nurses getting consents signed?

banditrn · Dec 21, 2006

I was taught in school that the nurse can get a consent signed AFTER asking the patient if the doctor explained the procedure and risks and asking the patient if they understand or have any questions. If the nurse has the patient sign, the nurse is signing as a witness only to the patient signing the consent. The nurse is not signing that she/he explained anything. That part is the physician's responsibility. If the patient states that the doctor has not explained, if the patient doesn't understand, or if the patient has any more questions for the doctor, then the signing of the consent is held off until the physician talks to the patient and the patient then fully understands.
This is also protocol in each hospital I've worked and we witness the signing of consents all the time. Again, we are only witnessing that the patient signed it.

This sounds right to me.

nurseangel47 · Dec 21, 2006

When I worked med/surg we nurses got the consent forms signed all the time. Again, as above posts stated, only as a witness to their signing the consent...not as having explained the processes of alternate therapies, complications, etc. that was the surgeon's job. If they had questions or were hesitant to sign, we then had doc see them again before the consent was signed...this rarely happened. They usually signed away. If there were unanswered questions, we would hold off until all info was answered.

Again, we were merely signing as witness to their signature.

zacarias, ASN, RN · Dec 21, 2006

While I agree that nurses do this all the time, I always think of it as a pt advocacy issue. Yes, while you are just witnessing the signature, the nurse has an ethical obligation to to make sure that the patient understands the procedure for which is signing, the benefits, risks, alternatives etc. It hard to verify this when the doctors and surgeons do this prior without us in the room.

While we may never change that, I think that the following would help make nurses feel better about the whole situation. When patients verbally give consent to the doctor about whatever procedure, the doctor simply writes in the chart progress notes, "Such and such procedure explained to patient including risks, benefits, alternatives, and outcome. Dr. Ilike Nurses."

classicdame, MSN, EdD · Dec 21, 2006

The MD should get the consent signed and they know it. Just tell them, sorry, but that is not our policy. In fact, this is a good thing to take to Admin for them to bring before the Medical Staff. What kind of liability is there to the hospital if the patient later alledges he felt coerced into signing but was not really informed? Naw---let the surgeon do it. They see the patient before surgery at some point so should bring the consent in with them.

lovemyjob · Dec 21, 2006

you are witnessing their signature, but you are also having them sign saying they understand the risks/benefit. A little old lady who is asked to sign a consent signs it b/c she thinks she is suppose to do what the nurse says. Did the doc consent her? Only the doc knows, unless you saw him consent the pt. Yet you are the one getting her to sign it.

When I worked in NBN the Doc went down with a nurse and had the pt sign the consent for a circumcision. I was taught that the doc gets the consent signed...... because he is the one who consents the pt. This is just one more way for a doc to get away with handing off his "busy work" to the nurse.

PamUK · Dec 21, 2006

First consult your hospitals policy for obtaining written consent, if that is not helpful, ask risk management or get advice from you union, professional or regulatory body. They must surely provide you with this level of support.

Although I live in the UK, nurses and other allied health professionals are permitted to obtain written consent IF the doctor has delegated this task to them as an individual but the doctor is still accountable. The nurse is obligated to have knowledge of the procedure and be able to explain the benefits and risks to the patient and answer any questions they may have.

At the end of the day, a signed consent form is not necesarily valid in a court of law (and this is the very reason we get consent forms signed - in case we end up trying to defend ourselves in court). An invalid consen t form would occur in circumstances were the patient could prove;

1 they were not given all of the relevant facts

2. they did not understand the facts

3. they were coerced in some way by another person (including family members)

Dont know if this all helps!

evans_c1 · Dec 22, 2006

i agree with the previous posters. its our policy that we are merely WITNESSING the signing..not actually explaining the procedure/risk/whatever

SharonH, RN · Dec 22, 2006

I've always had patients sign consents after the physician had explained the procedure. However, it is your job to assess whether or not the patient has an understanding of what is about to happen to them and the risks. That does not mean that you have to quiz them about the minute details of the procedure and the risks but that they have a good understanding. If they do not, do not allow them to sign the consent. I've pulled the pen out of patient's hands after it became apparent to me that they there was something they didn't understand. Also if they seem uncertain or ask questions, do not allow them to sign, just let the physician know. I've never had one yet who became angry or annoyed with me when I let them know that the patient didn't know or understand what was going on.

ginger58, ASN, RN · Dec 22, 2006

ncriverrat. . .the whole issue of getting consents signed should have been discussed with you when you were in orientation as a new employee at this facility. A public forum like this is not the appropriate place to get specific advice about what your employer will want you to be doing.

Daytonite, Yes, this should have been discussed and maybe it was. Often it's not but it's stuck in a handbook. Of course us folk can't give her specific info about her place of employment, but this is an appropriate place to ask about consents.

In this country, I would think that the consent witnessing is pretty standard, at least it has been for me. But it's what is actually practiced.

CHATSDALE · Dec 22, 2006

find out what is legal in your hospital

ifyou are the only nurse that refuses to get a consent signed then there are going to be some angry co-workers

i would never tell you to do something that you are uncomfortable with but you need to find what is accepted in your own facility

lovemyjob · Dec 22, 2006

I've always had patients sign consents after the physician had explained the procedure. However, it is your job to assess whether or not the patient has an understanding of what is about to happen to them and the risks. That does not mean that you have to quiz them about the minute details of the procedure and the risks but that they have a good understanding. If they do not, do not allow them to sign the consent. I've pulled the pen out of patient's hands after it became apparent to me that they there was something they didn't understand. Also if they seem uncertain or ask questions, do not allow them to sign, just let the physician know. I've never had one yet who became angry or annoyed with me when I let them know that the patient didn't know or understand what was going on.

but, in that situation, you are putting yourself in a position to be determining if the patient is in full consent to the procedure. But, when you sign the form, you are only witnessing a signature, not determining consent, which is the physicians job. I work in a teaching facility, and all of our docs get their own consents signed. I always assumed they were trying to teach the right way for it to be done.

TheCommuter, BSN, RN · Dec 23, 2006

At my workplace, I can sign consents for procedures that I personally do (such as vaccinations, psych medications, restraints, etc). However, the physician needs to sign consents for the procedures that (s)he performs (such as nerve blocks, surgery, etc).