nurses not using stethoscopes

Published

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!

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.

A good, experieced nurse is often doing a quick visual while doing other things.

Up Vote Up Vote ×
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".

Help them start a union. Go to legislators and get laws passed about staffing, breaks, overtime, and the like. Since you are retired, you probably don't have much to lose by being a rabble rouser.

Up Vote Up Vote ×
Specializes in ER, ICU, POST ACUTE CARE.

You do what you feel is good for the patient, do not do sloppy nursing because others do. To properly assess a patient, you must auscultate a persons lungs, heart and abdomen.

Up Vote Up Vote ×
Help them start a union. Go to legislators and get laws passed about staffing, breaks, overtime, and the like. Since you are retired, you probably don't have much to lose by being a rabble rouser.

If there were laws about staffing, you probably wouldn't need a union.

Up Vote Up Vote ×
Specializes in Cardiac Stepdown, PCU.

Just a couple thoughts...

Do you have so much free time that you can sit around and just watch what the other nurses are doing? You stalk them into patient rooms to monitor what they are doing? Or is it because you didn't *see* them specifically do something and just saw them pursuing through previous shift notes you assume they did nothing. Seriously. How do you know they didn't grab a steth and do a quick assessment while you were in attending to your own patient?

I don't carry my steth with me. After a few hours it's annoying, heavy, aching my neck, and more times than not gets in my way. I don't care to have it shoved in a pocket either, it's too bulky. One of my coworkers has this nifty thing that hangs it off the hip, like a holster, but that's a different subject. That doesn't mean I don't use my steth. It takes me less than 5 minutes to assess a patient and listen to lungs, heart, and bowels. I don't need to cart my steth around after my initial shift assessment. If there's a concern, I will grab it.

Also, going over previous shift notes is a great way to identify a change in condition. Not *everything* can be passed along in report. Some things get lost from one shift to another. Sometimes something minor can be forgotten because something else far more serious occurred. So yes, I want to know if the nurse before me noticed that the patient had developed a cough she didn't mention, or if it was a recent development, as well as if it were followed up on and to what extent.

Finally, all of this is going to depend on what setting your in. They are all different. In LTC the residents get a full assessment weekly, skin checks three times a week, and a "daily note". Unless there is a change in condition of some type, they have a certain disease or ailment, or they are a new admit there is simply no reason to do a full out, listen to everything head to toe on these patients every single day of every single shift. Also, in this setting you become familiar with your patients. You know if Ms. Barns suddenly has an altered mental status, or a cough she shouldn't, maybe a tremor she's never had before. On our sub-acute floors, it's pretty much the same. We monitor new admits for 72 hours; after that, full assessments are weekly unless there's some reason we need to otherwise assess them. Typically, these patients are quite capable of voicing a complaint and letting us know that something may be wrong or that there is a new onset of whatever. Again, this is all dependent upon the patient, and dependent upon the setting. In a hospital setting it would be different, and it would even be different depending on what unit within the hospital you are in.

Up Vote Up Vote ×

My thoughts exactly, Miss.Leo! I actually said something similar about 6 pages ago. I do not know how the OP could possibly be in every patient room during every 'assessment' to know if stethoscopes are being used. She claims each nurse just charts what the previous nurse charted. How does she know that exactly? How does she gain access to other nurses' charting? Does she check lockers and bags to determine the presence/absence of a stethoscope? When does she do her own assessments/charting? I'm too busy taking care of my own patients to do surveillance on my coworkers!

Up Vote Up Vote ×

Being mildly hard of hearing from a childhood illness I never was much good with a stethoscope. The hearing loss was never a big problem and I honestly didn't think of it in relation to my assessment skills as a nurse. I could never do a good lung and bowel assessment in 2- 3 minutes!

Maybe more nursing students need to admit, "actually I can't hear a thing" (slight exaggeration), after a 5 minute assessment of a healthy young talking, eating, pooping, classmate. I felt too stupid to admit this. Maybe nursing schools should ask about student's hearing. Advise that more expensive stethoscopes may be needed if they are having trouble hearing with a stethoscope. Then a 2 - 3 minute assessment would be realistic.

Up Vote Up Vote ×

It is actually illegal to chart an assessment you have not done. The patient's chart is a legal documentation of the care provided and the assessments made. By charting heart, lung, and bowel sounds you are stating what your assessment revealed. You know what is right and that's what you should do. Heaven help these other nurses if they had to defend their actions in court. I know it goes on because I have had patients ask me why I was listening To their chest. I was a patient for two days and in that time only one nurse actually did a full assessment. You use that stethoscope. Never mind what the others think.

Up Vote Up Vote ×
Specializes in Case Manager/Administrator.

I use my stethoscope when I am working direct patient care. Often times I need to close my eyes to listen better...(not sure if this is age or just concentration). The one thing I do not do is place my scope around my neck. I keep it in my pocket. If you see me around and do not see a scope it maybe in one of my cargo pockets. My initial encounter with a patient is to obtain the vitals first because I want a baseline. I rely on aids to get the BP thereafter, if it is the same I ask them to get it again. With certain medication I always obtain the vitals myself no delegation. I cannot imagine licensed professionals playing "follow the leader" when it comes to vital signs. One cannot assume this is not being completed.

Up Vote Up Vote ×
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.

Those examples are horrifying to me. Wow

Up Vote Up Vote ×
Specializes in ED, Cardiac-step down, tele, med surg.

Every nurse should have a stethoscope. However, I don't listen to breath sounds on every patient someone mentioned above, it is not necessary to list to breath sounds on a healthy patient admitted for something totally different than a cardiovascular issue. Example 21 year old patient, post appy, using their IS, sats 99 on room air. I'd breifly listen to bowel sounds and check the incision but that's it. Id mark WNL in cardiovascular and respiratory, circulation. Knowing when to listen is also important.

Up Vote Up Vote ×
Every nurse should have a stethoscope. However, I don't listen to breath sounds on every patient someone mentioned above, it is not necessary to list to breath sounds on a healthy patient admitted for something totally different than a cardiovascular issue. Example 21 year old patient, post appy, using their IS, sats 99 on room air. I'd breifly listen to bowel sounds and check the incision but that's it. Id mark WNL in cardiovascular and respiratory, circulation. Knowing when to listen is also important.

Just because a patient is young and healthy (as far as you know) isn't a good rationale for not listening to their heart and lungs postoperatively. Young patients can have complications of surgery, and can have breathing problems or contract respiratory infections, and can get overloaded with fluid too. That WNL that you chart for cardiac and respiratory function should mean that as part of your assessment you have assessed their cardiac and respiratory function by listening to their heart and lungs. If the patient did go on to develop complications postoperatively you haven't actually listened to their heart and lungs, and anyone reading your assessment to check on the patient's condition during the time you cared for the patient would likely conclude that by checking WNL you actually HAD auscultated the patient's heart and lungs.

Up Vote Up Vote ×
+ Join the Discussion