Did you know that physicians were hesitant to allow nurses to measure blood pressures?

In fact, nurses did not routinely use stethoscopes for blood pressure auscultation until the 1960s! Lest anyone mistake the nurse’s stethoscope for the doctor’s device, they were called “assistoscopes” or “nurse-o-scopes” and made in lightweight pastels. By differentiating between the two, the appearance of nursing overlapping medicine was minimized.

At the time of its introduction, the cuff represented a massive change in medical practice.

In the late 1800s, pulse palpation was used to assess blood flow. In 1901, a surgeon from the United States (Harvey Cushing) was introduced to the sphygmomanometer in Italy. While there were early enthusiasts, the acceptance of the device did not come easy. Physician’s were wary of the sphygmomanometer for two reasons:

• They felt that direct palpation was a medical art form that took years to master.
• When presented as something nurses could use - like the watch and the thermometer - there was concern over a new medical device being used by nonphysicians.

How would the measurement of pulse obliteration by a nurse compare to skilled tactile measurement of the tension, size, force and duration of an actual pulse?

Note that the concern was over pulse “obliteration”. Early BP cuffs were used only to palpate a systolic pressure. By 1910, auscultation of the blood pressure became standard and pulse palpation as a measure of blood flow receeded.

Auscultation required (a) skill and (b) stethoscopes were not used by nurses. Were physicians more accepting of blood pressure measurement once it was believed that it was a skill (as opposed to a task) putting it in the same league as the auscultation of heart and lung sounds?

Maybe. Nurses can appreciate this. My resource notes “…concerns about preserving a role for expert skills in the physican’s work.” As nurses, we fight what we consider our “expert skills” being delegated to unlicensed personnel.

So, the next time you drape that stethoscope over your shoulders, realize it wasn’t until the turbulent Sixties that nurses even needed them for assessment.

We’ve come a long way.

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Reference: Crenner, C. W. (1998). Introduction of the blood pressure cuff into U.S. medical practice: technology and skilled practice. Annals of Internal Medicine, 128(6), 488-493.