informed consent

[shortd]

The way I understand it an informed consent is when the MD explains the risks/ benefits of an invasive procedure to the pt/ representative and the nurse's only legal obligation is to witness that the pt consents to the procedure. I dutifully carry out the order "obtain consent for such and such" of probably 90% of the procedures done on my pts. Will this bite me if there's a lawsuit about a procedure I signed the consent when legally speaking there was no consent? Should I go to the administration about this?

[psu_213, BSN, RN]

And it does not have to be a nurse who witnesses the consent. Anyone in the room can witness the consent--by witnessing, that person is not saying they understand the procedure and risks, they are not saying the physician properly explained the procedure/risks...the witness is just saying that the pt's/guardians signature is actually their signature.

The RN cannot obtain consent for the procedure because they cannot adequately explain the procedure/risks and answer the pt's questions re: procedure/risks. Must be done by the provider.

[usernameallnurse]

The nurse's legal obligation is to make sure the patient SIGNS the consent: that is, match the name on the arm band to the name signed, to verify identity, then the nurse signs as a witness to the signature.(kind of like a notary). The nurse is NOT obtaining consent, nor is she a witness to anything the surgeon told the patient to inform him.

So is the consent already signed by dr and pt. then nurse verifies by asking pt if they and dr discussed procedure.

[Here.I.Stand, BSN, RN]

What I was taught was 1) to meet the legal definition for informed consent, the provider performing the procedure was to instruct the pt on the risks, benefits, and alternatives. Not the bedside RN--the provider performing the procedure. 2) The provider and the pt have to sign the consent form. 3) So since the provider is in the room and signing the form, he/she should have the pt sign at the same time. It makes ZERO sense to talk to the pt, sign the form, and then ask someone else to make a special effort to go BACK into the room and get the pt signature...when he/she, the form, the pen, and the pt were just all in the room together. I was taught that this is a HUGE legal risk to the RN, should the RN "get" the consent.

I came straight out of school refusing to "get" consents, and still refuse. Actually it's not an issue w/ most of our providers, but once a urologist asked me to get consent for a cystogram. Now we usually see urology only for traumatic bladder injuries and I had never seen this gentleman before, so I said "Here, I'll show you where we keep our consent forms." I got a form and a pt label, stuck the label on the form and handed it to the MD. He got the idea, although if he'd pressed it I would have said outright "No, I'm not the provider performing the procedure. You need to 'get' the consent." (I was pretty busy when this happened--in the middle of report after a long noc shift to be exact, so I didn't feel like a big drawn-out conversation.)

The only time I get involved in consenting is if the family is not physically present, and the provider has to obtain it over the phone. In that case I have sat right next to the provider and listened to him/her talk to the family; then I talk to the family to verify that they have had all of their questions addressed and that they agree to the procedure, and I sign that I witnessed the provider obtain a telephone consent. Of course, if our providers got UNinformed consent like what Chico David described from a few years ago ^^^ I'd have to get on the phone and tell the family member "I need you to ask Dr. Patronistic to tell you what the risks and benefits are, and then I can witness this consent."

[usernameallnurse]

Thank you for you reply

[Tenebrae, BSN, RN]

In district nursing I would regularly gain consent for treatment. Basically if the patient didnt consent there was nothing we could do.

The nurse's legal obligation is to make sure the patient SIGNS the consent: that is, match the name on the arm band to the name signed, to verify identity, then the nurse signs as a witness to the signature.(kind of like a notary). The nurse is NOT obtaining consent, nor is she a witness to anything the surgeon told the patient to inform him.

[Rose_Queen, BSN, MSN, RN]

In district nursing I would regularly gain consent for treatment. Basically if the patient didnt consent there was nothing we could do.

Is that the consent to be treated by the district nurse? If so, that's quite different from consent for invasive procedures/surgery. My facility gets consent for treatment by admission clerks, PCAs in direct admit areas (such as the outpatient units), and registrars in the ER. However, only a provider (preferably the provider performing the procedure, but one in the same practice / surgical group will be accepted) can obtain consent for invasive procedures such as cardiac caths or surgery.

[nurseprnRN, BSN, RN]

Everybody will always tell you that all you're witnessing is the patient's signature. However, that's a cop-out that reveals an ignorance of what our professional duty as RNs is. It is our duty (and that's a legal term) to provide patient safety, and that includes being sure the patient understands what he's consenting to.

If you have any concerns whatsoever that the patient does not understand the terms of the form or what the physician told him, you have a duty to act. This might be calling the physician to come and explain until the patient understands, to refuse to transfer the patient to OR or IR or whatever for the procedure, to provide nursing teaching to the patient (being careful not to cross over the line from the med/nursing shared body of knowledge), or whatever else is necessary to protect him.

[NicuGal, MSN, RN]

Never get consent! The consent has to be signed by the provider performing the procedure, not the resident on the day before, not the attending going off service the day of, the actual person. Where I work we only witness phone consents by asking if the person understands what they are told and what body part is involved. And they have to sign the consent personally when they come in.

[BrnEyedGirl, BSN, MSN, RN, APRN]

OP have you read your consents? Ours all clearly say that XYZ procedure is being performed by Dr A, explained clearly by Dr A and that the pt has had the opportunity to ask questions and that all questions have been answered by Dr. A. That is how I introduce my consents, "This is the consent for XYZ, that states that the Dr has fully explained the risks and benefits and that he has answered all of your questions", if the pt has further questions or states that he hasn't seen Dr A then we don't sign consent!

[IVRUS, BSN, RN]

Never get consent! The consent has to be signed by the provider performing the procedure, not the resident on the day before, not the attending going off service the day of, the actual person. Where I work we only witness phone consents by asking if the person understands what they are told and what body part is involved. And they have to sign the consent personally when they come in.

I believe that when you are talking about surgery to remove a body part, or surgery to fix an ailment and the MD is the one doing the procedure, then yes, the MD should be the only one explaining and obtaining consent. However, as a PICC nurse, we place invasive catheters all the time, and since we are the ones doing the insertion, we are the ones to explain the procedure and obtain consent.