consent for surgery - who's job is it - page 2

by MIRockstarRN

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... Read More


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    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.
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    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.
    Angie O'Plasty, RN likes this.
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    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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    The idea that a physician can place an order in a chart for a nurse to get a consent has always bothered me. Sometimes the doctor will have come in and talked to the patient, other times he(she) expects the consent to be signed prior to them even seeing the patient in the hospital! The hospital I work at competes very closely with another in town, the physicians and surgeons, know this and play one against the other, with a spineless CEO at this one the nurses are expected to get the consent. I never want to get an informed consent unless I heard the doc talk to the patient myself, something that rarley happens.

    What I do is ask the patient if they have any questions please address them to the physician, and do not sign the consent until and unless all of their questions have been answered to thier satisfaction. I will then place a stickly note on the consent if the patient doesn't sign, explaining that the paitent wishes to speak to the doctor before signing.

    I run about 50% of the patients wanting more information and/or assurances from thier doc before they agree. I know I have developed a reputation of not getting a consent, (i.e. not bending over), but, I really don't care.
    Angie O'Plasty, RN likes this.
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    I'm just saying that as Suzanne pointed out upthread, if a patient decides to sue later on, they can say "I didn't understand what CABG meant". So by writing up the nurse, the hospital covers itself. I'm not saying it's RIGHT, just that that could very well be the reason. Documentation of corrective action taken, so if the nurse does it again and there are legal ramifications, the hospital is less liable.
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    Quote from 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.
    Right on. I work in pre-op and your on the money with the consent stuff.

    Larry RN in Fl
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    Quote from MIRockstarRN
    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???
    If you're written up for not getting the patients' consent, call in the American Nurses' Association (if that's where you live and work). If you have a union, get them in on it. You're not the one doing the procedure, the doctor is!

    Things may have gotten skewed, when patients indicated that they hadn't a clue about what the procedure they were about to have, was. Since patient education has been our responsibility, we filled the gap without even a thank you from the doc - who was only to happy to turn over that responsibility to us.

    However, when malpractise insurance companies became more involved in lawsuit prevention, the ball of getting consent went back in the doctors' "court" (pun intended).

    I remember my doctor writing a special consent full of dire possibilities I could have as a result of breast cancer surgery, because he discovered that my husband was an attorney! An oncologist giving me chemotherapy also got a very detailed consent signed, and 2 miserable years afterward, said he never would have given me chemo if my husband hadn't been an attorney (that was in the mid '70s, before the current "triple agent" chemo was discovered as effective in Italy). Nevertheless, another primary malignancy in my other breast occurred in '78.

    I'm still alive and active in preserving patient rights, which aren't upheld by HIPPAA (which actually contains a clause in which consent is allowed for patient information to be given to "government agencies", any insurance company, and employers). It's a wonder that it doesn't effect their FICO score - yet! :angryfire
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    I was just in the GI doc's office for pre-procedure visit--routine colonoscopy to be done outpatient at a clinic.I assumed I would see the MD at this visit, but I was only intervewed by an LPN(that's what it said on her name tag, she didn't tell me her credentials). She went over the risks and then asked me to sign the consent!!
    I know there are different rules outside of the hospital, like a doctor's employee can act under the the doc's license, but does that carry over to informed consent? None of the references I can find state that the doc must obtain consent in person, so I am guessing that he can delegate this as well?
    I have e-mailed the licensing board, but has anyone else seen this?
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    Quote from nursej22
    I know there are different rules outside of the hospital, like a doctor's employee can act under the the doc's license, but does that carry over to informed consent? None of the references I can find state that the doc must obtain consent in person, so I am guessing that he can delegate this as well?
    Here's what the AMA says (http://www.ama-assn.org/ama/pub/category/4608.html):

    "Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.
    In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:
    • The patient's diagnosis, if known;
    • The nature and purpose of a proposed treatment or procedure;
    • The risks and benefits of a proposed treatment or procedure;
    • Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
    • The risks and benefits of the alternative treatment or procedure; and
    • The risks and benefits of not receiving or undergoing a treatment or procedure.

    In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention."
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    Quote from MIRockstarRN
    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???
    Wasn't this discussed with you at your orientation to the hospital when you were hired? We are merely witnessing the patient's signature on the consent form. Yes, we are to ask the patient if the doctor has talked with them and if they have any questions. If they do, then we are obligated to inform the doctor. Talk with your facility instructor or whoever conducts orientation classes to clarify this for you.


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