"I've never done this before"

JBMmom, MSN, NP · Oct 2, 2019

Generally, if I'm doing something I haven't done before, I'm bringing someone else with me that has experience. In that case I usually introduce the other person to my patient with an introduction like "I decided to bring in one of my expert coworkers, (name). We're going to work through this together so I have a second set of eyes." That way I'm not highlighting my lack of experience, but their expertise. I have told people I haven't done things before, though. It's all how you present it. If you're confident in your nursing abilities, and you've already established a good relationship, whatever task you're completing is just another skill. Most people are very understanding of that.

Guest219794 · Oct 2, 2019

2 hours ago, JabuJabule said:
So, when I was in nursing school this phrase was considered the devil. Accodring to them, you're NEVER allowed to tell a patient you don't know how to do something.
What are you thoughts on this? I found it to be a little ridiculous, especially coming from student nurses/new nurses. While I kind of agree it's not something that should be said often, but in reality new nurses will have to do new things they've never done or experienced. Do you think it breaks the "trust" you have with your patient, whether it's saying or not?
I'd love to see other's opinions on this.

"Accodring to them, you're NEVER allowed to tell a patient you don't know how to do something."

Feel free to tell them. But do not do it. don't do anything you don't know how to do.

As far as stuff you know how to do, but have little or no experience? What advantage is there to the PT to share this? What would you hope to accomplish by telling them this?

Research shows that PTs do better when they have confidence in the process. Part of your job is to instill that confidence.

As a new nurse, how do you plan to instill confidence?

Lynker, LPN · Oct 3, 2019

33 minutes ago, hherrn said:
"Accodring to them, you're NEVER allowed to tell a patient you don't know how to do something."
Feel free to tell them. But do not do it. don't do anything you don't know how to do.
As far as stuff you know how to do, but have little or no experience? What advantage is there to the PT to share this? What would you hope to accomplish by telling them this?
Research shows that PTs do better when they have confidence in the process. Part of your job is to instill that confidence.
As a new nurse, how do you plan to instill confidence?

I plan on instilling confidence by having other nurses do things with me, so I can see what I'm doing right and wrong.

Guest219794 · Oct 3, 2019

34 minutes ago, JabuJabule said:
I plan on instilling confidence by having other nurses do things with me, so I can see what I'm doing right and wrong.

Great plan.

Sour Lemon · Oct 3, 2019

I used to panic when I didn't know something. I'd even gone into the staff bathroom with a med/surg book a few times to try to figure various things out.
Now, I just flat out tell the patient I have no clue. Not only that, but I ask them to explain it to me at times.

"I've never heard of this medication before. What do you take it for?"

"I see "jsfdhklsfhs" in your history. I'm not familiar with that, what can you tell me about it?"

"I'm not sure which hose is supposed to connect to which part of this canister. Let me go find someone who's familiar with these 'damn' things."

If it's something painful or invasive, I'm a bit more subtle. I think people actually appreciate that you're open to seeking experienced guidance when you need it, though.

Lynker, LPN · Oct 3, 2019

43 minutes ago, Sour Lemon said:
I used to panic when I didn't know something. I'd even gone into the staff bathroom with a med/surg book a few times to try to figure various things out.
Now, I just flat out tell the patient I have no clue. Not only that, but I ask them to explain it to me at times.
"I've never heard of this medication before. What do you take it for?"
"I see "jsfdhklsfhs" in your history. I'm not familiar with that, what can you tell me about it?"
"I'm not sure which hose is supposed to connect to which part of this canister. Let me go find someone who's familiar with these 'damn' things."
If it's something painful or invasive, I'm a bit more subtle. I think people actually appreciate that you're open to seeking experienced guidance when you need it, though.

I love this reply. Thank you very much!

CharleeFoxtrot, BSN, RN · Oct 3, 2019

I've gotten a good response with an honest "I don't know __________, but I will find out who does know _______ and get back with you." It's the follow up that's important.

Quota, BSN, RN · Oct 3, 2019

Saying I don’t know isn’t a dirty phrase IMO. Presentation and follow up with an answer is important though. I’ve told pt’s I hadn’t done a procedure/skill before and was going to get a more experienced coworker to come show/guide me. Never been an issue. They appreciate the honesty and willingness to ask first and get things right vs fake it till you make it.

The key is “I don’t know but I will find out and get back to you”. Followed by getting back with them fairly quickly. I’m still less than a year in as a new nurse and things still come up that we just don’t do often on our unit. Simply explaining to the pt “we don’t see a lot of ‘xyz’ on this floor, let me check with my charge nurse/coworker before we do ‘xyz’.” is usually well received. They are usually happy I’m more concerned with getting things right than trying to appear I know everything.

JKL33 · Oct 3, 2019

19 hours ago, JabuJabule said:
I found it to be a little ridiculous, especially coming from student nurses/new nurses.

Acting as if it is some big sin to ever let a patient know that you're still gaining experience at something is unthinking. I find it an offensive mindset because it assumes the patient is stupid.

With students and orientees it is really rewarding to have them work with a patient who is one of those people who will feel good about having helped someone's learning process. The specific example I have in mind is the point where everyone needs to start their first real IV at some point. I won't put students/orientees or patients into situations like that without saying something....in about 5 seconds it's going to become obvious that this is one of the first times this has been attempted anyway--so why miss out on a chance to gain trust/develop rapport by just leveling with people? I will say straight up, "One of the things so-and-so is working on is starting IVs. Would it be okay if we start your IV together?" If they say yes/sure (which they almost always do), I thank them and we go about it. Very high rate of successful first IV starts with this. It's quite the happy moment. The patients will even say things like, "you did great!" or whatever, and the orientee/student is on cloud 9. In other words, this:

4 hours ago, Quota said:
They appreciate the honesty and willingness to ask first and get things right vs fake it till you make it.

If you're the (new) nurse in charge of the assignment get an experienced co-worker to join you when you need to perform something you are still gaining familiarity with. Review the procedure before hand. The experienced co-worker can make conversation with the patient and be there for guidance if needed. And since you are off orientation and are officially in charge of the assignment, I think it's all the more important that patients can trust your good judgment. Good judgment includes not "bravely" getting in over your head because you didn't want patients to question your abilities.

Lynker, LPN · Oct 3, 2019

49 minutes ago, JKL33 said:
Acting as if it is some big sin to ever let a patient know that you're still gaining experience at something is unthinking. I find it an offensive mindset because it assumes the patient is stupid.
With students and orientees it is really rewarding to have them work with a patient who is one of those people who will feel good about having helped someone's learning process. The specific example I have in mind is the point where everyone needs to start their first real IV at some point. I won't put students/orientees or patients into situations like that without saying something....in about 5 seconds it's going to become obvious that this is one of the first times this has been attempted anyway--so why miss out on a chance to gain trust/develop rapport by just leveling with people? I will say straight up, "One of the things so-and-so is working on is starting IVs. Would it be okay if we start your IV together?" If they say yes/sure (which they almost always do), I thank them and we go about it. Very high rate of successful first IV starts with this. It's quite the happy moment. The patients will even say things like, "you did great!" or whatever, and the orientee/student is on cloud 9. In other words, this:
If you're the (new) nurse in charge of the assignment get an experienced co-worker to join you when you need to perform something you are still gaining familiarity with. Review the procedure before hand. The experienced co-worker can make conversation with the patient and be there for guidance if needed. And since you are off orientation and are officially in charge of the assignment, I think it's all the more important that patients can trust your good judgment. Good judgment includes not "bravely" getting in over your head because you didn't want patients to question your abilities.

Thank you very very much. Great points. ?

nrsang97, BSN, RN · Oct 3, 2019

I have taken an ultrasound guided IV course. I have never had to opprotunity to use this skill on a patient. So when a patient asks me to go get the ultrasound, I respectfully decline. I explain that I have no experience outside of the lab doing so. I work nights so I let the patient know that we can have anesthesia try for an IV, but if they have nothing due overnight that we will call PICC team in the morning for an ultrasound guided IV.

Saying that you do not have the skill or do not know how to do something is not completely wrong. Not following up and getting someone that knows how is the problem.