Published Dec 7, 2004
Hi all, just changed my allnurses name from Studentrn as I graduated in May and I am now working in a Community ER... I had a issue at work and I am wondering how others deal with this issue. I had a patient that was going for surgery to remove his appendix. I did all preop paper work and got all the forms filled out and on the chart. I did not feel I should have him sign the Surgical Consent because I could not fully explain the surgery or it's risks. The charge nurse told me to call the doctor and get an order to get the conset. This makes no sense to me. I still have no idea how they do the surgery or all the risks. I said I would witness him signing if another doctor explained the surgery. Is there any law, act or something that states a rn's responsiblity on this issue? Thanks for your imput!
Tweety, BSN, RN
It is not the nurses job to inform the patient of the surgery or the risks. If the patient isn't informed, then no "informed" consent can be obtained.
At my facility, we only witness the signature to verify that the patient or guardian is the one doing the consenting. We don't do the informing.
Many times surgeons will phone order a consent for a procedure prior to even talking to the patient. It is not appropriate for a nurse to ask a patient to sign consent under these circumstances.
Check your hospital policy, the nurse practice act, not "that's the way it's always been done here". Good luck. :)
oh this is a big thorn in my side! At my facility, RN's are required to obtain "informed" consents. I cannot tell you how many times I have walked into a patients rooms to only find out that they did not know they were going for surgery at all. And I am stuck explaining to the patient who barely speaks English what the surgery is, why they need it, the risks and benefits, etc. I know that it is totally illegal but unfortunately my hospital has a policy that the RN obtains the consent from the patient. They will also fire you if you refuse to accept an unsafe assignment. Fortunately I am leaving in a few weeks.
How can I explain a surgery to a patient when I don't know if the surgeon is going to possibly divert from his plan and implant some kind of prosthesis or foreign body into the patient? How do I go into a patient's room and explain that the surgery is going to be performed laparoscopically only to have the surgeon change his mind mid surgery. That is not my responsibility. I am more than happy to answer questions they may have about the surgery after they have spoken to to surgeon. But I believe that most state practice acts and the nation practice act indicate that obtaining consent is clearly within the realm of the physician, many of whom are too lazy or overwhelmed to taked the time to talk to their patients.
Legally, it is the responsibility of whomever is actually going to be performing the procedure to explain the risks, benefits, alternative treatments, etc., to the client -- the nurse is only witnessing the signature on the consent form. What I used to do is ask the client about what the surgeon (or whomever) had explained -- if the client has no clue what is going to be done to her/him, it's not appropriate to ask them to sign the consent form.
dishes, BSN, RN
If the patient doesn't understand the surgery I ask the surgeon to explain it to the patient, if the surgeon tries to bounce it back to me, I tell the surgeon I am not qualified to explain the surgery and I think the patient's lawyer will agree that an unqualified person cannot give a patient full informed consent.
Once when I said this, the surgeon said how do you know the patient is going to speak to a lawyer? I told him, because his son is a lawyer ... the surgeon was up in 10 minutes explaining the surgery to the patient.
PostOpPrincess, BSN, RN
Was this in Pre-op? Wait until surgeon has spoken with patient, and then have them sign. Make sure not to pre-medicate or it becomes null and void.
Thank you all for your responses. The protocols of surgical consent was drilled into our brains and I will certainly address this with our nurse manager. I am only a first year RN and even the veteran RN manager of the OR feels helpless about this. Perhaps this will be a good reason to get fired, refusing to obtain surgical consent as opposed to witnessing....
GadgetRN71, ASN, RN
You did the right thing..it is the surgeon who is supposed to explain the risks, the surgery itself and to get informed consent. Any hospital that tells you differently is opening itself up to problems and they certainly won't back you up either.
I think it is absolutely unbelievable and absurd that a surgeon would not take the time to sit down with his patient before cutting them open. When I had my surgies, not only did the surgeon explain everything in detail and the various options he may use while I was under, but he was there in the PACU when I came through, explained how everything went and even gave me a follow up call a few days later. And this was for a very routine same day surgery.
My other surgery was much more complex and I was an inpatient and the surgeon explained the procedure and even gave me time to think about it. He then visited me every day after the surgery while I was in the hospital.
I don't think this is spectacular service but should be the standard protocol.
miss81, BSN, RN
I will fill out the consent form, ask the pt if the surgeon has discussed the surgery, risks and benefits with him. If yes, I will ask if he understands and if her has anymore questions. If the pt is "informed" I will witness the signature. If the surgeon did not discuss the surgery, I will place the form on the front of the chart and call the Holding Area in the OR to inform the RN there. Never had any trouble. She/He will get it signed when the surgeon shows up for the surgery.
If I do not get a signature, I usually put something in my clinical notes like "Pt with questions re: procedure. Consent not signed pending discussion with Dr. X. Written educational information re: procedure provided to pt."
We have standard written educational info that we hand out to the pts, and so I make sure they have that before they talk to the physician, just so they have some general idea of what the procedure and post-op course entails, so they can ask more specific questions and better understand the discussion with the physician.
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