consent for surgery - who's job is it

  1. This last weekend a co-worker (a nurse not even off orientation for maybe 2 months) mentioned that she had been written up by a PACU nurse for writing CABG instead of coronary artery bypass graft on the consent. I was telling my mom about this who is also an RN and she brought up a good point - why isn't the physician getting the consent signed. What do they do where you work? We are ALWAYS the ones that get consent where i work, often times without the physician or anesthesia talking with the patients first. I always ask my pt's if they would like to wait till they are talked to by the doc but then I feel like i run the risk of getting written up for not getting consent. What do you think???
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  2. 23 Comments

  3. by   danissa
    ALWAYS the Docs job to get consent for surgery! big responsibility to take on and not enough pay as a nurse to do so!
  4. by   ukstudent
    It's called informed consent. If the pt has not talked to the Doctor performing the procedure then they haven't been informed and no consent can be signed legally. If the doc is talking to them about the risk/benefit of the surgery then they can take the paper with them and get it signed. All the nurse is doing is signing after the pt has signed stating that they have received all the needed information and have no further questions. If you are filling out the form, then yes you need to write out what the procedure is and not use acronyms.
  5. by   elizabells
    Always, always the doc on our unit. We witness them only. For procedures that require anesthesia, there are actually two consents. The one for the surgery can be done a couple of days beforehand, usually by the surgery resident, or occasionally the fellow. The one for anesthesia must be done the day of the surgery, by the anes. resident, barring any unusual circumstances. Sometimes they do it over the phone if it's a situation like a first case and the parents live really far away, but that is not preferred.
  6. by   KulRN
    Informed Consent has to be done by the physician who will be performing the procedure/surgery. Authorization for surgery is done after the Informed Consent has been signed or at least after the physician talks to the patient...patient signs the authorization then a licensed nurse has to sign as a witness.I always check the patients chart if an informed consent has been signed by the doctor or at least it's written in the Doctor's progress note that MD has already spoken to pt or family regarding the procedure..if I don't see this then I call the Doctor and remind him/her that an inform consent has to be completed and sign by him/her. Sometimes, I actually ask MD's to talk to the patient on the phone (example if a patient needs a blood transfusion) then I document it on my note that MD and patient spoke on the phone and what has ben agreed.
  7. by   ready4crna?
    Informed consent is a conversation between the provider (surgeon, anesthetist, NP, MD) and the patient. The forms are a formality and are not really binding as to informed consent. It is the providers responsibility to obtain informed consent and usually they will have the patient sign the form at the same time as a matter of convenience. As a nurse, I would always ask if the patient had spoken with the provider and if they had any questions. If questions came up, I would page the provider to directly answer them to the patient, but I would have no problem witnessing thier signature.
  8. by   suzanne4
    Abbreviations on a consent are a no-no in any form. And that has nothing to do with who obtained the consent. The consent must be written out including the full words right or left as well as procedures that we usually abbreviations for. Patients may not know them and you want to posibility of them coming back and saying that they did not understand what the initials were for.

    The nurse is never the one obtaining consent, having a patient sign after they have spoken with their provider is not the same as obtaining consent; you are only witnessing their signature.

    And you will see some nurses sign that right on the consent form, that they were witnesses to the signing of the patient's name only, and nothing more.
  9. by   Dolce
    As an agency nurse I have seen this practice vary from facility to facility. Of course the doctor should be speaking with the patient before anything is signed. But, some hospitals "bully" the nurses into "obtaining" the consent from the patient before the doctor has even talked to them! I won't do that. When I have a patient sign the consent I always ask them first if they have talked with their physician and have had all their questions answered. If they still have questions about the procedure then I page the doc and tell them that the patient has questions before they sign the consent. As a patient advocate you cannot have them sign a consent before they have been fully informed of the risks, alternatives, possible outcomes etc. One time I had a surgeon get so mad at me for not getting a consent for surgery. Oh well!! If the patient still has questions I am not going to force them to sign the consent!
  10. by   CRNA2007
    I think it was very petty of a nurse to write someone up for using abbreviations. She couldn't just pull the nurse aside and explain it to her?
  11. by   elizabells
    If it's against protocol and could expose the hospital to liability, I understand why she was written up. Paper trail in case of later legal action.
  12. by   classicdame
    check your state's Nurse Practice Act. It may be delineated there. Consider that the surgeon gets the consent but the nurse makes sure it was documented and is on the chart. If the surgeon has not gotten consent then the procedure should be delayed and the patient should NOT get medication that would make him/her incompetent to sign.
  13. by   MIRockstarRN
    i understand what your all saying about the doc talking to the pt first then getting informed consent - but what happens at the hospital i work at is the docs will go in and talk to a pt, then write and order for the nurse to get consent. I work nights - if dayshift doesn't get the form signed, i have no idea if the docs actually talked to the pt about the procedure/surgery. i can ask if all there questions where answered, but that doesn't mean the doc actually answered any questions. I'm very uncomfortable about this whole thing - i have worked here for 2 years - and have come to think this was normal, even though in school they teach you is the surgeons/anesthesias responsibility. But since my coworker got written up (and i know what she did was wrong - but did it really require a write up, how but talking to that person like someone previosily posted) I really feel like the docs need to get there own consent signed.
  14. by   CRNA2007
    How would it expose the hospital to liability? The procedure has to be explained to the patient in order for informed consent to be obtained to begin with. It might be against protocol but I don't believe you can justify it as a libaility issue.


    Quote from elizabells
    If it's against protocol and could expose the hospital to liability, I understand why she was written up. Paper trail in case of later legal action.

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