Consent forms?

[SouthernLPN2RN, MSN, RN, APRN, NP]

Who gets surgical consent forms signed? In my experience, the nurse has always been the one to get the pt to sign, but now that I'm coming back to the hospital, I'm hearing that the Dr is supposed to be the one to obtain the signature.

[HappyNurse2005, RN]

Doctor. IN theory, they are supposed to explain the procedure, risks, benefits, alternatives, blah blah blah and they sign it, and the patient signs it.

I have had one doc who was going to do a cath who explained it to the pt, but then wrote an order asking nurse to get pt to sign it. (why? i don't know. maybe he was too lazy to find the consent form?)

[jmgrn65, RN]

Not in my hospital, The doctor should be explaining to the patient about the procedure.

[AuntieRN]

What we have learned in school (this question comes up every semester) is...it is the doctors responsibility to explain all procedures to the patient, but the nurse can actually have the patient sign the consent once they agree to the procedure. The way it was explained to me..and hopefully I am understanding this correctly is this means the nurse is witnessing the signature only. The doctor is supposed to put an order in the chart with the exact procedure being done and the nurse can fill out the consent and once she is satisfied the patient does indeed understand then she can hand the consent to them and witness them signing it. The doctor has already actually gotten the consent (supposedly). Am I understanding this correctly? because to me this is the same as the nurse obtaining consent. This is also what I have been witnessing throughout my CNA and student nurse careers.

[elkpark]

What we have learned in school (this question comes up every semester) is...it is the doctors responsibility to explain all procedures to the patient, but the nurse can actually have the patient sign the consent once they agree to the procedure. The way it was explained to me..and hopefully I am understanding this correctly is this means the nurse is witnessing the signature only. The doctor is supposed to put an order in the chart with the exact procedure being done and the nurse can fill out the consent and once she is satisfied the patient does indeed understand then she can hand the consent to them and witness them signing it. The doctor has already actually gotten the consent (supposedly). Am I understanding this correctly? because to me this is the same as the nurse obtaining consent. This is also what I have been witnessing throughout my CNA and student nurse careers.

Your explanation is correct. The person who will be performing the procedure (the doc/NP/PA) is responsible for explaining the procedure, risks/benefits/alternatives, etc., so that the client is in a position to give informed consent. Typically/traditionally, the nurse actually gets the signature on the piece of paper (after generally confirming that the client does understand the procedure). All the nurse is doing is witnessing the client's signature on the piece of paper -- documenting on paper the (verbal) consent which the client has already given the physician (that's why the nurse is not "obtaining consent").

[Daytonite, BSN, RN]

This should be explained to you during orientation. When a nurse get a surgical consent signed, you are merely witnessing the patient's signature. The patient is signing a document affirming that the doctor has spoken to him about the surgery he is about to have and has explained the pros and cons as well as all the complications that can occur, thus informed consent. It may be that the facility that you are going to be working in has made it a policy that the surgeon himself get the consent signed. I'm still having patient's sign consents and witnessing them.

[zacarias, ASN, RN]

You are witnessing the patient's signature yes, but ethics dictate that you do verify that the patient's Dr. has discussed risks, benefits, and alternatives with the patient. This is usually verified by asking the patient if the Dr. did indeed talk to them. Of course, the best situation would be a hospital policy that required a Dr. to write in the progress notes that he/she has discussed said procedure, benefits, and risks etc.

[Sumatra]

Interesting. I recently had a needle biopsy and the nurse explained the procedure and had me sign the form. Then the doctor came in. I had only seen the doctor briefly once before and she didn't explain anything. However, when I looked at the doctor's notes, the implication was that the doctor had obtained consent. Fortunately, everything went well and the nurse had covered everything thoroughly. This is unusual, however. Generally, the doctor explains the procedure, although not necessarily at the time the forms are signed. A nurse often obtains the signature.

[veegeern, BSN, RN]

We have short forms for a few routine tests such as EGD, Colonoscopy, etc...and for some procedures such as central line placement. Only the patient and nurse sign these. The nurse's line is actually labeled "witness." Our long forms give consent for surgical procedures. The Dr completes the consent and signs stating that they've covered the info with the patient. The patient signs giving consent and again the nurse's signature line states "witness." I have had a surgeon obtain verbal consent from the patient via telephone, and then call me at the nurse's station requesting that I have the long form signed. However, it's our hospital policy that the MD complete the long form BEFORE the patient signs the consent...makes sense to me.

[meownsmile, BSN, RN]

We always get signatures on consents. I dont know that ive ever seen a doctor take one in and have it signed. They write the order, supposedly after they speak and explain the procedure and we take the consent in and have it signed. I have called a doctor to come back to the floor and talk with the patient and family after he wrote for a procedure. I will not let a patient sign if they have any questions at all about what is going to be done.

[pricklypear]

Interesting. I recently had a needle biopsy and the nurse explained the procedure and had me sign the form. Then the doctor came in. I had only seen the doctor briefly once before and she didn't explain anything. However, when I looked at the doctor's notes, the implication was that the doctor had obtained consent. Fortunately, everything went well and the nurse had covered everything thoroughly. This is unusual, however. Generally, the doctor explains the procedure, although not necessarily at the time the forms are signed. A nurse often obtains the signature.

Wow. That's pretty poor practice. But I'm sure it happens all the time, especially with procedures like that. Technically, you were not adequately informed, and were not given the opportunity to ask questions about risks and alternatives of the doctor who performed the procedure.

All our consent forms (whether for surgery, or procedures) state that "I,________, have been informed by Dr. __________________ blah, blah, blah." I never have anyone sign consents unless the doctor (or NP/PA) has been IN to SEE the patient, and discussed the procedure. I always ask first whether Dr So and So spoke to them. If not, Dr. So and So gets a call from me. That's only happened a couple of times, thank goodness!

[bethem]

In my uni we are taught, and I have seen it in practice, that it is absolutely the doctor's responsibility to get the consent form signed. Recently I saw a patient who was due to go to another hospital to have some minor procedure, possibly an angiogram or something, done, and the transport was waiting, but the patient was not allowed to leave until the doctor came back and got the form signed. Several nurses including me witnessed the doctor telling the patient about the procedure, but the doctor still had to be the one to get the form signed.