[ginger58]

Originally Posted by Daytonite

ncriverrat. . .the whole issue of getting consents signed should have been discussed with you when you were in orientation as a new employee at this facility. A public forum like this is not the appropriate place to get specific advice about what your employer will want you to be doing.

Daytonite, Yes, this should have been discussed and maybe it was. Often it's not but it's stuck in a handbook. Of course us folk can't give her specific info about her place of employment, but this is an appropriate place to ask about consents.

In this country, I would think that the consent witnessing is pretty standard, at least it has been for me. But it's what is actually practiced.

[CHATSDALE]

find out what is legal in your hospital
ifyou are the only nurse that refuses to get a consent signed then there are going to be some angry co-workers
i would never tell you to do something that you are uncomfortable with but you need to find what is accepted in your own facility

[lovemyjob]

Originally Posted by SharonH, RN

I've always had patients sign consents after the physician had explained the procedure. However, it is your job to assess whether or not the patient has an understanding of what is about to happen to them and the risks. That does not mean that you have to quiz them about the minute details of the procedure and the risks but that they have a good understanding. If they do not, do not allow them to sign the consent. I've pulled the pen out of patient's hands after it became apparent to me that they there was something they didn't understand. Also if they seem uncertain or ask questions, do not allow them to sign, just let the physician know. I've never had one yet who became angry or annoyed with me when I let them know that the patient didn't know or understand what was going on.

but, in that situation, you are putting yourself in a position to be determining if the patient is in full consent to the procedure. But, when you sign the form, you are only witnessing a signature, not determining consent, which is the physicians job. I work in a teaching facility, and all of our docs get their own consents signed. I always assumed they were trying to teach the right way for it to be done.

[TheCommuter]

At my workplace, I can sign consents for procedures that I personally do (such as vaccinations, psych medications, restraints, etc). However, the physician needs to sign consents for the procedures that (s)he performs (such as nerve blocks, surgery, etc).

[crb613]

Originally Posted by SCRN1

I was taught in school that the nurse can get a consent signed AFTER asking the patient if the doctor explained the procedure and risks and asking the patient if they understand or have any questions. If the nurse has the patient sign, the nurse is signing as a witness only to the patient signing the consent. The nurse is not signing that she/he explained anything. That part is the physician's responsibility. If the patient states that the doctor has not explained, if the patient doesn't understand, or if the patient has any more questions for the doctor, then the signing of the consent is held off until the physician talks to the patient and the patient then fully understands.

This is also protocol in each hospital I've worked and we witness the signing of consents all the time. Again, we are only witnessing that the patient signed it.

I was taught the same thing

[kitten79]

I am soo happy to see this topic discussed!!!! In one practice I worked for they wanted the LVN, med assistant or secretary to consent the patient. I thought this was not appropriate - seemed like anyone but the MD!!!!! I had quite an issue with this. I am glad to see this discussed.

[zacarias]

This is a very good thread. I want to reiterate that while you are only witnessing the signature, ethical obligation requires you to determine if the pt did receive a proper explanation from the doctor. Stated in a different way, if a nurse witnessed a pt's signature and knew that the doctor didn't explain the procedure or didn't even come to see the pt, that nurse would be....well I wouldn't not to be that nurse. He/she may not get caught, since she only witnessed the signature, but she did commit a grave ethical infraction.

[CHATSDALE]

i have never heard of unlicensed personnel getting consents
but where i have worked the per surg check list had GET CONSENTS SIGNED listed

[mshultz]

I experienced "Coerced Consent" 3 times in 2003 (EGD and blood transfusion while in the hospital, colonoscopy as outpatient). I was not given the opportunity to meet with the doctors prior to the procedures, nor did I know the doctors were supposed to meet with me. The nurses did not discuss risks, benefits, and alternatives, did not ask if anyone had discussed this with me, and did not ask if I understood these items. I was not given a description of any of the procedures, either. Instead, after being given little more than the name of the procedure, I was asked if I had any questions, and then told to read and sign a form.

The implication at this point was that the time for asking questions was over. The form said to check that you knew the risks, benefits, and alternatives. There was no listing of these items, nor any explanation as to what to do if you did not know them. Because the nurses never explained that they were witnessing my signature (that went on a separate form which I never saw until I requested my records), I felt pressured to read and sign as quickly as possible. I was not given a copy of the consent, either.

I signed because I trusted the medical staff to be straight with me. My trust was violated. It took 2 years of hard work, but I understand Informed Consent now, and will insist on a thorough written description of risks, benefits, and all reasonable alternatives, and a thorough written description of the procedure prior to the day of the procedure.

[lovemyjob]

Originally Posted by zacarias

This is a very good thread. I want to reiterate that while you are only witnessing the signature, ethical obligation requires you to determine if the pt did receive a proper explanation from the doctor. Stated in a different way, if a nurse witnessed a pt's signature and knew that the doctor didn't explain the procedure or didn't even come to see the pt, that nurse would be....well I wouldn't not to be that nurse. He/she may not get caught, since she only witnessed the signature, but she did commit a grave ethical infraction.

You make a great point. IMO, thta is why the physician should get consent signed with a nurse at the bedside. If the doc rushes through it, or if the patient doesnt seem to comprehend, the nurse can be there as a pt advocate to help ensure the patient fully understands. Plus, the nurse can use the learning assessment to help the doctor ensure that the patient has the risks/benefits/procedure explained in a way that they can fully understand.