Trouble with Blood Pressure

Hi there. I was hoping some of you could give me some advice. I just graduated from MA school (I hope it is ok that I am posting on this website- I used to use it when I was in nursing school and everyone was so helpful, but I had trouble finding an MA forum website) and am having some serious concerns with my blood pressure measurement abilities. I really enjoy medicine and studying and hope to one day move up in the medical field, but feel stuck currently. I practiced blood pressure regularly in school and in my spare time, and practiced during my externship extensively. My technique is correct, and I have spent time carefully researching the exact art of taking bp. I also have a nice stethoscope, and have tried quiet a few different ones. I have no hearing problems. My problem is sometimes I just can't hear it, or sometimes can't differentiate where it starts and stops. I know this is a common concern, but I think it is a little worse with me. I would say I often have to recheck my blood pressures and probably have some real issues in around 5 percent of my patients. I studied hard in school and truly have a passion for medicine- but right now I am too scared to even apply for jobs. I want to be good at my job but feel stuck. Are some people simply unable to handle bp? Does anyone have any ideas? Thank you so much for your time.
I had a hard time with auscultation until I switched out for smaller earpieces on my stethoscope. Could be your stethoscope just doesn't fit you quite right.

I know you say that your technique is good... but follow me on this: first, make sure that the diaphragm is actually sending the sound. Put the stethoscope in your ears and tap the diaphragm. If you hear LOUD taps, you're good to go. Take stethoscope out of your ears... put the BP cuff on the patient. Straighten the arm until it's fully extended. Feel along the inside of the biceps tendon, just above the crease of the elbow. You should feel the pulse there. Don't allow the patient to flex the elbow. Put the stethoscope back in your ears, put the diaphragm right over where you felt the pulse, and inflate the cuff. As you inflate the cuff, you should start hearing the korotkoff sounds. If you do, inflate the cuff as normal and slowly deflate the cuff taking note of when you first hear the sounds and when they stop. That's the BP. Once you're done, then you can allow that arm to move again. I've had patients whose BP could NOT be heard any other way than by doing this. If they bend their elbow even a little bit, sometimes that brachial artery just seems to find a way to hide so you can't hear it unless that elbow is fully extended. I've been there...

I have had a very surprising number of people not realize that you have to have to twist the chestpieces of your stethoscope to make the tips point forward, towards the tip of your nose, to aim them down the ear canal. It's almost comical to see their eyes open wide when they realize what they've been missing. Give the smaller tips a try, too.

Quote from GrnTeaI have had a very surprising number of people not realize that you have to have to twist the chestpieces of your stethoscope to make the tips point forward, towards the tip of your nose, to aim them down the ear canal. It's almost comical to see their eyes open wide when they realize what they've been missing. Give the smaller tips a try, too.