turn south!

suzil · Sep 10, 2017

Yes, some places expect you to do a full head-to-toe assessment on every ED patient. Do you know why that is? Do you know why your employer may want you to listen to the bowel sounds of someone who limps in with a rolled ankle, or auscultate the heart sounds of someone who is there for a mosquito bite?
It isn't because the worst case can happen every where at any time...
I'm an advocate of the "appropriate" assessment as opposed to "a full assessment." In fact I think an carefully-considered, appropriate assessment is a full assessment (in that everything reasonable to consider has been considered), but a full head-to-toe assessment may not always be appropriate.
If you know the answer to my questions above, then you will also understand why a full head-to-toe assessment can actually be done for mostly unethical reasons, as opposed to honestly needing to do a full head-to-toe assessment because a patient's condition warrants it.
That's getting a little off-topic as far as people who "never" use a stethoscope, though. :)

The point is it takes minutes, yes mere minutes to whip through an assessment. I don't know how long it takes you but I don't take long at all! I also teach at the college level and my students appreciate learning this skill. By the end of the semester with me, they can all do a quick head to toe like it is second nature.

Kooky Korky, BSN, RN · Sep 11, 2017

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.

Loved one just had an MD appointment. As usual, we got a copy of the notes for that visit.

Doc charted Heart: RRR, no murmur

Lungs: clear bilat

Colonoscopy: current

Doc never listened to heart and lungs, never mentioned colonoscopy. I was in the room and am positive about that, so is LO. Since it was a GYN annual, I don't see why doc should even have to concern herself with these matters, unless it counts as preventive medicine.

And doctors (non cardiologists) who do listen to hearts often do it for all of maybe 2 seconds; only over the V2 area. Lungs get listened to very, very briefly, through clothing, not comparatively side to side, forget egophany, E to A changes, and whispered pectroliloquy, LOL.

Once had a patient ask the gynecologist to do a breast exam during the annual Pap visit. Pt was wearing a heavy winter sweater, had a bra on, too. Doc shouldn't have to have been asked, really. Doc does poke, poke at one spot on each breast, calls it a day. Patient refused to pay for that exam, as well she should have.

I know many nurses have way too many patients, but it is simply not acceptable to just copy the assessments someone else might have made. Might.

Old story about a Resident who charted PERRLA. Pt had a glass eye.

People have charted "pulses 2+, equal" with regard to leg/foot pulses. Amputee.

OP: do what you know is right. Some people might give you grief or might think you are a threat to them and try to sabotage you. Stay strong, don't preach, just say, "I have to do what I have to do". It's so interesting that those doing wrong often want others to do it along with them.

Some people don't chart at all or very little. Some use "refused" a lot.

Worked with a nurse whose patients loved her because she was with them so much, visiting with them in their rooms, with their families, too. Did she ever call a doc for a pain med? Cough med? When hair grows in the palm of my hand is when she'll do that. All of that business was left for the nurse who followed her.

The next question concerns what you intend to do about your new coworkers, if anything. I guess if you know for sure it's happening you are expected to report it. So unfair for you to have to deal with this on your first job. Best wishes.

JayHanig · Sep 11, 2017

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.

Good nursing? You have time to give good nursing? If only everybody did. I had 14 hours worth of work to do every 12 hour shift. Priorities develop. But not to worry: I quit at age 56 so I could be "lazy".

LeenishaThompson · Sep 11, 2017

A proper assessment requires a stethoscope. NO matter how long a person has been a nurse...lung and bowel sounds are bet auscultated and you can primarily do that with your item you hang around your neck. You continue to be the nurse that you were taught to be and utilize your knowledge and skills. IF it continues to get to the point that you dont see yourself wanting to follow with the other nurses. LEAVE.

suzil · Sep 11, 2017

Good nursing? You have time to give good nursing? If only everybody did. I had 14 hours worth of work to do every 12 hour shift. Priorities develop. But not to worry: I quit at age 56 so I could be "lazy".

Well like I stated in another post, I've been an RN for over 40 years. I've worked every single specialty, except Labor and Delivery. The thing is people that claim it takes too long, must be doing it wrong. It takes MERE MINUTES! I teach my students how to do one and by the end of the semester they get it done like it is second nature. Priorities? Ok, then a rapid is a priority. I like to PREVENT the rapid or codes. But that is just me.

NuGuyNurse2b · Sep 11, 2017

Well like I stated in another post, I've been an RN for over 40 years. I've worked every single specialty, except Labor and Delivery. The thing is people that claim it takes too long, must be doing it wrong. It takes MERE MINUTES! I teach my students how to do one and by the end of the semester they get it done like it is second nature. Priorities? Ok, then a rapid is a priority. I like to PREVENT the rapid or codes. But that is just me.

You sound like you've been out of the trenches for so long you've forgotten what it's even like, so your experience isn't relative to the conversation.

suzil · Sep 11, 2017

You sound like you've been out of the trenches for so long you've forgotten what it's even like, so your experience isn't relative to the conversation.

LOL I am an active RN and never stopped working! Funny. Not at all retired, too young to retire.

You have been a nurse for all of how many years NG? Talk to me about my experience not being relative to the conversation, when you have my wide variety of experience and the YEARS I have in it! You are no where near what I have. Try: all ICU's, ER's, including Trauma ER's, Trauma ICU's, SWAT RN, PACU, Pre-Op, Neuro ICU's, Open Heart First Receiver ICU, Neonatal ICU, Ped's ICU, Psych, Detox, you name it NG, I have done it. House Sup, Dept. Manager, While doing all of that I have also taught every level of nursing at the college level. You want to talk down to me NG? Insulting is what you are.

ohiobobcat · Sep 11, 2017

When I worked med-surg as a new grad, I got to the point where I could do a full head-to-toe assessment in 2-3 minutes on each patient, and I used my stethoscope A LOT. When I moved over to the ED, it was focused assessments, still frequently using my stethoscope. (We only were required to do skin checks if a patient was getting admitted.) Now, I work as a school nurse. Again, only focused assessments on an assumed healthy patient population. I don't use my stethoscope unless a student has a respiratory/cardiac/GI (sometimes- I don't auscultate N/V/D complaints unless I am concerned something other than a stomach virus is going on) complaint.

When I worked med-surg, there was a physician who would stand in the doorway to a patient's room and talk to them, then return to the nurse's station and write a full assessment on that patient. I asked one of the other physicians about it and he said "Ahh!! The good ol' "LGFD" assessment!" I, of course, had no idea what that meant. So I asked. He said "LGFD- looks good from door!". Huh. So I now know who I DON'T want for a physician for me or any of my loved ones.

Anna Flaxis, BSN, RN · Sep 11, 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!

Admittedly, I have skipped all of the replies. You do you. One of the first things I ever learned as a new RN was to do an assessment you can take to the bank. Now that I'm not so new, I feel a bit more comfortable with shooting from the hip. But, I am fully aware of how that can bite me in the butt. Again, you do you and don't worry about what the other nurses say.