Does the MD just say "Get the consent?"

mindlor · Apr 29, 2011

http://www.baylorhealth.edu/proceedings/13_2/13_2_thornton_cme.html

The above link explains how things are in TX......it is clear that the process of obtaining informed consent is the nondelegatable duty of the physician.

If the nurse takes on this duty, the nurses title can quickly go from nurse to defendant and probably not from defendant back to nurse....

I have to assume that this is fairly standard across the US....

So, I would say don't do it....

You dont ask the docs to do peri-care or change dressings do you?

Obtaining consent is their job

deemalt, BSN, RN · Apr 29, 2011

At my hospital, nurses always get consent. A few of us have questioned this but I have never been able to find something in writing (or on line) to prove otherwise. I am in CA. Most of our patients have a POA (LTAC) and we do a phone consent witnessed by 2 nurses.

Does it make a difference if it is a POA or does the surgeon have to explain procedure in this case too?

mindlor · Apr 29, 2011

my text, kozier and erb's fundamentals of nursing states that a nurse may be asked togather the signed form from the client. for example, say a client is in hospital awaiting surgery....the client may speak to the doc on the phone for an explanation of the procedure and then the doc may call the nurse to have the patient sign the form. the important thing here is that under no circumstance should the nurse attempt to explain the procedure.

this attempt at explanation is what opens the nurse up to liability. the nurse is responsible for assessing the patient and making sure consennt is being given voluntarily, that the signature is authentic and that the client is competent to give consent.

if the nurse has any concerns the nurse should abort the mission and call the doc. generally the person who is going to perform the procedure should obtain the consent.

paraphrased from,

[color=#333333]berman, a.j., snyder, s., kozier, b., & erb, g. (2008). kozier & erb's fundamentals of nursing: concepts, process, and practice (8th ed.). upper saddle river, nj: prentice-hall.

canesdukegirl, BSN, RN · Apr 29, 2011

Oh heck no! I would never in a million years try to explain a procedure for a consent, even if I know the procedure backwards and forwards. It is out of my scope.

Here is a thought provoking question: if a nurse did, in fact, obtain a consent without the doc explaining the procedure to the pt directly (or to the POA), would the consent then be considered null and void? I think I'm gonna research that one.

OP, if you are getting chewed out by the surgeon, take his happy butt directly to your NM's office and have THEM explain to this jackwagon that the consent is HIS responsibility. He is bullying you.

Crux1024 · Apr 29, 2011

Like many others, I only have the consent signed if the doctor has already spoken with them and answered ALL their questions. Sometimes the docs go in and explain but dont have a consent readily available, so they write an order to obtain one. Thats the only time Ill do it, I havent been told about it otherwise.

linearthinker, DNP, RN · Apr 29, 2011

This is a process problem. Those of you being asked to do this need to go to the VP of Nsg or whatever the top dog is called.

HeartRNBSN · Apr 29, 2011

I will share a story with you...

We had a patient come into our department once that was scheduled for a cardiac catheterization. The nurse assigned to this patient had previously worked in LTC and was unfamiliar with the consent process, not to mention just off of orientation. The physician, who would try any stunt with any nurse to get out of doing his job (I'm sure you know the type). This nurse got the consent for the procedure at the physician's requet. When the patient had questions, she told him to ask the physician before the procedure. The patient went down, was unable to see the physician beforehand (assumed that he was in good hands), and had the catherization done. However, no one had relayed the patient's bloodwork (creat 4ish) to the physician, assuming that he had seen the result and that Mucomyst was given. To make a long story short, the patient developed "trash foot" which led to an amputation and his kidneys were so badly damaged from the IV dye and post-op antibiotics that he required dialysis until he died from sepsis. The family filed suit and won. The nurse's license was supsended for 2 years for practicing outside of her scope, not sure what happened to the physician but he was mysteriously gone after the papers were served.

So please, DO NOT OBTAIN CONSENT FOR PROCEDURES!!!

PAROPPY, BSN, RN · Apr 30, 2011

Do not obtain consent for the MD. If the MD has time to explain the procedure and answer questions about the procedure then they have the time to get a piece of paper and have the patient sign it (even if they have to walk out of the room to get said piece of paper bc one isn't readily available). What if something went wrong during the procedure and it comes to light that the MD didn't obtain the consent...you did. I'm sure that can lead to a lawsuit. Even if you ask the patient if they understand everything and something goes wrong they could always go back and say my nurse didn't explain things to me and that would put you on the hook bc you got the consent not the MD (at least the MD would have scope of practice to back him up). Long story short...not worth it.

OCNRN63, RN · Apr 30, 2011

When I was in nursing school it was drummed into my head that the MD explains the procedure and gets the consent; I am just there to witness. After nursing school, I have never seen that. The MD will mostly just write in his orders "Get consent" and then here I go, off with a clipboard and a consent to a procedure I don't fully understand, trying to answer questions posed to me from anxious patients and families. If it's something easy like a colonoscopy, fine. But I shouldn't have to do that either should I?
The reason I'm writing this, is surgery just called and chewed me out for not using the language line (Hindu) to get the consent. The patient now says he didn't understand the procedure. Like I good nurse I took the chewing. Afterward, I started thinking about nursing school. And I won't forget either.
So what do you do? Get the consent like me, and hang your head when you've goofed against something that wasn't your job?

No, no, no.

I used to work in surgery (pre-op), and some of the surgeons tried to pawn this off on us. It is their job to obtain the consent and explain the procedure to the patient, not the nurse's job. Whenever a doc would try this with me, I would flat out refuse, and it was one of the few things mgmt. would back us nurses up on. It was actually a risk mgmt. issue.

I would call the doc who wrote the order and tell him/her that I will not get the consent, and that it is his/her responsibility to do so.

I wouldn't even witness a consent I hadn't heard. Who knows what the doctor actually told the patient? If I wasn't there, I am not signing my name to it.

nurse.sandi · Apr 30, 2011

The only consent I am concerned about getting in writing is the blood consent. As far as I am concerned it is the surgeon or Drs responsibility to get consents for procedures they are going to perform. Also, I was trained to never witness anything for a client. The only witnessing I do is for narcotic wastes, getting a new back up box, and insulin doses. Check with your facility and see what their policy is.