Legal/ethical question-signing as a witness for consent

[ILMRN]

This may be more details than necessary, but I’m just frustrated after a crazy day and am wondering if anyone has gone through a similar experience.

A baby I was caring for unexpectedly needed to have a Broviac placed as the UVC needed to be removed (low lying) and multiple PICC attempts had failed. The parents live 2.5 hrs away and weren’t present at the time. The OR called and wanted the baby right then, so I packed the baby up and headed to preop with my RT. As soon as I got there, the baby crumped and needed intubating (28 weeker on CPAP that was exhausted from the move and PICC attempts-not shocking). Mom and dad were on their way but didn’t make it there before we had to move to the OR and intubate. The UVC was still functioning so the surgery itself was not an emergency, but had to be done right away because of the surgeon’s availability. Apparently the parents knew this would be a possibility, but the surgeon and anesthesiologist hadn’t gotten consent yet as they were waiting to see if the PICC attempts would be successful.

All this to say, I was not present when the surgeon or anesthesiologist actually called to get phone consent. They called after we had to move from preop to the OR so we could actually go ahead and intubate. I assumed that when the time out was done in the OR, someone should have caught that no one witnessed the consent. In my hospital, policy is that phone consent requires two witnesses. Although the parents showed up after the surgery and acted understanding, I never saw or heard from them prior to the surgery as I was in the OR stabilizing the baby. Now my charge nurse wants me to sign (and back-time the date/time) as a witness so the consent is complete in the chart.

Am I wrong for refusing to sign this? I feel that signing as a witness to something I did not actually witness questions my integrity and puts my license in jeopardy. I did not witness any consent and I did not even perform the time out, so why am I having to deal with this now? Why is it my problem and not the surgeon’s?

If you made it this far, thanks for reading! Any input is helpful!

[ArmaniX, MSN, APRN]

Sounds like proper consent was not obtained per hospital policy. I think that you have two concerns here.

1. Witnessing a consent that you did not “hear” the provider consent family over the phone. It may vary by state but where I am from when I was I bedside nurse I signed my name on the consent I was only “witnessing” that the parent or whomever signed the document. If they said the doctor talked to them and they had no questions. Good and done deal. Sign away. If they had additional questions, I’d get them the provider.

2. Signing a consent and back dating/time your signature to form the appearance that everything was done per hospital protocol. I would not do this... if the charge is asking you to forge the consent and place a time/date other than the time of signature well then I’d just tell the charge that they can forge the document themselves and use their own signature.

[NurseBlaq]

Nope, you're not wrong. I would tell the charge nurse to sign it herself.

[JKL33]

Had you been able to speak with them on the phone after the surgeon and confirm their basic understanding, acknowledgement of and agreement with what was happening, signing would be appropriate (would note the proper time of the phone convo). Since that didn't happen/wasn't possible, no I wouldn't sign.

[ILMRN]

Thank you all for your answers. I don’t want to make trouble, but I’d never want to put my integrity or license on the line.

[jdsmom, RN]

I actually work as an RN in the operating room at a pediatric hospital. You are absolutely right to NOT sign it now or back date. Ultimately, the circulating nurse in the OR is responsible for ensuring the consent is signed and witnessed. Personally, if it was me in the OR with this patient, we could have intubated, stabilized the baby, and then got the parents on the phone to ensure they are on board with the broviac and then witness consent. The doctors would probably roll their eyes and say it's not necessary, but that's where I have learned I have to stand my ground. If they want to call it an emergency and document that in their op note (which is what is required at our hospital in order to perform a procedure without consent) then I'm good with that. Then it's on them. I have had to put my foot down sometimes about this, and they never like it, but my license is on the line. This situation sounds like a serious gray area that should be looked to ensure if it happens again that a proper process is followed so you can feel right about it. I think the Charge Nurse shows a horrible example by telling you to back date a consent. That's a serious violation of ethics.