My school has recently changed the way we take blood pressure from the normal, one step method so now we take a two step. If you're unfamiliar with two-step, I know my clinical instructors were, they had to learn it with us, this is accomplished by palpating the brachial artery and pumping the cuff until we no longer feel the pulse, deflate the cuff, then +30 to systolic so that you inflate 30mmHg above when you stopped feeling the pulse (If you felt the pulse end at 130mmHg then you inflate the cuff to 160mmHg), then you take the blood pressure a second time but now you are auscultating like you do normally in one-step but not inflating right to 200mmHg like you do with one-step, but to the number that you received from palpating, then boom after a lot of effort you have a reading! The instructors originally said they have no idea why we were doing it in the first place, which is not really encouraging. After us asking quite often "why" we have to do it this way, they figured out the "why" and they said the EBP behind it is that we put less pressure on the arm and it is supposedly more accurate. I don't understand this because 1. Whether or not you do 1-2 step, you get the same reading unless their blood pressure is over 200mmHg systolic 2. It is time consuming because it takes a while to find the brachial pulse and not lose it 3. It makes us look incompetent because rather than taking blood pressure once, we do it twice and at the beginning it takes quite some time, I believe this would cause the client to be less trusting of the nurse and question if they would want someone to care of them when they appear not to be capable of doing something as simple as taking vitals 4. You're taking blood pressure twice, doesn't that put greater pressure on the arm than it would inflating to 200mHg once? 5. Everyone is having a hard time feeling the brachial pulse especially because it isn't always strong, but when the cuff is inflated to a certain point the brachial pulse stops, wouldn't the radial pulse stop because it is below the cuff too? The radial pulse is much easier to find and not lose 6. My school says they keep up with the hospital and what they are doing so that we get "real world" experience, but in the real world, two-step blood pressures aren't done, they use an electronic cuff, which by the way, inflates to 200mmHg like we would when doing manual. Can anyone explain this to me because to my classmates and I, this makes very little sense. Thank you!