nurses getting consents signed?

[ncriverrat]

Hi,

I just started working on a med-surg floor a few months ago, and this is my first nursing job.

I have a lot of patients that go for procedures, surgery, etc., with consents to be signed.

The doctors write orders to have the consents signed, but I thought that the nurses could be a witness to the signing, but that it was the dr's responsibility to get the consent signed. I mean...as a nurse...I don't even know WHAT the Dr. has told the pt.....complications, etc.

I have gotten a couple of consents signed, but am now questioning this, so what's the correct way? getting physician to consent? Thanks!

[crb613, BSN, RN]

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.

I was taught the same thing

[carol72]

I am soo happy to see this topic discussed!!!! In one practice I worked for they wanted the LVN, med assistant or secretary to consent the patient. I thought this was not appropriate - seemed like anyone but the MD!!!!! I had quite an issue with this. I am glad to see this discussed.

[zacarias, ASN, RN]

This is a very good thread. I want to reiterate that while you are only witnessing the signature, ethical obligation requires you to determine if the pt did receive a proper explanation from the doctor. Stated in a different way, if a nurse witnessed a pt's signature and knew that the doctor didn't explain the procedure or didn't even come to see the pt, that nurse would be....well I wouldn't not to be that nurse. He/she may not get caught, since she only witnessed the signature, but she did commit a grave ethical infraction.

[CHATSDALE]

i have never heard of unlicensed personnel getting consents

but where i have worked the per surg check list had GET CONSENTS SIGNED listed

[mshultz]

I experienced "Coerced Consent" 3 times in 2003 (EGD and blood transfusion while in the hospital, colonoscopy as outpatient). I was not given the opportunity to meet with the doctors prior to the procedures, nor did I know the doctors were supposed to meet with me. The nurses did not discuss risks, benefits, and alternatives, did not ask if anyone had discussed this with me, and did not ask if I understood these items. I was not given a description of any of the procedures, either. Instead, after being given little more than the name of the procedure, I was asked if I had any questions, and then told to read and sign a form.

The implication at this point was that the time for asking questions was over. The form said to check that you knew the risks, benefits, and alternatives. There was no listing of these items, nor any explanation as to what to do if you did not know them. Because the nurses never explained that they were witnessing my signature (that went on a separate form which I never saw until I requested my records), I felt pressured to read and sign as quickly as possible. I was not given a copy of the consent, either.

I signed because I trusted the medical staff to be straight with me. My trust was violated. It took 2 years of hard work, but I understand Informed Consent now, and will insist on a thorough written description of risks, benefits, and all reasonable alternatives, and a thorough written description of the procedure prior to the day of the procedure.

[lovemyjob]

This is a very good thread. I want to reiterate that while you are only witnessing the signature, ethical obligation requires you to determine if the pt did receive a proper explanation from the doctor. Stated in a different way, if a nurse witnessed a pt's signature and knew that the doctor didn't explain the procedure or didn't even come to see the pt, that nurse would be....well I wouldn't not to be that nurse. He/she may not get caught, since she only witnessed the signature, but she did commit a grave ethical infraction.

You make a great point. IMO, thta is why the physician should get consent signed with a nurse at the bedside. If the doc rushes through it, or if the patient doesnt seem to comprehend, the nurse can be there as a pt advocate to help ensure the patient fully understands. Plus, the nurse can use the learning assessment to help the doctor ensure that the patient has the risks/benefits/procedure explained in a way that they can fully understand.

[rn/writer, RN]

At my hospital, the person performing the procedure is the one who needs to obtain consent. In most cases, that means the doc. We have had inservices on how to properly fill out pre-procedure paperwork. For the nurses, that means completing a loooong checklist of items ensuring that labs were done, that any pre-op meds or other treatments were given, and a host of other items.

For the docs, it's that pesky old consent form. They not only have to adequately explain things to the patient, they have to list the procedure completely and correctly on the form and their signature must be legible or printed following an illegible scrawl. They must also sign their hospital ID number.

I appreciate the fact that we have this policy and that it is being enforced. Docs need to be the ones to explain what they are going to do. If this is a weak area for them or they are not known for good bedside manner, the facility should, by all means, help them get their ducks in a row. What should not happen is that the doc passes the buck to the nurse and the nurse puts herself in harm's way by accepting a job that was never hers to begin with.

You might think you are only signing that you witnessed the signature. In reality, you are also signing the documentation in the consent form that all the things mentioned were adequately explained AND that the patient now has a basic understanding and approval of the procedure he or she is signing for. This can be especially dicey in the case of a conditional situation where additional surgery might be performed based on lab findings during the procedure, e.g., a radical vs. a modified mastectomy if tissue samples reveal lymph node incursion. If a patient wakes up to find the more drastic surgery was done, their reaction may have a great deal to do with how well the procedure and the possible outcomes were explained. The doc who made the decision and actually did the surgery is the only person who should be handling pre-op consents.

If your facility has fallen into the terrible habit of having nurses (or others!) handle the signing of consent forms, you might want to have a couple of you do some research with the local medical boards, your state BON, and anyone else who can tell you what the legal boundaries actually are.

In places where this is a long-standing practice, change may not be easy, but accepting the status quo is a dangerous option.

[gosilverstreaks]

As an Oncology nurse, we are required to get the consents from our patients prior to starting their chemotherapy. We are not present at the MD visits, so we do not know what has been discussed with the patient as far as their treatment regimen. So, when we approach the patient to get their consent, we give them printed information on all the drugs the doctor has ordered, offer them time to read through the information (sometimes they will take the opportunity to do this, sometimes not, but we offer them that choice), and we answer their questions to the best of our ability. We note on the actual consent form that printed information was given to the patient for review and for their personal records prior to obtaining their written consent. After they have signed the consent, and we sign that we have witnessed their signature, we also note, in ( ), the following - witness to signature only. At least here in Nevada, that gets us through the 'legal loophole'. We can not force anyone to read material that we give them, nor do we have the time to sit in on the MD visits to make sure that all pertenant information has been gone over with the patient and that all of their questions have been answered. If the patient has questions that we, the nurses, are unable to answer, or feel that the doctor is the one who should be addressing that issue, we get the doctor to come and talk to the patient, and not in our nurses notes that 'pt had questions prior to the start of treatment that the MD came to chairside to address prior to obtaining written consent.

[jill48, ASN, RN]

I have to agree. This is how I was taught to do this also.

:yeahthat:This is how I do it also. I'm not witnessing that the doctor explained it, I'm only witnessing the form being signed.

[SharonH, RN]

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.

I'm not sure what you mean by "determining consent". However, it is your job as patient care advocate to be sure that the patient understands what is about to happen to them. If the patient is making statements that indicate that they do not really understand what is going on or if they seem uncertain or if they are asking a lot of questions, then you have an ethical obligation to make sure that they do not sign that consent and to alert the physician. After that, all you have to do is alert their physician and it is up to him/her to make sure the patient understands the procedure, risks, etc.