I work urgent care in a clinic setting, and the most helpful thing I've found is to preface all of my questions with, "Hello, my name is such & such...I'm so and so's nurse and am going to get...
You should consider buying a double lumen stethoscope. I had a lovely Littman all through nursing school and couldn't hear squat. Then I bought a double lumen cheap-o stethoscope from prestige...