Informed Consent

Published

Specializes in ER, ICU, Education.

When obtaining informed consent, who does what. My understanding is the doctor or NP performing the procedure explains the risks and benefits to the patient and other options. The doctor has the patient sign the form. Nurses sign the form only indicating the patient (or authorized agent of) signed the form. An RN's job is to be patient advocate and have the Doctor performing the procedure thourghly explain the procedure, the nurse can put things in terms the patient understands etc. But it is not the nurses job to actually obtain the consent and expalin the risks benefits, is it?

Up Vote Up Vote ×

By signing a consent form, we, as nurses are acting only as a witness to the signature.

Before I obtain consent, I ask the patient if they have any questions regarding the procedure and if the doc explained everything. If they say no "I don't understand ____", I inform the doc that they need to come in and explain the procedure to the pt more fully. I have had this happen only twice. The docs involved were not happy with me but..........TOO BAD!!! One came in and answered the pt's questions. The other talked to the HCPOA over the phone and answered questions that way.

Up Vote Up Vote ×
Specializes in ER, ICU, Education.

The reason I ask is where I work now we just sign that the patient signed the form. We (RN's) try to ensure the pt is A&Ox3 and understands and things were properly explained to them. But that is another matter, we just sign that the patient signed the form. Appearently, around this city, nurses explain the risks and benefits and have the patient sign the form and the nurse signs the form as a witness. Then at some later time the doctor signs it. My father is in the hospital and had to have a PICC line put in. His staff nurse came in and said "We need to put in a special intervenous access so we dont have to stick you so often. Is that OK? " sign right here. My dad was not A&Ox3 and dosed off couple times during that short exchange. the PICC was then placed without diff iculty. The reason I think it is accepted practice is many years ago I was working agency to make a few extra bucks. At another hospital in this town where I was working nights I had a patient come in for some sort of "minor" surgery the next AM. The doctor called and gave me a list of orders. Then he said, Oh yea, make sure you get consent." I explained that doctors get consent nurses just sign as witnesses. He did not really get mad but you could tell it was a major inconvience to him. He then called the charge nurse and she came and told me to get consent. I said no, you get it and I hope they dont need me to work there anymore. Anyway I thought it was just those few doctors and nurses on that floor. That was not the reason but I have not worked agency since. I am just trying to find out how wide spread this practice is and if I was wrong back then.

Up Vote Up Vote ×
Specializes in Telemetry, Case Management.

It has been my experience that MD's that actually fully explain everything are few and far between. Some do, but most, especially for minor procedures especially PICCs expect the nurse to explain and get the consent. I'm not saying that's right, but that seems to be their expectation.

I saw an incident the other day where the MD had called the nurse and said make him NPO after MN. During report, the nurse told me the pt was NPO but had no idea what for. During report, OR called and said they were coming to get the patient!!!! The other nurse told them to the pt was NPO, he didn't know what for, the patient didn't know what for, and if they wanted to come get the patient's consent, that was fine with him!!!! An OR nurse came up and got the pt, and said they would get his consent down in holding. HOPEFULLY the MD explained to the pt.

Up Vote Up Vote ×
Specializes in ER, ICU, Education.

Maybe this would be a good issue to look into for my masters thesis. The entire concept of informed consent seems to me to be at the core of what nursing is and does. Patient Advocacy (maybe I cant spell it but I know what it is).

Up Vote Up Vote ×

The concept of negligence is applicable to nursing and the process of obtaining "informed consent." That is, the requisites for a finding of negligence are that the preponderance of evidence demonstrates: 1. Duty 2. Breach of Duty 3. Causation (actual and legal) 4. Damages

The duty is the standard of care for nurses which is what a reasonable nurse using ordinairy prudence would do under the same and/or similar circumstances. Given the great variabilities involved in obtaining an "informed consent", application of these principles provide both the ethical and legal frame work for decision making with regard to the same.

I am an R.N. and a Certified Legal Assistant. I am not an attorney. :rotfl:

When obtaining informed consent, who does what. My understanding is the doctor or NP performing the procedure explains the risks and benefits to the patient and other options. The doctor has the patient sign the form. Nurses sign the form only indicating the patient (or authorized agent of) signed the form. An RN's job is to be patient advocate and have the Doctor performing the procedure thourghly explain the procedure, the nurse can put things in terms the patient understands etc. But it is not the nurses job to actually obtain the consent and expalin the risks benefits, is it?
Up Vote Up Vote ×
Specializes in ER, ICU, Education.
The concept of negligence is applicable to nursing and the process of obtaining "informed consent." That is, the requisites for a finding of negligence are that the preponderance of evidence demonstrates: 1. Duty 2. Breach of Duty 3. Causation (actual and legal) 4. Damages

The duty is the standard of care for nurses which is what a reasonable nurse using ordinairy prudence would do under the same and/or similar circumstances. Given the great variabilities involved in obtaining an "informed consent", application of these principles provide both the ethical and legal frame work for decision making with regard to the same.

I am an R.N. and a Certified Legal Assistant. I am not an attorney. :rotfl:

I am not trying to be funny, I think that is exactly what I am asking. Are reasonable, prudent and comptetent nurses getting consents for doctors so the doctor does not have to? Is that the standard of care now? "Great variablities" get lots of people in trouble.

Up Vote Up Vote ×
Specializes in cardiac/critical care/ informatics.

We are always the ones to get the consent, however the MD should have discussed the risk and benefits to the patient. If the patient doesn't understand then he/she doesn't sign it, I then call the doctor and let him know that the patient still has questions.

Up Vote Up Vote ×
Specializes in ER, ICU, Education.
We are always the ones to get the consent, however the MD should have discussed the risk and benefits to the patient. If the patient doesn't understand then he/she doesn't sign it, I then call the doctor and let him know that the patient still has questions.

Should have discussed. Do you hear them? Legally I know if I sign that the patient signed, that is my legal obligation. But that is not even close to my professional obligation to my patient. I am not trying to argue, I am really not a young, idealistic RN, I am old, grizzeled and I think practical nurse I really am investigating this for my personal growth and if I find a vast difference this subject might make a good article or paper for my project. Maybe I should change my thinking about this. I know no doctor discussed the PICC line procedure with my Dad, ever.

Up Vote Up Vote ×
Specializes in CRNA, Finally retired.
Should have discussed. Do you hear them? Legally I know if I sign that the patient signed, that is my legal obligation. But that is not even close to my professional obligation to my patient. I am not trying to argue, I am really not a young, idealistic RN, I am old, grizzeled and I think practical nurse I really am investigating this for my personal growth and if I find a vast difference this subject might make a good article or paper for my project. Maybe I should change my thinking about this. I know no doctor discussed the PICC line procedure with my Dad, ever.

"Informed " consent is a philosophical, ethical, legal and practical issue. I believe that it is a vague ideal and in court cases, most consents are useless. Writing an essay on this concept is a great idea. How can a nurse signing a consent signify that the patient 'understands" anything? How can we know what the patient understands in relationship to what he was told by the surgeon? We can only truly attest that the patient himself signed the consent and that's it. It would be better, imh, to give the patient a consent that describes the procedure in general and have the surgeon add any specifics. I've seen a three page consent that one of our back surgeons uses for his spines, in which he doesn't spare the negatives. Excellent consent - protects both the surgeon and the patient.

Up Vote Up Vote ×
+ Join the Discussion