RN "Super Union" - pg.7 | allnurses

RN "Super Union" - page 9

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  1. Visit  herring_RN profile page
    2
    originally posted by onekidneynurse
    wishes? my patients "wish" for bananas, french fries, and ice cream. what kind of advocate would i be if i gave them those things. my surgical patient's wished for 3 day long naps, no cdbt. what kind of advocate would i have been then if i'd gone with their wishes?
    Quote from herring_rn
    it is a condition of my license as a registered nurse in the state of california. notice that best interest comes before wishes?
    standards of competent performance

    a registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process, as follows:
    (1) formulates a nursing diagnosis through observation of the client's physical condition and behavior, and through interpretation of information obtained from the client and others, including the health team.
    (2) formulates a care plan, in collaboration with the client, which ensures that direct and indirect nursing care services provide for the client's safety, comfort, hygiene, and protection, and for disease prevention and restorative measures.
    (3) performs skills essential to the kind of nursing action to be taken, explains the health treatment to the client and family and teaches the client and family how to care for the client's health needs.
    (4) delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates.
    (5) evaluates the effectiveness of the care plan through observation of the client's physical condition and behavior, signs and symptoms of illness, and reactions to treatment and through communication with the client and the health team members, and modifies the plan as needed.
    (6) acts as the client's advocate, as circumstances require by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided.
    http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf
    Quote from herring_rn
    i will not allow my lung cancer patient with an advance directive for dnr to be intubated.
    i will not send a patient to surgery who does not understand the consent.
    i will do all i can to provide the best possible care for my patient.
    and pray i recognize when circumstances require that i act on behalf of my patient.

    and when my patients don't like their therapeutic diet i take the time to listen, to educate, and obtain a dietary consultation.
    Quote from onekidneynurse
    you needed all that to agree with me? i never went over a surgical consent with a patient. that's the surgeon's duty. i've had surgeon's ask me to get a consent signed and i refused every time. i will go back into the room and ask the patient if that is their signature.

    please tell me how you know someone understands anything? many of them can parrot what they've heard but that doesn't mean they understand. if english is not their first language do you get an interpreter. and how do you know the interpreter knows what he/she is talking about?
    i was not agreeing with you. i was explaining the word "wishes" in my states nursing practice act.

    hospital policy requires i witness the signing of the consent.
    working nights there is often a doctors order to get a consent. if the exact wording is not in the written order i call the doctor and read it back. sometimes a secretary has prepared the consent.
    if the patient has any questions or misunderstanding i contact the doctor to come talk with the patient.

    ps: we have excellent tested interpreters. i always have an interpreter when assessing a patient and anytime there is a need. we don't think it is appropriate for a young family member to translate.
    and of course before they sign a consent they are asked if there are any questions. our physicians write (well type) extensive progress notes regarding what the patient was told and questions answered. but even then sometimes a patient forgets to ask a question so the doctor has to return to the hospital to answer.
    Last edit by herring_RN on Dec 30, '09
    lindarn and laborer like this.
  2. Visit  Onekidneynurse profile page
    1
    Quote from herring_RN
    I was not agreeing with you. I was explaining the word "WISHES" in my states Nursing Practice Act.

    Hospital policy requires I WITNESS the signing of the consent.
    Working nights there is often a doctors order to get a consent. If the exact wording is not in the written order I call the doctor and read it back. Sometimes a secretary has prepared the consent.
    If the patient has any questions or misunderstanding I contact the doctor to come talk with the patient.

    PS: We have excellent tested interpreters. I always have an interpreter when assessing a patient and anytime there is a need. We don't think it is appropriate for a young family member to translate.
    And of course before they sign a consent they are asked if there are any questions. Our physicians write (well type) extensive progress notes regarding what the patient was told and questions answered. But even then sometimes a patient forgets to ask a question so the doctor has to return to the hospital to answer.
    As I said witnessing a consent and explaining it to the patient are 2 very different things. I am not operating on the patient I am not explaining the risks or procedure. EVER.

    What happens when you go home and the surgeon never came in to talk with that patient. Where would your liability be with that scenario. You go right ahead and get consents for surgery signed. I won't be doing that.

    Who assesses the interpreter? Do you have staff who speak both languages so they can assess the medical knowledge of the interpreter. Often it's just someone who's been in the US for a couple of years. NO medical knowledge at all.
    lindarn likes this.
  3. Visit  herring_RN profile page
    0
    Quote from Onekidneynurse
    As I said witnessing a consent and explaining it to the patient are 2 very different things. I am not operating on the patient I am not explaining the risks or procedure. EVER.

    What happens when you go home and the surgeon never came in to talk with that patient. Where would your liability be with that scenario. You go right ahead and get consents for surgery signed. I won't be doing that.

    Who assesses the interpreter? Do you have staff who speak both languages so they can assess the medical knowledge of the interpreter. Often it's just someone who's been in the US for a couple of years. NO medical knowledge at all.
    The surgeon has already talked with the patient and has verbap consent. Then he or she askd the secretary to type it (yes on a three copy form). A nurse then WITNESSES the signing of the consent.

    I already stated that I do not witness a consent if the patient has questions. And that I call the doctor to come and answer the patients questions. PLEASE don't assume that I explain the risks or the procedure to the patient. I have typed that I do not multiple times.

    Our union and the union representing non RN staff have worked out with the hospital that the interpreter is a licensed healthcare provider. RN, LVN, RT, pharmacist, MD, DO, etcetra. We have a very diverse staff. Many speak more than one language. Generally in critical care a nurse already on the unit can speak Spanish, Korean, Armenian, or other language. That RN will be assigned to the appropriate patient so there is no need for a translator. When the surgeon or anyone else talks with that patient the RN/translator translates.

    Do you ask your patient if they understand what they are signing? Or just ask if it is their signature?
    What are the qualifications of your interpreters?
    Last edit by herring_RN on Jan 4, '10
  4. Visit  Onekidneynurse profile page
    0
    Quote from herring_RN
    I already stated that I do not witness a consent if the patient has questions. And that I call the doctor to come and answer the patients questions. PLEASE don't assume that I explain the risks or the procesure to the patient. I have typed that I do not multiple times.

    Our union and the union representing non RN staff have worked out with the hospital that the interpreter is a licensed healthcare provider. RN, LVN, RT, pharmacist, MD, DO, etcetra. We have a very diverse staff. Many speak more than one language. Generally in critical care a nurse already on the unit can speak Spanish, Korean, Armenian, or other language. That rN will be assigned to the appropriate patient so there is no need for a translator.

    Do you ask your patient is thy understand what they are signing? Or just ask if it is their signature?
    What are the qualifications of your interpreters?
    You said in post no. 78 " Working nights there is often a doctors order to get a consent. If the patient has any questions or misunderstandings I contact the doctor to come in to talk to the patient" Now if you haven't gone over the consent how does the patient know to ask questions. What do you mean by "get a conset" See you're even confusing me. So how can you expect a patient to understand you.

    As I said before many of the interpretors have no medical knowledge. If an interpretor is explaining a surgical consent shouldn't the interpretor be a surgeon? I do ask them if it's their signature. It's not my place to explain surgery. I'm not a surgeon. I won't be doing the surgery.
  5. Visit  herring_RN profile page
    2
    When there is a written order to prepare a consent and have the patient sign it I ask my patient if he or she has questions.

    If there are questions I ensure that the surgeon comes to the bedside to discuss it with the patient.

    In the event that the patient does not speak English and the surgeon does not speak the patients language I call a translator who has passed the fluency test in English and the patients language. This person is a healthcare professional. The SURGEON needs a translator to answer the patients questions.

    Sorry that it is so confusing to you. This is how it is done at most hospitals where I have worked. And I've worked registry on and off at a variety of hospitals for forty years.

    Wherever you work must have very different policies and procedures. I am glad our contract includes the requirement that the hospital provide RNs orientation to all policies and procedues as well as monthly updates when there is a change.
    Last edit by herring_RN on Jan 1, '10
    lindarn and laborer like this.
  6. Visit  tewdles profile page
    3
    I am very familiar with the practice of the RN obtaining the signed consent for a medical procedure. The surgeon absolutely explains the surgery, risks, etc and answers all questions. The nurse is frequently present during this interaction. The patient verbalizes understanding and agrees to the procedure. The RN reviews the legal consent with the patient and witnesses his/her signature. If the patient has any further questions or concerns the surgeon is recalled to the unit with the consent now his/her responsibility. If a translater was required it was provided by the hospital, ALWAYS someone who was specifically trained to provide medical translation. This happened in the PICU and L&D frequently.
    wondern, herring_RN, and laborer like this.
  7. Visit  Onekidneynurse profile page
    0
    Quote from tewdles
    I am very familiar with the practice of the RN obtaining the signed consent for a medical procedure. The surgeon absolutely explains the surgery, risks, etc and answers all questions. The nurse is frequently present during this interaction. The patient verbalizes understanding and agrees to the procedure. The RN reviews the legal consent with the patient and witnesses his/her signature. If the patient has any further questions or concerns the surgeon is recalled to the unit with the consent now his/her responsibility. If a translater was required it was provided by the hospital, ALWAYS someone who was specifically trained to provide medical translation. This happened in the PICU and L&D frequently.
    I worked Surgical for 15 years. And as both you and I have said the surgeon goes over the consent not the nurse. That's been my contention here all along. I don't let the surgeon go without the patient answering the questions.
  8. Visit  herring_RN profile page
    1
    Quote from Onekidneynurse
    I worked Surgical for 15 years. And as both you and I have said the surgeon goes over the consent not the nurse. That's been my contention here all along. I don't let the surgeon go without the patient answering the questions.
    Do you mean you make the patient answer questions?
    laborer likes this.
  9. Visit  Onekidneynurse profile page
    1
    Quote from herring_RN
    Do you mean you make the patient answer questions?
    Yes sometimes patients do answer questions. Like do you have any questions, do you understand ? I would hope they would answer those questions.......

    In this instance I did mean ask questions. I still don't get a consent for a surgical patient. I will WITNESS the signature but I don't explain the procedures.
    wondern likes this.
  10. Visit  herring_RN profile page
    2
    Quote from Onekidneynurse
    Yes sometimes patients do answer questions. Like do you have any questions, do you understand ? I would hope they would answer those questions.......

    In this instance I did mean ask questions. I still don't get a consent for a surgical patient. I will WITNESS the signature but I don't explain the procedures.
    Me too. We agree.
    wondern and laborer like this.


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