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Should I be asked to get consent without the doctor?

Nurses   (2,208 Views 19 Comments)
by GaryRay GaryRay (Member)

GaryRay has 10 years experience and works as a Radiology.

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Hi there,

No, you are not able to obtain informed consent for medical procedures as an RN in Texas. The medical provider who is trained in and will perform the procedure is responsible for explaining risks, benefits, alternatives, and answering questions.

Your signature only indicates that you witnessed the patient's signature. Can you sign without an MD present? Yes, technically.

Is your patient legally "informed," and are you advocating for your patient if you allow him/her to go to a medical procedure without speaking to the MD first? No, and allowing your patient to undergo a procedure without informed consent doesn't meet the minimum standard of practice.

You can, of course, obtain consent for all nursing procedures independently.

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MunoRN has 10 years experience and works as a Critical Care.

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Wonder if it is state specific but this is the exact opposite of what is considered true in Florida. While bedside in FL when I would have family/surrogate sign consent. My signature is ONLY confirming that I witnessed the person sign the consent. I am not signing that I witnessed informed consent was provided. "Did Dr SoSo talk with you about placing a central line in your husband? Did you have any additional questions for the Dr?" Sign and sign. This was drilled into us from the Risk department many times.

That being said, at no point would I attempt to have a consent signed when I knew for fact the conversation never happened or the patient seemed unsure/had questions or the usual 0500 culprit when we figured out the surgeon never got consent during the prior day the typical patient response of "I don't remember if he told me about my big surgery I've been NPO for.." a call to the surgeon/dr is most definitely warranted at that time.

Like many states, RNs in Florida are expected to ensure not only that the person actually signed the consent (you don't have to see the signature happen, you can just ask them if that's their signature) but to also confirm they were actually consented.

If a nurse is delegated the responsibility of having an informed consent form signed by a patient, the nurse should make sure the physician has properly explained the procedures, risks and alternatives to the patient.

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GaryRay has 10 years experience and works as a Radiology.

2 Likes; 3 Articles; 4,352 Visitors; 191 Posts

Hi there,

No, you are not able to obtain informed consent for medical procedures as an RN in Texas. The medical provider who is trained in and will perform the procedure is responsible for explaining risks, benefits, alternatives, and answering questions.

Your signature only indicates that you witnessed the patient's signature. Can you sign without an MD present? Yes, technically.

Is your patient legally "informed," and are you advocating for your patient if you allow him/her to go to a medical procedure without speaking to the MD first? No, and allowing your patient to undergo a procedure without informed consent doesn't meet the minimum standard of practice.

You can, of course, obtain consent for all nursing procedures independently.

So everyone is sort of echoing my thought process

I know a consent isn't valid even if it's signed in all the right spots if the patient never spoke to a doctor, but I'm in a screwy position because I'm taking the patient to the procedure knowing they aren't properly consented.

to add to the cluster I'm sedating 90% of these patients so even if they didn't get properly informed on their procedure I'm giving them proper informed consent on sedation (amazing how many people mistake me for an Anesthesiologist)

So I can't just refuse to sign because I need them to sign for the sedation before I give it under my license.

Ethically I know I'm telling them everything the MD would be telling them, but I'm answering questions I'm not licensed to answer and I don't think I should be put in that spot.

Before I take a stance on this, I would really like to have my facts straight. This is a "don't rock the boat" sort of organization and it is very likely I'm going to need a back up job before this is over.

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Daisy4RN has 20 years experience.

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The last hospital I worked at had a policy that stated the nurse was only witnessing the patient signature, that was all. It depends on your hospital P/P and also the state nurse practice act. If you are having trouble deciphering that there is a ask a lawyer function on this site. I would want to know this if I were in your shoes also, CYA!

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273 Visitors; 11 Posts

So everyone is sort of echoing my thought process

I know a consent isn't valid even if it's signed in all the right spots if the patient never spoke to a doctor, but I'm in a screwy position because I'm taking the patient to the procedure knowing they aren't properly consented.

to add to the cluster I'm sedating 90% of these patients so even if they didn't get properly informed on their procedure I'm giving them proper informed consent on sedation (amazing how many people mistake me for an Anesthesiologist)

So I can't just refuse to sign because I need them to sign for the sedation before I give it under my license.

Ethically I know I'm telling them everything the MD would be telling them, but I'm answering questions I'm not licensed to answer and I don't think I should be put in that spot.

Before I take a stance on this, I would really like to have my facts straight. This is a "don't rock the boat" sort of organization and it is very likely I'm going to need a back up job before this is over.

As long as you're a properly trained RN with demonstrated competency, TBON allows you to administer conscious/moderate sedation (position statement 15.8). RNs are able to obtain consent for nursing care, so there's no problem with you obtaining consent for sedation unless your facility has a stricter policy, in which case you'd follow the stricter of 2 standards.

TBON is also very clear that your duty is to your patient, and this duty can't be superceded by a physician's order or facility policy (position statement 15.14). This means that "We know informed consent should be ontained by the provider, but this is how everyone does it here" doesn't fly. Additionally, informed consent can't be legally delegated, so you can't just go along with "Dr. Smith ordered me to obtain consent." TBON offers a 2 hour CE on jurisprudence, and one of the things it covers is 15.14. The training says you can always get another job, but not another license.

*Informed* consent is a legal requirement; it's not optional. It's not within a nurse's scope to do the informing when you aren't trained in medical/surgical procedures. The problem is that the vast majority of facilities turn a blind eye to this practice and expect nurses to obtain consent. It's often more acceptable to pressure a nurse into performing a questionable action than it is to bother a surgeon, or as you said, rock the boat. An OR nurse even commented on this thread that she regularly consents patients, which goes back to my first post... Sure, technically you can sign the form as a witness to the signature, but you're not really adhering to the ANA Code of Ethics nor TBON's standards of practice when you knowingly allow a patient to undergo a procedure without being informed.

Is your manager open to discussion? If so, maybe you could share the following.

Informed consent

Bad Request (See point 28.)

If not, you may consider submitting an anonymous report to your risk management system or corporate compliance hotline. As you know, there's always a chance that anonymous isn't really anonymous with a little investigating from your organization.

I'm sorry to hear that your organization isn't more supportive of RN concerns! Really, I think this is a prevalent problem that most organization's pretend doesn't exist to keep things simplified.

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36 Likes; 10,222 Visitors; 1,369 Posts

So everyone is sort of echoing my thought process

I know a consent isn't valid even if it's signed in all the right spots if the patient never spoke to a doctor, but I'm in a screwy position because I'm taking the patient to the procedure knowing they aren't properly consented.

to add to the cluster I'm sedating 90% of these patients so even if they didn't get properly informed on their procedure I'm giving them proper informed consent on sedation (amazing how many people mistake me for an Anesthesiologist)

So I can't just refuse to sign because I need them to sign for the sedation before I give it under my license.

Ethically I know I'm telling them everything the MD would be telling them, but I'm answering questions I'm not licensed to answer and I don't think I should be put in that spot.

Before I take a stance on this, I would really like to have my facts straight. This is a "don't rock the boat" sort of organization and it is very likely I'm going to need a back up job before this is over.

But you're not the one actually ordering the sedation, even if you do administer it, so the provider still needs to talk to the patient about it. And even if you want consent for the administration of sedation, then the consent forms specifies that and only that (not the procedure).

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Here.I.Stand has 13 years experience and works as a RN.

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If a nurse is delegated the responsibility of having an informed consent form signed by a patient, the nurse should make sure the physician has properly explained the procedures, risks and alternatives to the patient.[/Quote]

I don't get this... I hear that it happens, but WHY delegate this? Since the provider is informing the pt, and the pt verbally consents, why the world doesn't provider hand the pt the form and pen him/herself?

One of my nursing instructors (Wisconsin, early 2000s) did a fair amount of legal nurse consulting on the side. That was one of her pieces of advice -- since the provider has to get consent, they can get the dang signature themself.

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