I thought I had a handle on what witnessing consent meant - that I had been present for a conversation in which the provider (MD, PA, NP, etc) had outlined the invasive procedure to be performed, explained the risks, offered (or at least mentioned that) alternative treatments (existed) and answered questions from the patient or family.
In my orientation to this new hospital system (about a year ago) the educator was adamant that my perception was WRONG. That as a nurse, I was only witnessing a signature, nothing else. No conversation, understanding, clarification, NOTHING but a literal signature. Since the policy for this hospital system is floating somewhere in the Nothing (don't even get me started) I have always used my own ethics to conclude that this is a bunch of crap.
I have always refused to sign a surgical or blood consent for which I did not witness the conversation - I'm not a jerk about it, I just take the paper, walk back into the room, ask, "Is this your signature? So your having a left lobectomy? Do you feel like you understand the risks? Do you have any questions about alternatives?" 99% of the time the answer is "No, I get it, I'm good." Cool.
This week, a doc freaked the **** out on me, in the hallway, because I refused to sign a consent for a urology/nephrology procedure on a patient who was:
1. Not consentable, in my personal opinion (she was ether MR or close to it)
2. Told me point blank she didn't understand why they had decided to do one procedure rather than the other
3. Wanted her son and husband to be part of the decision (and no family members are ever around to consent at 6am...)
So when I paged, called the OR, paged again, called the OR again to say that I would not witness the consent (Oh, BTW, the surgeon tossed the paper at me after speaking to the patient and said "sign this,") I apparently was breaking an unwritten rule.
The Very Important Surgeon then had to waste his precious time coming back up to the unit and have the conversation again (in which he again, did not include me, the witness) and then freaked out when I again, wouldn't sign the consent.
Dude! How did you not get this the first time?? Get the freaking nurse in the room if you want her to sign the consent! Honestly!
Suffice it to say, we had words...
There is obviously more to this story, but for the sake of brevity, I'll leave it here. What do you guys think of this? While we are told in nursing school that you are witnessing the X, Y and Z that I outlined, is that really what we are SUPPOSED to be witnessing? Or was my educator right? Are we really only supposed to be signing that we saw the patient sign and nothing else?
Any evidence - federal, state or even facility policies would be appreciated, I can't seem to find a good source. As always, anecdotal experience is really what I'm after.
You are misunderstanding. Half the surgical consents are signed in the surgeons office @ the time of booking the case-// by a MA usually.... as an RN our responsibility is to ensure the document ( consent) EXISTS, and has been signed by PT and md...
As an RN you also have a professional duty to advocate for the patient, this would include confirming they understand the procedure and have no further questions and wish to proceed.
MunoRN, RN
8,058 Posts
As an RN you also have a professional duty to advocate for the patient, this would include confirming they understand the procedure and have no further questions and wish to proceed.