"I've never done this before"

6 hours ago, Kooky Korky said:

Would you want to know that your nurse doesn't know what to do or how to do a procedure?

Yes I would want to know. That gives me the opportunity to be understanding when they bring a mentor with them to accomplish it. What I would not want is someone trying to bamboozle me, which is very near the top of a short list of things I can't easily abide.

Yes, patients want to be able to trust their nurse and the nurse's skills. But what some of you are saying is that this translates into not wanting to know if the nurse doesn't have a particular skill. That makes no sense. Patients want to be able to trust that the nurse has the skill/knowledge or will seek additional help to responsibly provide the care), not that s/he doesn't have the skill and chooses to cover that up "for [patients'] own good."

6 hours ago, Kooky Korky said:

Fair to keep your fears and feelings of inadequacy to yourself? Appropriate? I think so because the pt's need to trust his or her nurse trumps your need to unburden yourself.

The exact opposite could be said: The patient's need to receive appropriate care trumps the nurse's emotional need to not have a particular (and very temporary) inadequacy exposed.

The bottom line is that I suspect that appropriate disclosures are the more safe thing in the long run. I would expect this to be true with each relevant incident of care but also over the long haul. An expectation/culture of fake it till you make it can't possibly be as safe as appropriate disclosures and an expectation of teamwork that allows for mentoring of newer nurses. If you don't want to talk about this in terms of nurses, consider interns/residents. Their traditional MO was "see one, do one, teach one" - the "do one" part being that you'd better have enough guts to go off and find one to do and figure it out and get it done without a lot of hoopla and oversight. I'm pretty sure most hospital nurses know of an incident or two where this didn't turn out so well.

I'm really not talking about burdening the patient; I'm talking about being humble enough to ask a mentor for guidance instead of going off on one's own and fumbling through and then claiming that we all should do that because patients need to be able to trust us.

What is it that they are trusting if the person doesn't actually know how to do the skill? What part of that situation engenders trust?

13 hours ago, Kooky Korky said:

I think the pt has enough to worry about without being burdened by a nurse who wants the pt to be rational.

And a nurse who wants the pt to be supportive of the nurse's emotions is expecting too much.

Don't burden your patients with an expectation like that. Just get someone experienced to be with you. And be quiet about the reason the other nurse is with you.

Would you want to know that your nurse doesn't know what to do or how to do a procedure? Maybe you would. I would not. Silence is golden. Fair to keep your fears and feelings of inadequacy to yourself? Appropriate? I think so because the pt's need to trust his or her nurse trumps your need to unburden yourself.

I agree, know your audience. I've seen patients in the hospital (years ago, haven't worked one in years) and in LTC request a new nurse when the nurse they have isn't familiar with the med/procedure/disease, even if they are capable in every other way. Sad, because we all have to start and learn sometime. As long as you have expert help those first few times, you should be golden. I found this to usually be true in older folks--I'm not going to be a Guinea pig!

My school did not teach this, but the nurses I had clinical with certainly did.

It seems obvious to me that one cannot instill trust by being dishonest.

If you've never done something before it's important to have an experienced person with you, to guide you. This should be done openly and honestly. The open communication between you and your teacher will help the patient feel comfortable. If you are afraid to ask a question because you think you are supposed to know everything or pretend to know everything, the resulting tension and stress will be communicated to the patient and decrease his or her confidence in you.

Saying you don’t know how to do something and saying you have never done something are two different things. And I don’t think either thing should be said in front of a patient. It should be said by the new nurse or student to the nurse they are following before they enter the patients room.

Honesty, with discretion but, always honesty.