nurses not using stethoscopes

'... comparing their notes to the previous shift notes', instead of using a stethoscope, to me is like saying 'well, their vital signs were just fine yesterday, so they must be fine today'.

Not quite. Vitals are checked every shift. Someone who isn't in for respiratory issues isn't going to likely suddenly develop one. I know people like to think "anything can happen" and it does, but the chances of it on an alert oriented clear lungs pt in for a sprained ankle or something is pretty low. You have to choose your battles. OP is looking at nursing through the Utopia lenses, and theoretically she is correct that we should be assessing head to toe on everybody, using the stethoscope, but it's not realistic and those judging nurses with the comments I've seen in this thread is just utterly presumptuous and unfair. I am far from management's favorite and even when I am cutting corners, I am still racking overtime because it's that much work on my floor. The comments i see here are what I imagine upper management must think when they see the floor nurses, the ones in the trenches, sitting at a computer.

Not quite. Vitals are checked every shift. Someone who isn't in for respiratory issues isn't going to likely suddenly develop one. I know people like to think "anything can happen" and it does, but the chances of it on an alert oriented clear lungs pt in for a sprained ankle or something is pretty low. You have to choose your battles. OP is looking at nursing through the Utopia lenses, and theoretically she is correct that we should be assessing head to toe on everybody, using the stethoscope, but it's not realistic and those judging nurses with the comments I've seen in this thread is just utterly presumptuous and unfair. I am far from management's favorite and even when I am cutting corners, I am still racking overtime because it's that much work on my floor. The comments i see here are what I imagine upper management must think when they see the floor nurses, the ones in the trenches, sitting at a computer.

Actually she made no statement to indicate the utopia lenses and this other out there stuff you said. It was a med surg floor. Are you sure you understood correctly? Only some of the patients will be qs vitals, some q4, some might even be post operative.. Many people are gonna be in bed for extended periods and need to be checked out for pneumonia, minimum, especially if they are older. Every med surg floor I've worked universally and routinely checks lung sounds. I really don't know what hospital you weren't at but it must be awful if you are to overloaded to do your necessary assessments, because every med surg floor over ever worked on listened for lung sounds routinely on everyone, as well as heart or bowel sounds if applicable. That actually really scares me that you have this perspective. I guess you don't cough and spiro with your pts either? Do you not listen for bowel sounds after surgery? What is it that you actually do? You sound like a huge liability.

Edit: Actually just realized ur nurse and have no clue what ur talking about. Kudos for misinforming. I'm really getting tired of that. I wish this forum would verify users.

Never gonna prevent flash pulmonary edema or prevent needless rapid responses of codes without a steth. You should be using that at *least* two times per patient per shift. Next time someone tells you to put it away, tell them to take their's out instead.

Someone who isn't in for respiratory issues isn't going to likely suddenly develop one. I know people like to think "anything can happen" and it does, but the chances of it on an alert oriented clear lungs pt in for a sprained ankle or something is pretty low.

On a med/surg unit the chances of someone developing lung issues is actually quite good, especially if they have had surgery. Patients don't like to breath deep after surgery and this can lead to all sorts of lung issues, most of which can be caught early by listening to their lungs. And in today's healthcare world, your pt is not going to be healthy with only a sprained ankle.. those patients don't get admitted.

You have to choose your battles. OP is looking at nursing through the Utopia lenses, and theoretically she is correct that we should be assessing head to toe on everybody, using the stethoscope, but it's not realistic and those judging nurses with the comments I've seen in this thread is just utterly presumptuous and unfair.

I don't think it's unfair for a patent to expect the minimum of care... and listening to LS and BS on an admitted pt is a minimum. If I were to follow a surgical patient from PACU to the floor, I would start to expect to hear BS within four hours of surgery... if not I would be keeping a close eye (or ear) on that. ERAS patients usually with start moving gas and such even sooner. It really does not take that long to do listen to those two things.

So while you assessments can be focused, no-one should be routinely not using a stethoscope to assess patients.

We use to have patients that were admitted that only had one issue, but that has been gone for a long time (along with being admitted the night before surgery for bowel prep, bath, and pre-op pain control, Does anyone else remember the routine 75 mg Demerol and 25mg phenergan given IM before each pt went to surgery?) Now our patients are sicker with multiple co-morbidities, and although they may be admitted for one diagnosis, it's up to us to know how that impacts the others and assess for it.

But OP also referred to nurses charting that they did do these assessments when they did not. Expecting proper and correct documentation of a patients condition and what you did/assessed is not "Utopia", is ethical, legal and minimum care.

I use my stethoscope every shift. I listen for lung sounds, bowel sounds, and to the heart sounds. Just because "they" are doing it that way (the wrong way), doesn't mean you have to follow suit. An actual physical assessment helps you find out what's going on with the patient. It gives you the chance to see if there is anything new as far as changes. It gives you a chance to examine their skin. If the patient states he hasn't had a bowel movement in four days, you can reassure him by telling him about the bowel sounds you heard through your stethoscope. Your patient on 125 mL/hr NS originally had clear lung sounds but now has crackles, potential pulmonary edema, can be identified by listening with your stethoscope.

In short, don't follow the masses. Do what is best for your patient and actually assess them the way you were taught. Taking short cuts like your co-workers are telling you to do is not beneficial to the patients.

Someone who isn't in for respiratory issues isn't going to likely suddenly develop one. I know people like to think "anything can happen" and it does, but the chances of it on an alert oriented clear lungs pt in for a sprained ankle or something is pretty low. You have to choose your battles. OP is looking at nursing through the Utopia lenses, and theoretically she is correct that we should be assessing head to toe on everybody, using the stethoscope, but it's not realistic and those judging nurses with the comments I've seen in this thread is just utterly presumptuous and unfair. I am far from management's favorite and even when I am cutting corners, I am still racking overtime because it's that much work on my floor. The comments i see here are what I imagine upper management must think when they see the floor nurses, the ones in the trenches, sitting at a computer.

Are you a nurse? You don't listen to lung sounds? You really believe that a patient whose primary complaint isn't a respiratory one can't develop respiratory problems? Your post is frightening.

This is an excellent opportunity for you to shine as a patient advocate. As a patient advocate, it is essential to listen to the heart, lung, and bowel sounds. Unless you have super-sonic hearing, the stethoscope is the only way to go.

It is also an opportunity for a research project reflecting best evidence-based practice that you can present to your team in order to change the poor practice that seems to be present on your unit.

Start your career with building your own way you do assessments. Listen to lungs. Hearts bowel sounds. All that. Start yourself off with these good habits. Soon people will stop noticing that you're the few that carry a stethoscope. And if they find it strange that's on them. Not you... it's your job to assess and you can't chart that lungs are clear if you did not listen to them. (Well you can. But please please do not be that nurse!) my old unit everyone carried stethoscopes. My new unit(L&D we just use the crappy disposable baby stethoscopes. But if I have a patient requiring a more in depth listening assessment(on magnesium, preeclamptic, HTN or something of the sort) I will grab my expensive stethoscope to carry around and take a good listen. And I'm one of the few that do this. (Not the same but also on my old unit everyone wore this "nurse fanny pack" things. My new unit no one but me does... at first I felt weird still wearing it with no one else doing it. So I didn't for a few shifts. Hated it. Haha. So I keep wearing it and people joke(light heartedly) about it. But guess who also has scissors, hemostats, extra alcohol wipes, etc... when you need them in a pinch..?) the the nurse you started nursing school dreaming you wanted to be. Start good habits now!

Are you a nurse? You don't listen to lung sounds? You really believe that a patient whose primary complaint isn't a respiratory one can't develop respiratory problems? Your post is frightening.

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.

On a med/surg unit the chances of someone developing lung issues is actually quite good, especially if they have had surgery. Patients don't like to breath deep after surgery and this can lead to all sorts of lung issues, most of which can be caught early by listening to their lungs. And in today's healthcare world, your pt is not going to be healthy with only a sprained ankle.. those patients don't get admitted.

I don't think it's unfair for a patent to expect the minimum of care... and listening to LS and BS on an admitted pt is a minimum. If I were to follow a surgical patient from PACU to the floor, I would start to expect to hear BS within four hours of surgery... if not I would be keeping a close eye (or ear) on that. ERAS patients usually with start moving gas and such even sooner. It really does not take that long to do listen to those two things.

So while you assessments can be focused, no-one should be routinely not using a stethoscope to assess patients.

We use to have patients that were admitted that only had one issue, but that has been gone for a long time (along with being admitted the night before surgery for bowel prep, bath, and pre-op pain control, Does anyone else remember the routine 75 mg Demerol and 25mg phenergan given IM before each pt went to surgery?) Now our patients are sicker with multiple co-morbidities, and although they may be admitted for one diagnosis, it's up to us to know how that impacts the others and assess for it.

But OP also referred to nurses charting that they did do these assessments when they did not. Expecting proper and correct documentation of a patients condition and what you did/assessed is not "Utopia", is ethical, legal and minimum care.

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.

Actually she made no statement to indicate the utopia lenses and this other out there stuff you said. It was a med surg floor. Are you sure you understood correctly? Only some of the patients will be qs vitals, some q4, some might even be post operative.. Many people are gonna be in bed for extended periods and need to be checked out for pneumonia, minimum, especially if they are older. Every med surg floor I've worked universally and routinely checks lung sounds. I really don't know what hospital you weren't at but it must be awful if you are to overloaded to do your necessary assessments, because every med surg floor over ever worked on listened for lung sounds routinely on everyone, as well as heart or bowel sounds if applicable. That actually really scares me that you have this perspective. I guess you don't cough and spiro with your pts either? Do you not listen for bowel sounds after surgery? What is it that you actually do? You sound like a huge liability.

Edit: Actually just realized ur nurse and have no clue what ur talking about. Kudos for misinforming. I'm really getting tired of that. I wish this forum would verify users.

Well seeing that you joined Sept 2017, I think you need to read the rules of the forum. And once again, nobody's talking post ops and "this other out there stuff" I supposedly (ie, you misread) said.

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.