Asked to get Consent

In witnessing consent, the simple legal standard is that you are only verifying that it was indeed the patient who signed the consent form. The ethical standard however is much different, and in my state it is the ethical standard that the BON holds all Nurses to. We are required by the BON to confirm that the patient has actually consented (has been informed of and understands the indications, risks, alternatives, etc) to the procedure when signing as a witness. Unfortunately, there's really not much that prevents an employer from firing you for refusing to sign as a witness if the patient has not actually been appropriately consented, yet if you do sign just to keep you job, you can lose your license.

I usually just remind the patient that they are confirming that the Physician consented them, if they haven't done that then don't sign yet, if the patient hasn't signed then there's nothing for you to witness. When possible remind the Physician that they haven't yet consented the patient.

Do you have to chart anything? We just keep the order open until the provider has seen them. It's not unusual for our post op floor to get, among the other orders for the night from the surgeon, an order to get consent signed. It's the middle of the night, said surgeon has not been up to see them, is just getting all the orders in the system and prepping for the am. If I'm that nurse, I'm not going to document that I didn't get the order completed, I'll just let that be on the day shift nurse when the surgeon comes in (or I'll do it in the am, if the surgeon happens to be one of our guys who likes to start rounding at 0530).

it is just a time saver for the MD. They don't want to get the consent THEN go to the room and talk to the patient and find you to witness. If the patient states they have not been informed, do not press them to sign. Make sure the OR knows the consent is not signed yet.

You actually are not supposed to even get a signed consent until after the provider has explained everything to the patient. It seems to be the other way around. MD says patient is going for a procedure, we get the consent, then they explain everything right before the procedure is done.

I had a patient who was going for a PICC line placement but they refused to sign a consent until they got their INFORMED consent from the MD. I called the MD because the patient and family member were requesting to speak to him regarding the procedure, and he told me as-a-matter-of-factly that the nurses should never get consent until AFTER the patient receives their informed consent. We always do it wrong. He's right.