Sign a consent without witnessing actual signature

  1. So I work at a surgeon's office as my main job. One of the duties we have (the LPNs and MAs) is signing the surgical consent forms as witnesses.

    After we room the patient, we fill out some basic stuff on the form and leave it for the provider. Usually the providers are good about holding off on signing the consent until they can track one of us down to witness.

    I don't know what the protocol was before I came to the office as I started at the beginning of this year, but I've had a surgeon not come get me when he and the patient signed the consent form. He just hands me the signed form and apparently expects me to sign it as a witness.

    I will not sign the consent form unless I have heard the provider going over the risks benefits and/or physically seen the patient sign the form.

    Every time I have brought this up with my MA coworkers, they seem to think writing "to sig only" after my name puts me in the clear.

    Would you guys sign a consent form that you physically did not witness being signed?
  2. Visit knotizer12 profile page

    About knotizer12, LPN, EMT-B

    Joined: Jul '18; Posts: 38; Likes: 29

    35 Comments

  3. by   cleback
    Is there any reason that the surgeon cannot sign as a witness?

    I was taught by a legal consultant that consenting is actually a provider owned process. The papers we have patients sign do not mean much legally.
  4. by   knotizer12
    Not sure as to the reason, but our surgery scheduler informed us that they cannot act as their own witness.
  5. by   chare
    The witness certification on our consent form is structured so that we can sign after the physician obtains consent. Rather than attesting that the patient signed the form I our presence, we are attesting that the patient, or person providing consent answers yes to the following questions.
    a) Did a health care provider explain the procedure(s) to you?
    b) Did a health care provider explain that selected tasks may be performed by assistant(s)/resident(s)?
    c) Did a health care provider explain alternative procedures and treatments and their risks and benefits?
    d) Have you given your consent for the procedure(s)?
    e) Have all of your questions about the procedure(s) been answered?
  6. by   Sue Damonas
    When I worked in the hospital the physicians were not allowed to witness their signature and would often come out of a room and expect me to sign it. I would not sign it till the physician walked back in the room with me and had the patient verify that everything was explained and this was their signature. One time one got a phone consent and did not have anyone listen in to witness and asked me to sign it afterward. I made him call the person back with me listening as witness. Never put your job on the line.
  7. by   FolksBtrippin
    Ideally I would be there while the surgeon explained the procedure and answered patient questions. But I doubt that is always possible. Alternatively, I would be okay with signing as long as I talked to the patient myself-- "Did you get an opportunity to talk to the surgeon about your procedure? Can you tell me what's going to happen in the procedure? Do you have any questions?" If I was satisfied with those answers, I would sign. If not, get the doc and say "Patient still has some questions about the procedure." Then sign when I see doc answer the questions and I confirm that patient understands them.

    Consent is not a piece of paper. The point is to have a second person assessing the situation, to make sure that the consent is true consent, meaning the patient understands the benefits and risks and is making a free will choice. In nursing school we were taught that witnessing a consent is not about seeing a physical signature, it's about having the info to know that the patient gets it and is on board.

    There could be instances where a patient signs and you still should not witness the consent. Example: You watch doc explain to patient that he will amputate the right foot. Doc signs the consent and then leaves you to get patient signature and witness. Patient signs the consent form, then hands it to you and says, "I'm really glad I will get to keep my foot." Do you sign the form? The answer is no. You do not. You go get the doc and tell him that patient does not understand the surgery and you do not currently have consent.

    As long as you understand that you are agreeing that the patient understands what is going on, it's okay to use your judgment on whether or not to sign.

    I think we run into problems when we give this kind of responsibility to someone who is not licensed. It's not really fair. MAs should not have to assess patient knowledge, and should not be placed in a position where they might have to challenge a surgeon. But that is not really part of the original question.
  8. by   knotizer12
    Ok so here is how I handled this case: I called the patient and asked him if he felt he was provided adequate information regarding the procedure. He said he was and denied having any other questions and was able to describe it to me. I felt comfortable signing the consent form. I still would like my providers to have the patient sign in my presence but it worked out this time.

    I guess I can agree somewhat regarding MAs and consents but isn't that why you have the witness in the room when the patient and the physician sign? To actually witness that everything is explained?
  9. by   Rose_Queen
    Quote from knotizer12

    I guess I can agree somewhat regarding MAs and consents but isn't that why you have the witness in the room when the patient and the physician sign? To actually witness that everything is explained?
    You are only confirming that the patient signed the consent. Do I ask if they have any questions and if the procedure was explained? Yes. Have they signed it while not in my presence? Yes. Which is when I ask "Is this your signature allowing us to ..." It is not uncommon for the explanation with the surgeon to occur in an inpatient unit but for the consent not to be witnessed until the patient is in the preop area. Even if it is witnessed, I still have the patient verify that it is their signature on the consent.

    From OR Manager:

    "Q: Do nurses witness the signature only or give their signature to
    verify patients' understanding? (Nurses never seem to get this
    right.)
    Balfour: At a minimum, nurses or other care providers witnessing the signature
    should be confident the patient himself or herself is signing the consent,
    and the patient is competent to sign. The nurse should make sure the patient
    is not impaired by medications in agreeing to the procedure. Competency can
    also relate to age; for example, the nurse should ensure minor patients' consents
    are signed by the responsible parent(s) or guardian.
    While the responsibility for informing the patient and obtaining consent
    rests with the physician, witnessing the patient's signature on the consent is
    the optimum time to ensure the patient has had all questions answered about
    the procedure. While the nurse may not be, the doctor is required to verify the
    patient's understanding and consent. (Sometimes doctors don't get this right.)
    The nurse asking, "Has the doctor answered all of your questions about the
    procedure?" is a good step. If not, the consent process is not complete, and the
    doctor should be sought out before the surgery to get the questions answered.
    Nurses should be careful, though, not to offer advice about the risk/benefit calculations;
    such calculations and advice should be left to the doctors.
    The contemporaneous signature of a witness serves 2 purposes. First, it
    impresses upon the patient the importance of the document the patient is signing.
    Second, it documents a part of the informed consent process, namely the
    patient's agreement to undergo the procedure. The facility benefits from the
    nurse assuring the patient's comprehension. The nurse is not required to verify
    the patient's comprehension of and consent to the procedure to protect his
    or her own liability, but the nurse's doing so helps to protect the facility from
    liability, both by assuring that the patient has consented and continuing good
    open communication with the patient."

    https://www.google.com/url?sa=t&rct=...V5_55gjJIUVAnf
  10. by   LovingLife123
    I know every facility is different but it doesn't make sense to me to have a nurse or MA physically witness a consent. The only time I have sign a witness is a phone consent. Otherwise, the surgeons are perfectly capable of getting consent on their own. To me, it's not within our scope of practice to judge the physician explaining the procedure to the patient. They know their procedures much better than me.

    For a phone consent I simply ask who the person is, their relation to the patient, and do they have any additional questions. Obviously we are not getting phone consent from the patient in the hospital.
  11. by   OldDude
    To simply answer your question...no.
  12. by   hherrn
    "Every time I have brought this up with my MA coworkers, they seem to think writing "to sig only" after my name puts me in the clear."

    I am not sure what kind of legal training MAs get, but that doesn't sound right. Now maybe if they wrote "Not witnessed, but I signed it because he told me to and I like my job", that would hold up.

    " a person who observes the signing of a document like a will or a contract and signs as a witness on the document attesting that the document was signed in the presence of the witness."

    Has anybody here ever seen a written policy stating that a "witness" does not have to witness? Or, is more like "well, I was told...."

    BTW, I do it fairly regularly. But I am under no illusion that it is the right thing to do.
  13. by   FolksBtrippin
    Quote from knotizer12
    Ok so here is how I handled this case: I called the patient and asked him if he felt he was provided adequate information regarding the procedure. He said he was and denied having any other questions and was able to describe it to me. I felt comfortable signing the consent form. I still would like my providers to have the patient sign in my presence but it worked out this time.

    I guess I can agree somewhat regarding MAs and consents but isn't that why you have the witness in the room when the patient and the physician sign? To actually witness that everything is explained?
    Not exactly. You are assessing your patient, for whether or not they consent to the surgery. You are not assessing the doctor for whether or not he explained the surgery.

    Edited to add: It makes sense that an MA would write "to sig only" on the witness line. That protects them from looking like they went outside their scope, since they really aren't qualified to assess the patient's understanding. They are essentially stating, I saw the patient sign this. As a nurse, this isn't really enough. You have a responsibility to perform your own assessment of the patient.
    Last edit by FolksBtrippin on Sep 11
  14. by   JKL33
    One of the problems with compromising on stuff like this is that it always morphs over time via interpretations and misunderstandings that are passed on person-to-person.

    Frequently, this consent issue morphs to the point that no one has talked about anything and yet the form is being signed and witnessed. Nurses have a great tendency to conflate signing the form with obtaining the consent. The two are not the same. The person performing a procedure is (generally) the one who can/should obtain a legal consent. The form is separate, and is merely an attestation by the patient that they have had the conversation, understand what's going to happen and why, and have indeed given consent.

    If I wasn't present for the consent conversation, then the only thing I could possibly be attesting to/witnessing is the signature itself. So no I would not be signing if I hadn't witnessed it.

    If you're ever aware of a situation where things aren't quite as they should be, you will learn to be prickly about this. If you're working in a situation where you are expected to have all forms signed when literally no one to be involved in the procedure has met the patient, you will learn to be prickly about this. I have successfully put my foot down about this very thing. It's not okay. In many instances, the nurse making sure this is done correctly is THE one and only stop-gap. For instance, if I agree to have patients sign things because someone upstairs plans to talk to them about something, I have just foiled the entire process of making sure that it actually happens. I get sick of people going along with stuff like this.

    We are there for patients.

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