Obtaining consent

[RiverNurse]

Hypothetical situation:

Patient is scheduled to have a permacath placed in the morning. Nursey Nurse is told to fill out the consent form, have the patient sign it and send it with patient to surgery where physician will sign his name.

Dichotomy: I learned in school that nurses are supposed to witness a consent, not obtain one... or is this the "real world" vs. "school"?

Many thanks,

Shawna

[elizabells, BSN, RN]

This is not real world vs school. This is an MD who doesn't want to do his/her job. If something happens and that patient claims they didn't give informed consent, the hospital can hang you out to dry. Don't do it.

eta: I just realized I sound kind of mean. It's not directed at you! It's directed at providers who want us to do their jobs but would never, ever back us up if things went bad.

[Daytonite, BSN, RN]

In the real world, "obtaining" a consent and "witnessing" a consent mean the same thing. This should have been explained to you during your orientation.

[elizabells, BSN, RN]

I guess the question would be whether the nurse obtaining/witnessing the consent was confident that the patient was, in fact, informed. From the OP it doesn't sound like it, to me, but if so, then Daytonite is correct, per usual. She always gives good advice. :)

[RiverNurse]

Yes, I am sure that I should have been taught the concepts of consent in orientation - but alas - that was two months ago and many, many night shifts ago... LOL LOL...

Perhaps I should see if there's a remedial orientation class at my facility .

Shawna

[husker_rn, RN]

I wouldn't get that consent or even sign as witness, same thing. If you sign it, it means you have covered all the "what can happen and go wrong things " and if something did go wrong you are in a position for a lawsuit. I usually would fill out what I could info wise and send with the patient down to the surgical suite where the doctor could go over all the necessary info.

[NotReady4PrimeTime, RN]

I wouldn't get that consent or even sign as witness, same thing. If you sign it, it means you have covered all the "what can happen and go wrong things " and if something did go wrong you are in a position for a lawsuit. I usually would fill out what I could info wise and send with the patient down to the surgical suite where the doctor could go over all the necessary info.

I agree completely with this.

This scenario comes up fairly often in our unit and we are backed up by our senior management that it is NOT the nurse's responsibility or place to be getting that consent form signed. I've had to call docs out of the OR to get consent when they've neglected to even speak to the parents about what they plan to do and I've taken kids down with the unsigned consent on the chart, handed over care of the child tot he OR staff and left it to them to get consent sorted out. It makes them cranky, but if I've just come back after a few days off and this is the first time I've laid eyes on this family, I'm not even going to guess at what they know or don't know.

One incident that just cracks me up was the time the unit was packed to the rafters and we had to cancel the elective cardiac surgeries for the following day. My patient was a cardiac surgery patient whose repair didn't fix her, and we knew she would eventually need further surgery. So at 0215, the CV surgery fellow pops up at my bedside and tells me that they're going to take her to the OR first thing in the morning. (He'd been scoping out their patients to see if there was somone already in the unit that they could cut so the day wouldn't be "wasted", and they picked her.) He gives me an order to put her NPO (but no IVF orders) and then asks me to call her mother so he could get consent. I told him in no uncertain terms that I would NOT be waking this poor woman up at 0230 so he could get consent when I knew the lady would probably be at the bedside by 0600. I told him to take a nap... I wouldn't want him operating on my infant's heart on no sleep... and when the mom arrived I'd call him. I also promised that if she want there by 0615, then I'd call her, but not before. If that didn't work for him then he was more than welcome to call her himself... He took the nap.

[suanna]

Your signature as a witness on a consent form is documenting that the patient/or the responsible party was the person signing the form. It has nothing too do with whether or not the patient was given adequate information to agree to to the procedure. Most consent forms I have read state that the patient understands the risks and benifits of the proceedure. Its the doctors responsibility to explain those risks and benifits. If the patient is willing to sign the consent they are agreeing that they have enough information to consent to the procedure. If a patient has questions and you feel comfortable answering them, by all means do so, health education is a vital part of the nurses function, but it is not what you are documenting with a consent form. Be careful however, nurses do not give medical advice. The last thing you want to do is confuse the patient further or talk them out of a necessary proceedure by listing every possible problem you ever heard of happening. If the patient has many questions beyond the "will I be coming back to this room" variety I will usually ask them if they want the doctor to explain the proceedure more before they sign the consent. Most of the time they say "no, I know all I need to know, lets get it over with".