Should I be asked to get consent without the doctor?

  1. I'm working in a non-teaching hospitals radiology department. Every procedure we do requires consent. In my past life of working in the ICU either the resident had to call the family for consent ahead of time or get the order for it to be deemed emergent. I was always told to never even witness a consent form unless I literally saw both parties sign the form.

    Even when our doctors do bother to see the patient first, they just run through the procedure in two sentences, tell them to ask the nurse if they have any questions, sign a blank consent form, then leave the form on the table for me to fill out and have patient sign.

    The first time I had a family member that wasn't present my coworker called them for me, consented them over the phone then handed me the phone and had me verify consent... they never spoke to a doctor.... two RNs don't make an MD... or did I miss something?

    Then I started seeing this with ICU patients too, instead of bringing the families down, the ICU nurse would just consent them upstairs and have the Rad sign the form when they got downstairs. I've even seen orders that state "consent patient for procedure"

    How is this a legal informed consent if the patient or family never spoke to a doctor?

    Should I be witnessing the form being as though I didn't see the doctor consent the patient?

    Will i be liable for any of this? Or is it ultimately the Rad's responsibility to get permission to do the procedure?

    I'm in Texas, I tried to go through the practice act but it's really vague and I don't have an attorney to interpret it for me. Hoping someone here has thoughts.
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    About GaryRay, BSN, RN

    Joined: Jan '16; Posts: 193; Likes: 482

    18 Comments

  3. by   cleback
    I've been told by a legal consultant that came to speak at my former hospital that the consent forms nurses have patients sign mean little to nothing in court. They said consent is a provider owned process. The consent conversation that the provider has with the patient/family should be documented in the chart.

    That said, I would not sign any form that said the patient has had that conversation with the provider when I know he hasn't.
  4. by   CX_EDRN
    I can only speak for where I live (not Texas), but we don't consent anyone. I can be a witness to consent, but the MD has to actually consent the patient. If I was asked to consent someone I think I would literally laugh in their face. Not my job! Luckily it's never been an issue.
  5. by   Here.I.Stand
    Oh **** no. The physician must consent the pt him/herself -- for their OWN protection in addition to the pt. Do they really want to get sued down the road, when the pt suffers a bad outcome, and it comes to light that the pt didn't give INFORMED consent??
  6. by   KelRN215
    Surgeon is responsible for surgical consent, Anesthesiologist is responsible for anesthesia consent.
  7. by   Pixie.RN
    Quote from Here.I.Stand
    Oh **** no. The physician must consent the pt him/herself -- for their OWN protection in addition to the pt. Do they really want to get sued down the road, when the pt suffers a bad outcome, and it comes to light that the pt didn't give INFORMED consent??
    Yep, this! I can only witness consent, not actually consent patients.
  8. by   hherrn
    Quote from GaryRay
    I'm working in a non-teaching hospitals radiology department. Every procedure we do requires consent. In my past life of working in the ICU either the resident had to call the family for consent ahead of time or get the order for it to be deemed emergent. I was always told to never even witness a consent form unless I literally saw both parties sign the form.

    Even when our doctors do bother to see the patient first, they just run through the procedure in two sentences, tell them to ask the nurse if they have any questions, sign a blank consent form, then leave the form on the table for me to fill out and have patient sign.

    The first time I had a family member that wasn't present my coworker called them for me, consented them over the phone then handed me the phone and had me verify consent... they never spoke to a doctor.... two RNs don't make an MD... or did I miss something?

    Then I started seeing this with ICU patients too, instead of bringing the families down, the ICU nurse would just consent them upstairs and have the Rad sign the form when they got downstairs. I've even seen orders that state "consent patient for procedure"

    How is this a legal informed consent if the patient or family never spoke to a doctor?

    Should I be witnessing the form being as though I didn't see the doctor consent the patient?

    Will i be liable for any of this? Or is it ultimately the Rad's responsibility to get permission to do the procedure?

    I'm in Texas, I tried to go through the practice act but it's really vague and I don't have an attorney to interpret it for me. Hoping someone here has thoughts.
    How is this a legal informed consent if the patient or family never spoke to a doctor?

    Unless the patient was informed of the risks and benefits of a procedure, by somebody qualified to do so, they have not been informed. Pretty sure that has to be the doc, though I did go to a community college for 2 years to get my degree.

    Should I be witnessing the form being as though I didn't see the doctor consent the patient?

    I'm no lawyer, but I feel I can field this one. No. Do not claim to have witnessed something you did not witness.

    Will i be liable for any of this? Or is it ultimately the Rad's responsibility to get permission to do the procedure?

    You will probably not be held liable- You have shallow pockets, so what is the point? But, I would still avoid lying to cover docs who don't do their job corretly.
  9. by   hherrn
    Quote from GaryRay
    I'm working in a non-teaching hospitals radiology department. Every procedure we do requires consent. In my past life of working in the ICU either the resident had to call the family for consent ahead of time or get the order for it to be deemed emergent. I was always told to never even witness a consent form unless I literally saw both parties sign the form.

    Even when our doctors do bother to see the patient first, they just run through the procedure in two sentences, tell them to ask the nurse if they have any questions, sign a blank consent form, then leave the form on the table for me to fill out and have patient sign.

    The first time I had a family member that wasn't present my coworker called them for me, consented them over the phone then handed me the phone and had me verify consent... they never spoke to a doctor.... two RNs don't make an MD... or did I miss something?

    Then I started seeing this with ICU patients too, instead of bringing the families down, the ICU nurse would just consent them upstairs and have the Rad sign the form when they got downstairs. I've even seen orders that state "consent patient for procedure"

    How is this a legal informed consent if the patient or family never spoke to a doctor?

    Should I be witnessing the form being as though I didn't see the doctor consent the patient?

    Will i be liable for any of this? Or is it ultimately the Rad's responsibility to get permission to do the procedure?

    I'm in Texas, I tried to go through the practice act but it's really vague and I don't have an attorney to interpret it for me. Hoping someone here has thoughts.
    How is this a legal informed consent if the patient or family never spoke to a doctor?

    Unless the patient was informed of the risks and benefits of a procedure, by somebody qualified to do so, they have not been informed. Pretty sure that has to be the doc, though I did go to a community college for 2 years to get my degree.

    Should I be witnessing the form being as though I didn't see the doctor consent the patient?

    I'm no lawyer, but I feel I can field this one. No. Do not claime to have witnessed something you did not witness.

    Will i be liable for any of this? Or is it ultimately the Rad's responsibility to get permission to do the procedure?

    You will probably not be held liable- You have shallow pockets, so what is the point? But, I would still avoid lying to cover docs who don't do their job corretly.
  10. by   FurBabyMom
    Quote from hherrn
    Should I be witnessing the form being as though I didn't see the doctor consent the patient?

    I'm no lawyer, but I feel I can field this one. No. Do not claim to have witnessed something you did not witness.
    This is so commonly misconstrued. You are not witnessing the signature itself. You are confirming that the conversation took place. Either you saw and witnessed it by standing there or immediately outside of a room...or...more likely...there are questions on the form that you must ask before signing if you did not see/hear the conversation (physically witness). While different between states and facilities - these address procedure explanations, were risks/benefits and alternatives discussed, (if applicable) was that parts might be performed by an assistant or trainee discussed, have you (pt or legal representative) given permission, etc. If you ask the questions your facility lists on their consent form, it's pretty safe to say the conversation occurred. That is what the witness is doing - saying I saw or I believe this conversation occurred. The information given to patients and families (addressing the above concerns) is the responsibility of the provider or their designee (resident and/or sometimes NP or PA).

    I'm an OR nurse, and I witness consent forms all the time. Sometimes for some reason the surgeons have to get consent on the day of surgery - procedure was added the day of (outpatient or inpatient), the surgical plan revised so a new consent form might be needed, etc. And sometimes, the clinic nurses just didn't complete the form (and sometimes the pre op RNs don't see or address - or I get to see the patient before them - it happens). In the latter situations, I do my interview and ask the questions I normally ask (allows me to assess neuro status). Then I ask the extra questions and if I believe everything was explained well, I sign the form. If not, I page the resident or attending with the concern.
  11. by   JKL33
    I do not involve myself in signing or presenting for the patient's signature, any form that is to be signed under the promise/presumption that someone is going to talk to the patient at some later point.

    I won't sign or present to the patient any form that asks them to attest to something that is clearly false, either, such as "I have spoken with [so-and-so and] had all my questions answered" when they have spoken with no one.

    It doesn't matter how this is parsed, I won't do either of these two things.
  12. by   ArmaniX
    Quote from FurBabyMom
    This is so commonly misconstrued. You are not witnessing the signature itself. you ask the questions your facility lists on their consent form, it's pretty safe to say the conversation occurred. That is what the witness is doing - saying I saw or I believe this conversation occurred.
    Wonder if it is state specific but this is the exact opposite of what is considered true in Florida. While bedside in FL when I would have family/surrogate sign consent. My signature is ONLY confirming that I witnessed the person sign the consent. I am not signing that I witnessed informed consent was provided. "Did Dr SoSo talk with you about placing a central line in your husband? Did you have any additional questions for the Dr?" Sign and sign. This was drilled into us from the Risk department many times.

    That being said, at no point would I attempt to have a consent signed when I knew for fact the conversation never happened or the patient seemed unsure/had questions or the usual 0500 culprit when we figured out the surgeon never got consent during the prior day the typical patient response of "I don't remember if he told me about my big surgery I've been NPO for.." a call to the surgeon/dr is most definitely warranted at that time.
  13. by   bugya90
    I'm in Texas. The spot where you sign on the form is just you witnessing that the patient or legal guardian is in fact the person signing the form. Obtaining informed consent is the providers responsibility. The nurse just witnesses the signature, that's it. I always ask did Dr "Smith" talk to you about X procedure, did you have any further questions, are you still willing to have this procedure done? As long as all of those are good then I have patient sign and I sign that I witnessed their signature.
  14. by   FacultyRN
    Hi there,

    No, you are not able to obtain informed consent for medical procedures as an RN in Texas. The medical provider who is trained in and will perform the procedure is responsible for explaining risks, benefits, alternatives, and answering questions.

    Your signature only indicates that you witnessed the patient's signature. Can you sign without an MD present? Yes, technically.

    Is your patient legally "informed," and are you advocating for your patient if you allow him/her to go to a medical procedure without speaking to the MD first? No, and allowing your patient to undergo a procedure without informed consent doesn't meet the minimum standard of practice.

    You can, of course, obtain consent for all nursing procedures independently.

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