Surgical consents

[Cheyenne RN,BSHS]

I have recently returned to working on the medical floor. I have been a nurse since 1985, so I am not new, and I try to stay current with new surgeries, tests, and procedures.

At the facility where I currently work, the doctor's and anesthesiologist's do not have their consents signed, but leave it to the nursing staff. The nurses have always accepted that responsibility because the "doctor's are so busy."

Sometimes the anesthesiologist does not even see the patient or their chart until they roll into surgery. They will call and ask the nurse assigned to that patient fifty-trillion questions as they order you to get the permit signed "before they come up."

Several times I have had patients tell me they were uncomfortable signing the consents or did not want to sign until they talked to their doctor.

I have refused to have the consents signed on numerous occasions and was taught that nurses are to witness "signature" only. I do not believe that "explaining" the procedure and the risks and marking any "additional" procedures is within my scope of care. Specially since the cardiac caths are done at a hospital across town.

My nurse manager is supportive and is also new to this facility. He says that I am right not to have anyone sign if they are unsure. I believe that I am doing the right thing, but it certainly is not popular the doctor's or the other nurses who think I just want to make waves.

Am I doing the right thing? Any comments would be very much appreciated.

[sjoe]

Good for you.

I particularly like it when the patient is already under pre-sedation, on his/her back on a gurney, confused and probably frightened--at which point the RN is supposed to cram a pen into his/her hand, put a "consent" form where it can be signed, and order it to be signed.

Yeah right. So much for "informed" consent.

[chartleypj]

Informed consent is the absolute responsibility of the surgeon and anesthesiologist in the facility I work in. Have you checked your hospital's policy on consents?

Check out this web site for more info.

http://www.intrepidresources.com/html/informed_consent.html

Paula

[roxannekkb]

The facility's policy is dangerous and I believe illegal. The doctor is always supposed to explain the procedure to the patient. They are the ones, afterall, performing the procedure. The nurse may be a witness, can answer questions s/he is comfortable with, but ultimately, it is the doctor's obligation. Ditto for anesthesia. They are supposed to not only see a patient, but also to thoroughly check that it is safe to give them anesthesia, that they have no allergies to drugs, and so forth.

The nurses in your facility need to stand up for themselves, and tell the doctors to do their job. You are right in refusing, and I am glad that your manager supports you. Don't let yourself be bullied by the other nurses and doctors.

[nialloh, RN]

In my facility, the Dr is to explain the procedure to the pt. The nurse can then further educate the pt if necessary. If the Dr didn't explain the procedure, or the pt can't remember/ is unsure, we send the pt up with an unsigned consent and call the Dr to let him know. If the pt has to be pre medicated, the Dr is called down first. The Drs. are usually pretty good about it.

I think you have to break your Drs. in :)

[Tweety, BSN, RN]

We are onlyl the witness that said patient signed the form, not that the patient is informed. As has been said, that's not our job. If the patient isn't formed, you can't let them sign the consent that they are.

I went into a patient's room, following doctors order to get consent for a surgery. The patients screamed and cried "I CAN'T BELIEVE I HAVE TO HAVE SURGERY! What do you mean I'm having surgery." Needless to say I didn't get her to sign the consent and was very angry at said surgeon.

[bklynborn]

ok here's one for you............which tests need a consent? mri, ct....I am still not sure.........................

[Cheyenne RN,BSHS]

I appreciate all the input thus far. Paula, thank you so much for the site that you listed. It was very helpful.

As for what procedures require permits, all the invasive ones.

The dialysis patients have A-V grafts and perma-caths inserted, port-a-caths, cardiac caths, and actual surgical procedures with the ortho doctors. (They do back and knee surgeries there too.) These all require anesthesia.

I can't think of all the procedures, just the ones that I have had patients scheduled for recently. They insert PICC lines in radiology and triple lumen caths on the floor. These also require permits but at least no anesthesia.

[catrn10]

My travel assignment was at a large hospital that required that the MD's get their own consents signed for EVERYTHING. Nurses could not even sign as a witness. At first, I thought it was crazy. Then I got where I loved it. They actually had to see the patient and explain to them what was going to be done. No more worrying about whether the correct body part or procedure was on the consent as they had to fill it out themselves. Of course, I checked for errors, but it sure took the burden of responsibility off of me.

[stella123 rn]

Where I work the surgeon will go in and give about a 30 second explanation of the surgery and then write an order for a consent. We go into way more detail when we are witnessing the signature. I can deal with that. Most patients say "I talked to the doctor and am comfortable signing this."

The anesthesia consent is another story. They rarely come up and see the patient before. I never have them sign the consent if they have not been seen. Once I did not have a patient sign it and left a note that the anesthesia consent had not been signed yet. I came back the next day and was going through paperwork and notcied that it was never signed (this was post-op). I told my charge nurse and she said "I always have them sign it even if they have not been seen yet to avoid this problem." I said, "so the surgery crew does not even check to make sure they are signed, I am not comfortable with that. I will not have them sign unless they have been seen." Well, the other charge nurses agreed with me. Just because it is easier does not mean that it is right.

[Cheyenne RN,BSHS]

I guess what I am really asking is what exactly is the legal responsibilty of the nurse in getting a consent signed and what is the physicians?

When are we out of our scope of care?

The policy book says the physician gets the consent signed BUT "all" the nurses "try to work well with the doctors here."

In the end, if I got a consent signed and then things did not go well, all the MD has to say is that the nurse assumed the responsibilty and then I would be the one hung out to dry.

I saw a lawsuit at another place I worked at with a doctor who was "all for nurses" UNTIL his tail got into a legal mess and then he turned the tables and said the nurses were to blame.The case settled out of court.

I respect doctors, but I am not dumb. If it comes down to them loosing their license or me loosing mine, they would sacrifice me in a heart beat.

[EricTAMUCC-BSN, BSN, RN]

Fire Wolf: It is not in your scope of practice to have the patient sign the consent forms. It is the doctors obligation to explain the procedure and the risks and benefits. I'm sure you can find this information in nursing textbooks related to pre-op care. It looks like you should take this problem up the chain of command. good luck.