By: Fran Fasching, DNP, RN, FNP- BC
In 2015, during the Miss America pageant‘s talent competition, Kelley Johnson (Miss Colorado) made nurses’ stethoscopes famous. Instead of singing or dancing, Miss Johnson, a registered nurse, stood on stage in navy blue scrubs with a stethoscope around her neck. She recited a monologue about caring for “Joe”—an elderly man with Alzheimer’s disease—and the moment she realized nursing’s value.
The next day, on the ABC show The View, host Joy Behar asked, “Why does she have a doctor’s stethoscope around her neck?” This statement highlighted the ignorance about nursing assessment and diagnostic abilities—and the nurses’ use of stethoscopes—to the forefront of American media. The social media uprising from nurses across the country and a clarifying statement from Pamela Cipriana, American Nurse Association President, “Nurses don’t wear costumes; they save lives,” secured nurses’ strong position in all areas of patient care.
Expert advice from nurses like you
Initial assessment of the chest, performed by physicians laying an ear on the naked chest, was suboptimal. Stethoscopes are the first tool that allowed physicians to assess patient organs without opening the body cavity. However, using the rudimentary stethoscope was limited to physicians. Then, nurses were introduced to stethoscopes in the 1930s to monitor patient blood pressures.
In the 1940s, Sprague and Rappaport invented the modern stethoscope to evaluate adults and children by switching out the head size on one stethoscope. Many medical device companies still produce this brand. As stethoscopes evolved, so did the nursing role. Nurses became trusted to use stethoscopes to assess and interpret lung, heart, and abdominal sounds. In the 1970s, Dr. David Littmann (Littmann stethoscope’s inventor) underscored stethoscope use in nursing assessment and diagnostic skills.
Willacker (1973) credited nurse stethoscope assessment skills to successful treatment and poor outcome prevention in abdominal pain patients. The nurse role evolved, and nurses now perform complex examinations and are skilled diagnosticians.
The Gold Standard
Choosing the right stethoscope expands assessment skills and benefits patients by contributing to quality patient care. Nurses of all experience levels must use quality stethoscopes.
Although many brands exist, 3M Littmann is the gold standard for nurses and other medical professionals. This US-based company is the leader in stethoscope sales due to:
- Lightweight products
- Superior acoustics
- Quality components
- Free Littmann Learning Institute Application
- Product warranties for up to 7 years
However, there are more affordable, highly rated brands other than 3M Littmann. Welch-Allen and American Diagnostic Corporation (ADC) are other commonly used brands.
Anatomy of a Stethoscope
When shopping for a stethoscope, nurses need to know some fundamental differences.
Dual head – A dual head stethoscope has two listening areas- the diaphragm (larger surface) to listen to high-pitched sounds, and the bell (smaller surface) to hear lower-pitched sounds.
Single head, or acoustic, stethoscopes allow auscultation of high and low pitched sounds based on how the amount of pressure applied to the head. Low pitched sounds can be heard with the stethoscope diaphragm resting lightly on the patient, and are easily converted to high pitched sounds when the examiner places firm contact pressure on the stethoscope head.
Digital or electronic stethoscopes allow ambient noise filtration and heart and lung sound recordings. However, these stethoscopes are very expensive and are not superior to dual or single head stethoscopes.
Acoustic Performance Levels
3M Littmann classifies all stethoscopes with acoustic performance levels from six to ten. No other brand rates the acoustic level of their products.
- Performance Level 6: These stethoscopes are ideal for checking blood pressures and making limited patient assessments.
- Performance Level 7-8: Stethoscopes at this performance level have excellent acoustics and are ideal for patient assessments and continued patient monitoring.
- Performance Level 9-10: These stethoscopes have more sensitive acoustics and are ideal for critical care patients
- Performance Level 10+: Stethoscopes at this performance level amplify sounds 24 times, reduce ambient noise, and offer BlueTooth connectivity to record auscultated sounds.
Stethoscope tubing, made of polyvinyl chloride (PVC), is latex-free and easy to clean. The tubes will crack after long-term exposure to human skin substances, so longevity increases if nurses place the stethoscope over a collar or minimize tube to skin contact. Most higher-performing stethoscopes have a double lumen in a single tube from the diaphragm to the earpieces, allowing for improved sound quality.
Some lower-performing stethoscopes have a single tube—one tube traveling from the diaphragm, then splitting off into a tube to each earpiece. Acoustics are less sharp in the single tube stethoscope but are adequate for checking blood pressures. Nurses should avoid purchasing single lumen poor acoustic stethoscopes.
Stethoscope tubing is available in 22-inch to 28-inch lengths. Medical practitioners once thought that the acoustics were better in a shorter tubing length. However, research proved that no real acoustical difference exists. The tube length is a personal preference. Nurses might want to consider a five to six-inch difference in distance from sick patients and the ergonomic benefits of bending less during assessments.
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Stethoscope Rating and Review
The best overall stethoscope is the 3M Littmann Classic III. This dual head stethoscope boasts excellent acoustics (Performance Level 7-8) for a wide range of adult and pediatric patients. The bell is covered with a removable diaphragm, perfect for pediatric patients, and protects the bell from dust and debris. The 3M Littmann Classic III is less than $120, and over 90% of almost 43,000 Amazon customers rated five stars. Although recommended for non-critical care settings, the excellent acoustics and reasonable price give it the top spot. 3M offers the classic III in 18 colors and seven different finishes for optimal personalization.
The MDF MD One rivals the 3M Littmann Classic III with 4.6/5 stars. Amazon customers cited this more affordable ($50-$60) option as comfortable, high-quality, and lightweight. The MDF MD One offers 20 color options.
The best stethoscope for nursing students is the 3M Littmann Classic II (Performance Level 7-8). At about half the cost of the Classic III (approximately $60), this quality, single-head stethoscope has excellent acoustics for adult patients. Considered an “entry-level stethoscope,” it is lightweight with sound acoustics. Over 80% of over 45,000 Amazon reviewers gave the Classic II five stars.
A more reasonably-priced option, the MDF Sprague Rappaport scores 4.5/5, with 72% of Amazon users giving 5-star reviews. Stethoscope cost and quality received positive reviews. Negative comments included stethoscope weight and low acoustic quality. This stethoscope ranges from $30-$50 and has many color options.
Emergency Room/Intensive Care Unit/Critical Care Areas
3M Littmann Cardiology IV (Performance Level 9) is a superior stethoscope for critical care and patient care areas. Although more expensive than the 3M Classic III, Littmann boasts that the astute examiner using the Cardiology IV can detect subtle patient conditions. The Cardiology IV has a removable covered bell for pediatric patients and offers nine colors and combinations for personalization. This stethoscope ranges from $220-$350 based on the retailer.
Welch Allen offers the Harvey stethoscope line claiming superior acoustics and the ability to detect a full range of frequencies. There are no Amazon reviews available for this brand, but quality scores are high with other retailers. The cost is $270 – $330, with four color options.
The American Diagnostic Corporation ADscope 600 Cardiology Stethoscope has an Amazon rating of 4.6/5 stars, citing acoustics similar to the Littmann Cardiology IV, lightweight design, and ear comfort. The cost is less than $150, and buyers can choose from 10 colors.
3M Littmann and Eko combined artificial intelligence and Littmann quality in the Littmann Digital Core stethoscope (Performance Level 10+). This state-of-the-art product amplifies heart sounds up to 40 times and can record and analyze heart sounds through HIPAA compliant Bluetooth technology. Patients’ heart sounds are saved in 15, 30, or 60-second recordings to create a library or enter into patient charts. This technology allows patient heart condition monitoring for progression and provides an excellent educational and clinical resource. However, the cost is prohibitive. The Littmann Digital Core stethoscope costs about $350, and the Eko subscription for heart sound analysis and recording expenses costs up to $720 per year.
Pediatric stethoscopes are similar to adult stethoscopes, but the chest pieces are smaller. Nurses must use the correct size to properly auscultate the right amount of surface area and minimize ambient noise. There are pediatric stethoscopes for neonate (2 cm), infant (2.7 cm), and pediatric (3.3 cm) patients.
A pediatric stethoscope designed for infants and neonates, the Welch Allen Professional Pediatric stethoscope has a single lumen and stainless steelhead. It auscultates high and low pitches to identify challenging abnormalities. This stethoscope costs less than $150 and is available in four colors. There is no Amazon rating for Welch Allen products; however, this product rates well with other retailers.
The Littmann Classic II Pediatric (Performance Level 7-8) stethoscope has single lumen technology, similar to the lower model adult Littmann products. The cost is identical to the Welch Allen pediatric stethoscope. Amazon reviews are 4.6/5 stars, and it is available in 10 colors.
The ADC Adscope Adimals Pediatric stethoscope offers a lightweight, acoustic design in a child-friendly, animal-faced stethoscope. Nurses can choose from 6 tubing colors and change the animal to seven interchangeable snap-ons (Panda, Frog, Koala, Bear, Deer, Monkey, Tiger). The cost is less than $50 for this 4.6/5 star-rated product on Amazon.
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Caring for your stethoscope
Stethoscopes require routine maintenance to keep them clean and functioning correctly. The following steps ensure long use and safe handling:
- Clean the stethoscope head with a mild antibacterial cleanser after each patient. Do not submerge it in a fluid of any kind. Antibacterial wipes, isopropyl alcohol, or mild antibacterial soap provide safe and gentle cleansing.
- Store the stethoscope in a cool, dry place. Avoid extreme temperatures.
- Clean the earpieces weekly, replacing them as needed.
- If wearing the stethoscope around your neck, avoid resting the tubing on bare skin. Contact with body oils and sweat causes cracks in the tubing.
The stethoscope is the most common clinical tool for nurses of all disciplines and experience levels. Over the years, stethoscope use evolved from physicians only to a nursing skill that earns respect and acknowledgment in health care communities. Understanding the working parts, the differences in performance, and the best use situations of each permit nurses to perform proficient and skilled patient assessments.
Amazon, as a retail marketplace, also allows consumers to score and comment on products. These scores provide information to guide nurses in making the best purchase and allow comparison with other brands. Furthermore, caring for the stethoscope properly guarantees the longevity of this investment required for reliable and skilled patient care.